Dear Chairperson:

to the head of a Knesset Committee after she celebrated on facebook the convening of a hearing on cults:

And I accuse you again of ignoring the worst medical scandal—with cultic aspects (unfortunately abetted by professionals who should know better)—that the world has ever faced, and in which Israel is complicit.

You are not only on this committee, but also on Health, Education, the Status of Women. You also claim to caucus for Teaching Torah, Empowering Women, Preventing Sexual Assault (I don't see how castration and removal penises, breasts, and ovaries under false pretenses is not this), Early Childhood, Public Hospitals, Mental Health (problems of which usually co-occur with gender-confused children) and Prevention of Suicidality (another byproduct of this “care"), and the Jewish People (I would say mistakenly sterilizing even one should cause you to shudder).

The Queer ideology on which “gender affirming care” rests is a virus of the mind. It requires people to ignore the name and biology. It teaches victimhood and powerlessness with the necessity of overthrowing power structures as a cure. The ideas are rooted in Marx, or Judith Butler, if you want someone more recent.

And while the United Kingdom, France, Norway, Sweden, Finland, Denmark and 27 of the United States love their children enough to put severe limits on this, Israel continues to support this craziness, which one activist doctor suggests also affects 5000 Israelis.

Please stop ignoring me and help me end this. I have personal connections to three people currently being harmed by this, and I haven't gone looking.

Sincerely
David R. Herz

End the Butchery Now

LGB has enough of TQ. When will you?

The LGB Alliance has gone international. Their Goal:

To provide a global voice to represent the views of and advocate for LGB people at global level including to UN agencies and multinational institutions.

“We advocate for the right of adults and young people to mature, develop and explore their sexuality and personalities without gender identity ideology. Children should be protected from medical transition treatments. We combat harmful misinformation and disinformation about gender identity ideology which particularly targets lesbians, gay men and bisexuals.”

LGB International is the federation of national organisations of lesbians, gay men and bisexuals. Since LGB Alliance began in the UK in 2019, groups have begun in a variety of countries, rebuilding a movement for LGB people who do not subscribe to gender ideology.

LGB International

Sincerely
David R. Herz

End the Butchery Now

Hello Mr. Ohana:

The LGB community is under attack by the TQ. I don't know if it is as obvious in Israel as in the rest of the world, but the truth is a lot of confused young men and women are being told that they are in the wrong body rather than that maybe they just have other inclinations.

This should bother you enough as a gay man to at least cause investigation into this horrific, expensive form of predation upon and mutilation of confused youth and young adults.

What is worse is that this is just a symptom of a radical world view that is against the Likud, the modern democratic state, and humanity itself.

To take a Charlie Kirk moment: “When one of theirs is killed, they burn down cities. When one of ours is, we burn candles.”

Trans ideology is anti-west, anti-G-d, Maoist in nature.

We can at the very least stop its ultimate attack upon and consumption of our children and our future.

I have sent you more than 90 e-mails on this topic.

Please respond so we can put together a plan to end this.

Sincerely
David R. Herz

End the Butchery Now

There are a few new people receiving this mail; so I bring you up to speed.

Israel's medical system and various social institutions have been captured by the very non-scientific advocates of a gender-ideology that denies biology and common sense. These activists, assisted by an insufficiently inquisitive press, feed our population, but most disturbingly our children, the idea that the gender in your head can be different than that between your legs.

The result is that confused Israeli children and young adults are convincing themselves, with the assistance of a “gender-affirming" model of care, that they must alter their bodies to match the gender in their mind.

The rest of the world (the UK, US, Germany, the Netherlands, France, Norway, Sweden and Finland included), is seeing the insanity and taking a step back. Most of Israel's policy makers still have their heads in the sand. And millions are spent cutting off people's healthy body parts and making them serious medical patients for the rest of their shortened lives.

I have spent hundreds of hours translating reports and articles and summarizing the main points. These can be found here.

I share some information on this topic twice a week.

I invite you to have a conversation with me about what we can do to end this travesty.

I will be back in Israel September 19 to October 14. I would be glad to meet any one of you in person, or to present to any one of the committees that should be addressing this, particularly the Health and Education Committees, but anyone who is in support of our children living normal, fulfilling, fruitful, healthy lives, should also take an interest, such as the Caucuses for Women's Health, the Prevention of Sexual Assault, the Advancement of the LGBTQ Community (many who are convinced they are trans would otherwise grow up to be normal, functioning homosexuals), Public Psychology, Public Hospitals (we now have three clinics peddling in this unsubstantiated treatment), Protection of Chilren Online (the numbers and cohort very much suggest social contagion), Mental Health and the Prevention of Suicidality (one solid study suggests that those who transition are 19 times more likely to commit suicide), Future Generations (if you castrate and sterilize this, what future generation can you have), Fertility and Birth, Early Childhood (this has found its way into our schools, there being official guidance that parents should be sidelined if they don't agree), Combatting the Bullying and Ostracizing Phenomena (some go trans because of an internalized homophobia, some because they have been abused and have come to hate their own bodies), Child Protection, Advancing the Well-Being of At-Risk Minors.

Almost all who think they are trans have comorbidities that should be dealt with first.

What would you do to save your own child? When there are doctors in our country who suggest there are thousands of these children in our midst, thousands at risk, maybe the time has come to do something about this.

I have suggested lines of inquiry. I would be happy to discuss these with you.

Yours Truly,

David R. Herz

End the Butchery Now

Context for my last post: What is the Issue?

Someone was missing context and reached out; so I expect more of you are probably in a similar place.

Go to my website. Look around. There are boys who think they should be girls, or are trans, whatever that means. There are girls who think they are boys. There is one of each of these flavors connected to families in Bet Rimon. Both of these children are being given cross sex hormones for mental health issues. This is unethical, if not criminal.

The medical establishment has allowed itself to be guided by standards of care developed by activists. These standards are based on ridiculous ideas instead of any solid scientific or medical research.

This has been known for some time, but a handful of major reports in 2024 have shown just how bad this is.

Yet we now have three clinics in Israel dealing with this, one doctor estimating 5000 trans kids (there shouldn't be 500 trans individuals in the whole country according to a 2015 study on incidence of gender dysphoria).

Instead of reminding children that “male and female He made them,” that everyone goes through periods of change, and some will hate their bodies as they grow up and become the man and woman they were meant to, there's a social contagion that is suggesting to the most vulnerable (there are really high levels of Autistic, ADD, ADHD, depression, abuse; there are almost always comorbidities) that they are probably just stuck in the wrong body, and if they fix that, then all will be good.

At its deepest level, this is the Satan telling us that 2+2=5. This is Marx warmed over. Find a circumstance, call it a crisis, suspend normal thinking and controls to deal with it, use this as a lever to take over an institution, always in the name of compassion, and severely punish anyone who has the temerity to say that 2+2=4.

The adherents to the cult do not let go easily. This has not only crept into our medical system, but into the psychological services for our schools.

The victims, especially if they've had their sex organs removed, which sometimes are so degraded by cross-sex hormones that this is necessary (what girl or young woman should end up with a hysterectomy because of a mental condition? There is no justification) even if that wasn't the original intent, will have shortened lives and end up as lifelong medical patients. For what? because they were abused, or confused, or are stuck in certain rigid modes of thinking (if I like makeup, I must be a woman) or just had a baby sister and think that their parents like girls more. Even worse, because they are gay. It's found that many of those who are started down this “trans” path, if left alone, would just find out they are gay.

This is what I am against. I want to scream it to the world, especially in Israel.

I have made significant efforts with members of Knesset: 90 e-mails over ten months, calls to everyone on the health committee (they don't even pick up most of the time), calls to the committee itself (gatekeepers mostly, but at least a human), text and social media messages where I have the contacts. They are deaf to this, or think I am just one crazy American. This is against both nature and G-d.

I will talk to anyone who will cover this.

Please provide suggestions, if you have contact information, even better.

Thank you for any help you can give.

Yours Truly,
David R. Herz

End the Butchery Now

Castrate the Gays

I am a religious man. I don't believe that gay marriage should be legal. It is not in the best interests of a child that two gay men should be able to rent out a womb and then tear a child from his mother to form a “family.” There is great value in privileging certain norms.

But I would never, ever, suggest that a man should have his testicles cut off for being gay.

People argue about the numbers, but this castration is one effect of gender-affirming ideology. A child, confused, abused, often autistic, depressed, almost always with other comorbidities or quite troubling circumstances, says “I think I was born in the wrong body.”

If properly counselled, most of the gender-confused come to find they are gay, or they deal with the traumas that caused them to not want to be their actual sex.

If subject to the “gender-affirming” model of therapy, especially by activist therapists, they will be encouraged to embrace their “true” gender identity, their parents will be asked “Would you prefer a dead son or a live daughter?”

They will be pointed down a particularly troubling path, and at a least a few proto-gay men will instead be castrated.

I am not homophobic either. Inclinations are not sinful. Acts can be.

“Gender-affirming care” occurs as the worst kind of homophobia. Instead of suggesting a person might be gay, “changing his sex” just makes him straight again. Except that you can't do that. It's coded in every cell.

This “treatment” might keep him alive in a country where homosexuals are routinely killed, such as Iran, which is big in this business, But it is not appropriate to Israel.

Among the most heinous of acts is cutting off a person's normal development. There is no treatment that can reverse the effect of castration.

The worst a “true” transgender person might experience from delayed care is a too big Adam's apple, or a more boyish body.

For the improperly diagnosed dysphoric child, his punishment is the ending of his blood line, the assurance that the future will be without offspring, the loss of proper sexual function, and a highly medicalized shortened life.

As long as you allow this to occur in Israel, you are complicit.

Please do something about it. If you are not sure what, contact me and we'll figure it out.

Thank You,
David R. Herz

End the Butchery Now

סרס את ההומואים

אני אדם דתי. אני לא מאמין שנישואים חד-מיניים צריכים להיות חוקיים. זה לא לטובת הילד ששני גברים הומואים יוכלו לשכור רחם ואז לקרוע ילד מאמו כדי ליצור “משפחה”. יש ערך רב בהעדפת נורמות מסוימות.

אבל לעולם לא הייתי מציע שגבר יסורס בגלל היותו הומוסקסואל.

אנשים מתווכחים על המספרים, אבל סירוס זה הוא אחד ההשפעות של אידיאולוגיית אישור המגדר. ילד מבולבל, מותעלל, לעיתים קרובות אוטיסט, מדוכא, כמעט תמיד עם קומורבידיות אחרות או נסיבות מטרידות במיוחד, אומר “אני חושב שנולדתי בגוף הלא נכון”.

אם יקבל ייעוץ נכון, רוב הילדים המבולבלים מגדרית יגלו שהם הומוסקסואלים, או שהם יתמודדו עם הטראומות שגרמו להם לא לרצות להיות המין האמיתי שלהם.

אם הם ייחשפו למודל הטיפול “מאשר מגדר”, במיוחד על ידי מטפלים אקטיביסטים, הם יעודדו לאמץ את זהות המגדר “האמיתית” שלהם, ההורים שלהם ישאלו “האם תעדיפו בן מת או בת חיה?”

הם יופנו לנתיב מטריד במיוחד, ולפחות כמה גברים הומוסקסואלים פוטנציאליים יסורסו במקום זאת.

אני לא הומופובי. נטיות אינן חטא. מעשים יכולים להיות.

“טיפול מאשר מגדר” מתרחש כסוג ההומופוביה הגרוע ביותר. במקום להציע שאדם עשוי להיות הומוסקסואל, “שינוי מינו” פשוט הופך אותו לסטרייט שוב. חוץ מזה שאי אפשר לעשות זאת. זה מקודד בכל תא.

“טיפול” זה עשוי לשמור על חייו במדינה שבה הומוסקסואלים נרצחים באופן שגרתי, כמו איראן, שגדולה בעסק הזה, אבל זה לא מתאים לישראל.

אחד המעשים הנתעבים ביותר הוא חיתוך ההתפתחות הנורמלית של אדם. אין טיפול שיכול להפוך את השפעת הסירוס.

הגרוע ביותר שאדם טרנסג'נדר “אמיתי” עשוי לחוות מטיפול מאוחר הוא גרוגרת אדם גדולה מדי, או גוף נערי יותר.

עבור הדיספורי המאובחן בצורה לא נכונה, עונשו הוא סיום קו הדם שלו, הבטחה שהעתיד יהיה ללא צאצאיו, אובדן התפקוד המיני התקין שלו, וחיים מקוצרים בעלי מדיקליזציה גבוהה.

כל עוד אתם מאפשרים שזה יקרה בישראל, אתם שותפים לכך.

אנא עשו משהו בנידון. אם אינכם בטוחים מה, צרו קשר איתי ונמצא פתרון.

תודה,
David R. Herz

סיים את הטבח עכשיו

The tide turns. It is sad you seem stuck in the sand.

Below is what the world is doing to look into the scandal that is “gender-affirming treatment,” the majority of it critical.

With what you know, you should follow suit.

Yours Truly,
David R. Herz

Critical Events

US House Judiciary Subcommittee Hearing (July 27, 2023): Hearing titled “The Dangers and Due Process Violations of 'Gender-Affirming Care' for Children.” Focused on exposing risks and coercion in gender transition procedures for minors; no direct legislation but highlighted due process concerns.

US Senate Hearings for NIH and FDA Nominees (March 2025): Senate hearings where nominees advised against forms of gender-affirming care, aligning with federal efforts to restrict such care; tied to broader policy shifts under the Trump administration, including Executive Order 14187 to limit federal support for care under age 19.

Arkansas Legislative Sessions (2023): Hearings on HB 1156/SB 199, which allowed malpractice suits against providers of gender-affirming care for minors and extended statute of limitations; enacted to deter care provision, effective August 2023.

Florida Legislative Hearings (2023): Debates on SB 254/HB 1421 banning gender-affirming care for minors, including puberty blockers and hormones; passed May 2023, with provisions for custody loss for parents allowing care.

Iowa Legislative Hearings (2023): Discussions on SF 538 banning healthcare professionals from providing gender-affirming care to minors; signed March 22, 2023, prohibiting hormone therapies and surgeries.

Kansas Legislative Hearings (2025): Debates leading to override of veto on SB 233 banning gender-affirming care for minors; effective July 2025, restricting puberty blockers and hormones.

Missouri Legislative Hearings (2023): Sessions on SB 49/SAVE Adolescents from Experimentation Act banning gender-affirming care for minors; effective August 2023, with exceptions for ongoing treatments.

Montana Legislative Hearings (2023): Debates on SB 99 banning medical and surgical gender-affirming care for minors; passed April 2023, but permanently enjoined by court.

Nebraska Legislative Hearings (2023): Discussions on LB 574/Let Them Grow Act restricting gender-affirming care for minors under 19; effective October 1, 2023.

North Carolina Legislative Hearings (2023): Debates on HB 808 overriding veto to ban gender-affirming care for minors; effective August 16, 2023, covering surgeries and hormones.

Ohio Legislative Hearings (2023-2024): Sessions on HB 68 banning gender-affirming care for minors; override of veto January 2024, effective April 2024.

Oklahoma Legislative Hearings (2023): Debates on SB 613 prohibiting gender-affirming care for minors; effective immediately upon signing in May 2023.

Tennessee Legislative Hearings (2023): Discussions on SB 1 banning gender-affirming care for minors; effective July 2023, upheld by Supreme Court in June 2025.

Texas Legislative Hearings (2023): Sessions on SB 14 banning gender-affirming care for minors; effective September 2023.

Wisconsin Assembly Debate (March 13, 2025): Tense debate on bill to ban gender-affirming care for youth; part of multiple transgender-related bills heard in recent weeks.

UK House of Commons Debate (April 30, 2025): Debate on “Gender Incongruence: Puberty Suppressing Hormones,” discussing potential impacts on children; led to considerations for restrictions.

UK House of Commons Debate on Cass Review (April 15, 2024): Discussion of the Cass Review findings, leading to NHS ban on puberty blockers for under-18s with gender dysphoria.

UK House of Commons Statement on NHS (May 23, 2024): Announcement of intention to introduce banning order on puberty blockers for minors, with limited exceptions.

UK House of Commons Debate on Conversion Practices (December 6, 2023): Discussed restrictions on puberty blockers as part of broader conversion therapy ban considerations.

UK House of Lords Debate on Gender Identity Services (April 19, 2023): Focused on risks of puberty blockers for children, arguing against their use.

Australian Senate Debate (October 18, 2023): Discussion of Childhood Gender Transition Prohibition Bill 2023, aiming to prohibit health practitioners from providing gender-affirming interventions to minors; bill not passed but highlighted opposition.

New South Wales Parliament Proceedings (March 14, 2025): “Future of Gender Medicine" event critiquing flaws in gender-affirming care practices, cautioning against its continuation.

US Federal Trade Commission (FTC) Workshop (July 9, 2025): Event titled “The Dangers of 'Gender-Affirming Care' for Minors,” exploring whether practices in gender-affirming care for minors are unfair or deceptive under FTC authority; no legislation but aimed at potential enforcement actions against providers.

US Department of Justice (DOJ) Inquiry and Subpoenas (July 2025): DOJ issued subpoenas to over 20 clinics and doctors providing gender-affirming care to minors, investigating allegations of deceptive practices; referenced during FTC workshop, signaling potential federal enforcement.

US Department of Health and Human Services (HHS) Report Release (May 1, 2025): Comprehensive review titled “Treatment for Pediatric Gender Dysphoria,” challenging the scientific basis of gender-affirming care for minors and contradicting medical group guidelines; no direct legislation but informs policy restrictions.

US White House Report to the President (April 28, 2025): Executive summary on “Protecting Children from Surgical and Chemical Mutilation,” detailing harms of puberty blockers and hormones for minors and noting over 7,000 children affected in recent years; supports executive actions to limit such care.

Norway Healthcare Investigation Board (UKOM) Report (March 2023): Report deemed puberty blockers, cross-sex hormones, and surgery for children and young people with gender dysphoria as experimental; recommended restrictions, defining treatments as unsafe due to insufficient evidence.

Denmark Health Authority Restrictions (August 2023): Centralized gender service shifted to offering counseling rather than medical treatments like puberty blockers for most teenagers with gender dysphoria; restricted access to hormones and surgeries for minors based on evidence review.

France Senate Inquiry Report (March 2024): Senate report on transgender minors called for banning hormone therapy, puberty blockers, and transitions before age 18; highlighted risks and lack of evidence, leading to draft law proposals for restrictions.

Finland Council for Choices in Health Care (COHERE) Recommendation Update (May 8, 2025): Updated guidelines for medical treatments of gender dysphoria in minors, prioritizing psychosocial support and psychotherapy over irreversible interventions like hormones or surgery; warned of uncertainties for those under 25.

Sweden National Board of Health and Welfare Updates (2024): Following 2022 restrictions, introduced National Highly Specialised Care Centres in January 2024, emphasizing psychotherapy as first-line treatment and limiting hormones/puberty blockers to exceptional cases under research protocols.

Germany Association of Scientific Medical Societies (AWMF) Draft Guidelines (2024): New guidelines for gender incongruence/dysphoria in children and adolescents, stressing caution, comprehensive assessments, and restricting medical interventions due to low-quality evidence; finalized in 2025 with focus on non-invasive approaches.

Netherlands Health Council Review and Amsterdam UMC Debates (2024): Ongoing review questioning the sustainability of the Dutch Protocol for youth transitions; Amsterdam UMC clinic faced criticism post-Cass Review, leading to calls for more evidence-based restrictions on puberty blockers and hormones for minors.

Events in favor of “gender-affirming" treatment

US Senate Bill Introduction (2023-2024): Discussions around S.2246 Gender-Affirming CARE Act, authorizing funds for research on barriers to gender-affirming care; referred to committee but not passed.

Colorado Legislative Hearings (2023): Debates on HB 23-1071 and SB 23-188 protecting access to gender-affirming care; enacted to shield providers and patients.

Illinois Legislative Hearings (2023): Sessions on HB 370 protecting transgender healthcare access; effective January 2024.

Maryland Legislative Hearings (2023): Discussions on SB 119/HB 461 as shield laws for gender-affirming care; effective July 2023.

Minnesota Legislative Hearings (2023): Debates on HF 146 designating Minnesota as a refuge for gender-affirming care; effective March 2023.

New Mexico Legislative Hearings (2023): Sessions on HB 7 protecting reproductive and gender-affirming care; effective June 2023.

UK House of Commons Debate on LGBT+ History Month (February 13, 2025): Highlighted concerns over NHS waiting times and puberty blocker bans, advocating for better access.

Australian Senate Statement (February 4, 2025): Affirmation that Australia's gender-affirming care regime is established, supported, and evidence-based.

Queensland Parliament Petition (January 31, 2025): Petition to protect and expand access to gender-affirming healthcare amid global bans.

Swedish Parliament Approval (April 2024): Debates on new acts allowing legal gender change from age 16 without diagnosis, facilitating access to related medical procedures.

France Haute Autorité de Santé (HAS) Guidelines (January 2025): New medical guidelines supporting gender-affirming care for transgender youth, including puberty blockers and hormone therapy, emphasizing their importance despite earlier Senate criticisms.

Canada Health Ministry Transition Binder (July 2025): Document for the Minister of Women and Gender Equality noting gender-affirming care as lifesaving, highlighting uneven access across provinces and calling for improved equity; informs federal policy support.

Neutral Events

UK House of Commons Debate on Gender Self-Identification (May 19, 2025): Balanced discussion on impacts of self-ID, including access to gender-affirming care and puberty blockers; no clear stance but addressed rights and bans.

UK House of Lords Debate on Conversion Therapy Prohibition (February 9, 2024): Explored puberty blockers in context of conversion practices, with arguments on both sides regarding gender-affirming care.

Australian Federal Government Consideration (December 2023): Discussions on adding 21 Medicare items for gender-affirming surgeries; aimed at improving access without explicit pro/anti framing.

Australian Health Minister Press Conference (January 31, 2025): Announcement of review into healthcare for trans and gender diverse children, focusing on evidence without predetermined stance.

Canada Institute for Health Information (CIHI) Outcome Measurement Review (March 2025): Scoping review analyzing health outcome measurements in gender-affirming care across Canada, identifying barriers and enablers without advocating for or against expansion.

Sincerely
David R. Herz

End the Butchery Now

On a comment by a member of Knesset about graffiti in Jerusalem:

Whoever stands idly by while hundreds of children and young adults ruin their bodies with the facilitation of the Drs. Frankenstein who administer “gender-affirming care,” who has been put on notice of this, who sits on the Health Committee of the Israeli Knesset, who is aware the US, UK, Germany, France, the Netherlands, Norway, Finland, and Sweden have all taken steps to rein in this “treatment,” who ignores e-mails and direct messages, lets her Knesset phone ring without answer, and who instead postures about graffiti, should hang her head in shame.

None of us like this graffiti, but maybe you should fix what is in your control first.

Sincerely
David R. Herz

End the Butchery Now

A Medical Scandal About Which We Can Agree With The West

Below is a summary of the official reports from the West's largest nations—The United States, The United Kingdom, Germany, France, The Netherlands, Finland, Sweden and Norway—on the issue of “gender-affirming medicine.” You will note that they agree that this is medical experimentation and not medicine.

The house of cards promoting “one of the greatest ethical scandals in medicine" is falling, but it is still doing major damage in the west, including in Israel.

We are a country that is so far ahead of others in so much. It is a shame that this is the place we fall behind, especially when the price is so high.

Please be in communication so we can discuss the next steps.

With respect,

David R. Herz

Cass Review (Independent Review of Gender Identity Services for Children and Young People, UK, April 2024)

• Overview and Context: Commissioned by NHS England, the review, led by Dr. Hilary Cass, examined gender identity services for children and young people, finding that the field lacks robust evidence and that research on medical interventions like puberty blockers and hormones is inadequate.
• Key Findings on Evidence Base: The review concluded that the evidence for puberty blockers and hormone therapies is of poor quality, with no reliable data showing improvements in gender dysphoria, mental health, body image, or psychosocial functioning; it highlighted a shift from early-onset childhood dysphoria to adolescent-onset cases often linked to comorbidities like autism, trauma, or mental health issues.
• Concerns with Current Practices: Gender-affirming care models were criticized for being overly medicalized without sufficient holistic assessment; the review noted rapid increases in referrals (over 3,000% in a decade), potential social contagion influences, and risks of irreversible harm from interventions without long-term data.
• Recommendations: Emphasized a holistic, multidisciplinary approach prioritizing psychotherapy and psychosocial support over medical interventions; recommended banning puberty blockers outside research settings, establishing regional centers for care, and conducting more rigorous research; also called for follow-up studies on detransition and long-term outcomes.
• NHS England responded by halting routine puberty blocker prescriptions and planning service reforms.

HHS Report: Treatment for Pediatric Gender Dysphoria - Review of Evidence and Best Practices (US Department of Health and Human Services, May 2025)

• Overview and Context: This 409-page report, released under the Trump administration, evaluates evidence on interventions for youth with gender dysphoria, concluding that medical approaches like puberty blockers and hormones lack strong scientific support and pose significant risks.
• Key Findings on Evidence: The report found limited, low-quality evidence for benefits in psychological outcomes; it disputes claims by major US medical groups, highlighting that interventions do not reliably reduce distress, suicide risk, or improve mental health, and may exacerbate issues in some cases.
• Risks and Harms: Interventions carry risks including infertility, sterility, sexual dysfunction, impaired bone density, and potential cognitive impacts; the report notes over 7,000 US children received such treatments in recent years, often without adequate informed consent or exploration of comorbidities like autism or trauma.
• Recommendations: Prioritizes psychotherapy and gender exploratory therapy as first-line treatments; advises against routine use of puberty blockers, hormones, or surgeries for minors, aligning with European restrictions; calls for more research and criticizes gender-affirming models as potentially conversion therapy in disguise.
• This report contrasts with a 2022 HHS guidance supporting affirming care.

Norwegian Healthcare Investigation Board (UKOM) Report on Gender-Affirming Treatment (Norway, March 2023)

• Overview and Context: The report reviewed gender-affirming treatments for youth, deeming puberty blockers, hormones, and surgeries experimental due to insufficient evidence, following complaints about care quality.
• Key Findings on Evidence: Found no reliable evidence supporting the safety or efficacy of medical interventions for minors; highlighted rapid increases in referrals (especially among adolescent females) and comorbidities like mental health issues, suggesting social influences may play a role.
• Risks and Concerns: Treatments pose risks of irreversible harm, including fertility loss and bone health issues; the report criticized inadequate informed consent and the shift from counseling to medicalization without long-term data.
• Recommendations: Restrict hormones and surgeries to research settings; prioritize psychosocial support and counseling; revise guidelines to emphasize caution, leading Norway to centralize care and limit interventions for most teens.
• Outcomes: Resulted in policy changes, including halting routine puberty blockers outside trials; criticized by some as unsafe and biased against trans youth.

Swedish National Board of Health and Welfare Guidelines on Care for Children and Adolescents with Gender Dysphoria (Sweden, December 2022, with 2024 Updates)

• Overview and Context: Updated guidelines based on systematic evidence reviews, shifting from affirmative medical care to caution due to a 1,500% referral increase and weak evidence base.
• Key Findings on Evidence: Low certainty evidence for benefits of hormones or blockers; most studies show no improvement in mental health or dysphoria, with risks outweighing potential gains for minors.
• Social and Diagnostic Aspects: Emphasizes comprehensive assessments for comorbidities (e.g., autism, trauma); recommends social support for families and youth, noting gender dysphoria may resolve without intervention.
• Recommendations: Prioritize psychotherapy as first-line; limit hormones and blockers to exceptional cases in research protocols; ban surgeries for minors; establish specialized centers for evaluation.
• Implementation: Led to centralized care in 2024, focusing on non-invasive approaches; aligns with broader European caution.

Finnish Council for Choices in Health Care (COHERE) Recommendation on Medical Treatment for Gender Dysphoria in Minors (Finland, June 2020, Updated May 2025)

• Overview and Context: Guidelines emphasize caution for minors, prioritizing non-medical interventions amid rising cases and evidence gaps; 2025 update reinforces psychotherapy focus.
• Key Findings on Evidence: Irreversible interventions like hormones or surgery lack proven benefits and carry risks (e.g., infertility, bone issues); dysphoria often resolves naturally, especially if linked to comorbidities.
• Diagnostic and Support Needs: Stresses thorough assessments for underlying issues; notes uncertainty in outcomes for those under 25 due to brain development.
• Recommendations: Psychosocial support and psychotherapy as primary; hormones only if identity is stable and causes severe dysphoria, no surgeries for minors; ongoing monitoring required.
• Policy Impact: Finland restricts medical transitions, focusing on reversible supports; aligns with systematic reviews questioning efficacy.

French Senate Report on Transgender Minors (France, March 2024)

• Overview and Context: Conservative senators' report critiques rising transgender identifications among minors, calling for restrictions on medical transitions amid ethical concerns.
• Key Findings on Evidence: Describes gender reassignment as potentially “one of the greatest ethical scandals in medicine,” with insufficient evidence for benefits and high risks of harm; notes social contagion and over-medicalization.
• Risks and Ethical Issues: Highlights irreversible effects like sterility; criticizes influence of activists and lack of long-term studies.
• Recommendations: Ban hormone therapy, puberty blockers, and transitions before age 18; prohibit surgeries; led to a draft law for restrictions, passed in Senate May 2024.
• Responses: Sparked protests and rallies for trans rights; contrasts with HAS guidelines supporting care, but influenced debate.

German Association of Scientific Medical Societies (AWMF) Guidelines on Gender Incongruence/Dysphoria in Children and Adolescents (Germany, Draft 2024, Finalized 2025)

• Overview and Context: Evidence-based guidelines stress caution due to low-quality evidence, but recommend affirming care including medical interventions in some cases.
• Key Findings on Evidence: Low certainty for benefits of blockers and hormones; emphasizes comprehensive assessments for comorbidities and uncertainties in long-term outcomes.
• Diagnostic Approach: Focuses on multidisciplinary evaluations; acknowledges psychological factors and need for support.
• Recommendations: Prioritize non-invasive therapies; allow puberty blockers and hormones after thorough assessment, but with informed consent on risks; no surgeries for minors.
• Criticisms: Some view it as overly affirming despite evidence gaps, diverging from European trends; others praise access improvements.

Netherlands Health Council Advisory Report on Medical Care for Transgender Children and Adolescents (Netherlands, June 2023, Ongoing Review)

• Overview and Context: Amid debate over the “Dutch Protocol" (origin of youth transitions), the council reviewed care sustainability, questioning evidence amid rising cases.
• Key Findings on Evidence: Weak evidence for long-term benefits; highlights comorbidities, potential regret, and need for better research on puberty blockers' effects.
• Concerns with Practices: Criticizes rapid medicalization; notes ethical dilemmas in minors' consent and cultural shifts influencing referrals.
• Recommendations: More cautious approach with psychosocial focus; ongoing review to inform guidelines, potentially restricting interventions outside trials.
• Impact: Sparked national debate, with calls for scrutiny; aligns with Cass Review influences.

Sincerely
David R. Herz

End the Butchery Now

שערורייה רפואית שבה אנו יכולים להסכים עם המערב

להלן סיכום של הדוחות הרשמיים ממדינות המערב הגדולות ביותר—ארצות הברית, הממלכה המאוחדת, גרמניה, צרפת, הולנד, פינלנד, שוודיה ונורבגיה—בעניין "רפואה מאשרת מגדר". תשים לב שהם מסכימים כי מדובר בניסוי רפואי ולא ברפואה.

בית הקלפים שמקדם "אחת השערוריות האתיות הגדולות ביותר ברפואה" מתמוטט, אך הוא עדיין גורם נזק רב במערב, כולל בישראל.

אנו מדינה שכל כך מקדימה אחרים בהרבה תחומים. חבל שזה המקום שבו אנו נופלים מאחור, במיוחד כשהמחיר כה גבוה.

אנא היו בקשר כדי שנוכל לדון בצעדים הבאים.

בכבוד רב,

דוד ר. הרץ

Cass Review (Independent Review of Gender Identity Services for Children and Young People, UK, April 2024)

• סקירה כללית והקשר: הוזמן על ידי NHS England, הביקורת, בהובלת ד"ר הילרי קאס, בחנה שירותי זהות מגדרית לילדים ולצעירים, ומצאה כי התחום חסר ראיות חזקות וכי המחקר על התערבויות רפואיות כמו חוסמי התבגרות והורמונים אינו מספיק.
• ממצאים מרכזיים על בסיס הראיות: הביקורת הסיקה כי הראיות לחוסמי התבגרות ולטיפולים הורמונליים הן באיכות ירודה, ללא נתונים אמינים המראים שיפורים בדיספוריה מגדרית, בריאות נפשית, דימוי גוף או תפקוד פסיכו-חברתי; היא הדגישה מעבר מדיספוריה מוקדמת בילדות למקרים מתחילים בגיל ההתבגרות הקשורים לעיתים קרובות לקומורבידיות כמו אוטיזם, טראומה או בעיות בריאות נפשית.
• דאגות לגבי פרקטיקות נוכחיות: מודלים של טיפול מאשר מגדר בוקרו על היותם רפואיים מדי ללא הערכה הוליסטית מספקת; הביקורת ציינה עליות מהירות בהפניות (מעל 3,000% בעשור), השפעות אפשריות של התפשטות חברתית, וסיכונים לנזק בלתי הפיך מהתערבויות ללא נתונים ארוכי טווח.
• המלצות: הדגישה גישה הוליסטית, רב-תחומית המעדיפה פסיכותרפיה ותמיכה פסיכו-חברתית על פני התערבויות רפואיות; המליצה לאסור חוסמי התבגרות מחוץ למסגרות מחקר, להקים מרכזים אזוריים לטיפול, ולערוך מחקרים קפדניים יותר; קראה גם למחקרי מעקב על דה-טרנזיציה ותוצאות ארוכות טווח.
• NHS England הגיבה בהפסקת מרשמים שגרתיים של חוסמי התבגרות ותכנון רפורמות בשירותים.

HHS Report: Treatment for Pediatric Gender Dysphoria - Review of Evidence and Best Practices (US Department of Health and Human Services, May 2025)

• סקירה כללית והקשר: דוח זה בן 409 עמודים, שפורסם תחת ממשל טראמפ, מעריך ראיות על התערבויות לצעירים עם דיספוריה מגדרית, ומסיק כי גישות רפואיות כמו חוסמי התבגרות והורמונים חסרות תמיכה מדעית חזקה ומציבות סיכונים משמעותיים.
• ממצאים מרכזיים על ראיות: הדוח מצא ראיות מוגבלות באיכות נמוכה להטבות בתוצאות פסיכולוגיות; הוא חולק על טענות של ארגונים רפואיים מרכזיים בארה"ב, ומדגיש כי התערבויות אינן מפחיתות באופן אמין מצוקה, סיכון להתאבדות או משפרות בריאות נפשית, ועשויות להחמיר בעיות במקרים מסוימים.
• סיכונים ונזקים: התערבויות נושאות סיכונים כולל אי פוריות, עקרות, תפקוד מיני לקוי, פגיעה בצפיפות עצם, והשפעות קוגניטיביות אפשריות; הדוח מציין כי מעל 7,000 ילדים בארה"ב קיבלו טיפולים כאלה בשנים האחרונות, לעיתים קרובות ללא הסכמה מדעת מספקת או חקירה של קומורבידיות כמו אוטיזם או טראומה.
• המלצות: מעדיף פסיכותרפיה וטיפול חקירתי מגדרי כטיפולים ראשונים; מייעץ נגד שימוש שגרתי בחוסמי התבגרות, הורמונים או ניתוחים לקטינים, בהתאם להגבלות אירופיות; קורא למחקר נוסף ומבקר מודלים מאשרי מגדר כטיפול המרה במסווה.
• דוח זה מנוגד להנחיות HHS מ-2022 התומכות בטיפול מאשר.

Norwegian Healthcare Investigation Board (UKOM) Report on Gender-Affirming Treatment (Norway, March 2023)

• סקירה כללית והקשר: הדוח סקר טיפולים מאשרי מגדר לצעירים, וקבע כי חוסמי התבגרות, הורמונים וניתוחים הם ניסויים בשל ראיות לא מספיקות, בעקבות תלונות על איכות הטיפול.
• ממצאים מרכזיים על ראיות: לא נמצאו ראיות אמינות התומכות בבטיחות או ביעילות של התערבויות רפואיות לקטינים; הדגיש עליות מהירות בהפניות (במיוחד בקרב נערות מתבגרות) וקומורבידיות כמו בעיות בריאות נפשית, מה שמרמז כי השפעות חברתיות עשויות לשחק תפקיד.
• סיכונים ודאגות: טיפולים מציבים סיכונים לנזק בלתי הפיך, כולל אובדן פוריות ובעיות בריאות עצם; הדוח ביקר הסכמה מדעת לא מספקת והמעבר מייעוץ לרפואה ללא נתונים ארוכי טווח.
• המלצות: להגביל הורמונים וניתוחים למסגרות מחקר; להעדיף תמיכה פסיכו-חברתית וייעוץ; לעדכן הנחיות כדי להדגיש זהירות, מה שהוביל את נורבגיה לרכז טיפול ולהגביל התערבויות עבור רוב הנערים.
• תוצאות: גרם לשינויי מדיניות, כולל הפסקת חוסמי התבגרות שגרתיים מחוץ לניסויים; בוקר על ידי חלק כלא בטוח ומשוחד נגד צעירים טרנסים.

Swedish National Board of Health and Welfare Guidelines on Care for Children and Adolescents with Gender Dysphoria (Sweden, December 2022, with 2024 Updates)

• סקירה כללית והקשר: הנחיות מעודכנות מבוססות סקירות ראיות שיטתיות, עוברות מטיפול רפואי מאשר לזהירות בשל עלייה של 1,500% בהפניות ובסיס ראיות חלש.
• ממצאים מרכזיים על ראיות: ודאות נמוכה להטבות מהורמונים או חוסמים; רוב המחקרים מראים ללא שיפור בבריאות נפשית או דיספוריה, עם סיכונים העולים על רווחים פוטנציאליים לקטינים.
• היבטים חברתיים ואבחנתיים: מדגישה הערכות מקיפות לקומורבידיות (למשל, אוטיזם, טראומה); ממליצה על תמיכה חברתית למשפחות ולצעירים, מציינת כי דיספוריה מגדרית עשויה להיפתר ללא התערבות.
• המלצות: להעדיף פסיכותרפיה כטיפול ראשון; להגביל הורמונים וחוסמים למקרים יוצאי דופן בפרוטוקולי מחקר; לאסור ניתוחים לקטינים; להקים מרכזים מיוחדים להערכה.
• יישום: הוביל לטיפול מרוכז ב-2024, מתמקד בגישות לא פולשניות; מתיישב עם זהירות אירופית רחבה יותר.

Finnish Council for Choices in Health Care (COHERE) Recommendation on Medical Treatment for Gender Dysphoria in Minors (Finland, June 2020, Updated May 2025)

• סקירה כללית והקשר: הנחיות מדגישות זהירות לקטינים, מעדיפות התערבויות לא רפואיות בעקבות עלייה במקרים ופערים בראיות; עדכון 2025 מחזק מיקוד בפסיכותרפיה.
• ממצאים מרכזיים על ראיות: התערבויות בלתי הפיכות כמו הורמונים או ניתוח חסרות הטבות מוכחות ונושאות סיכונים (למשל, אי פוריות, בעיות עצם); דיספוריה לעיתים קרובות נפתרת באופן טבעי, במיוחד אם קשורה לקומורבידיות.
• צרכי אבחון ותמיכה: מדגישה הערכות יסודיות לבעיות בסיסיות; מציינת אי ודאות בתוצאות עבור אלה מתחת לגיל 25 בשל התפתחות המוח.
• המלצות: תמיכה פסיכו-חברתית ופסיכותרפיה כראשוניות; הורמונים רק אם הזהות יציבה וגורמת לדיספוריה חמורה, ללא ניתוחים לקטינים; ניטור מתמשך נדרש.
• השפעת מדיניות: פינלנד מגבילה מעברים רפואיים, מתמקדת בתמיכות הפיכות; מתיישבת עם סקירות שיטתיות המטילות ספק ביעילות.

French Senate Report on Transgender Minors (France, March 2024)

• סקירה כללית והקשר: דוח של סנאטורים שמרנים מבקר עלייה בזיהויים טרנסג'נדרים בקרב קטינים, קורא להגבלות על מעברים רפואיים בעקבות דאגות אתיות.
• ממצאים מרכזיים על ראיות: מתאר שינוי מגדר כפוטנציאלי "אחת השערוריות האתיות הגדולות ביותר ברפואה", עם ראיות לא מספיקות להטבות וסיכונים גבוהים לנזק; מציין התפשטות חברתית ורפואה יתר.
• סיכונים וסוגיות אתיות: מדגיש השפעות בלתי הפיכות כמו עקרות; מבקר השפעת פעילים וחוסר מחקרים ארוכי טווח.
• המלצות: לאסור טיפול הורמונלי, חוסמי התבגרות ומעברים לפני גיל 18; לאסור ניתוחים; הוביל להצעת חוק להגבלות, שאושרה בסנאט במאי 2024.
• תגובות: עורר מחאות והפגנות למען זכויות טרנסים; מנוגד להנחיות HAS התומכות בטיפול, אך השפיע על הדיון.

German Association of Scientific Medical Societies (AWMF) Guidelines on Gender Incongruence/Dysphoria in Children and Adolescents (Germany, Draft 2024, Finalized 2025)

• סקירה כללית והקשר: הנחיות מבוססות ראיות מדגישות זהירות בשל ראיות באיכות נמוכה, אך ממליצות על טיפול מאשר כולל התערבויות רפואיות במקרים מסוימים.
• ממצאים מרכזיים על ראיות: ודאות נמוכה להטבות מחוסמים והורמונים; מדגישה הערכות מקיפות לקומורבידיות ואי ודאויות בתוצאות ארוכות טווח.
• גישה אבחנתית: מתמקדת בהערכות רב-תחומיות; מכירה בגורמים פסיכולוגיים וצורך בתמיכה.
• המלצות: להעדיף טיפולים לא פולשניים; לאפשר חוסמי התבגרות והורמונים לאחר הערכה יסודית, אך עם הסכמה מדעת על סיכונים; ללא ניתוחים לקטינים.
• ביקורות: חלק רואים זאת כמאשרת מדי למרות פערי ראיות, סוטה ממגמות אירופיות; אחרים משבחים שיפורים בגישה.

Netherlands Health Council Advisory Report on Medical Care for Transgender Children and Adolescents (Netherlands, June 2023, Ongoing Review)

• סקירה כללית והקשר: בעקבות דיון על "פרוטוקול ההולנדי" (מקור מעברי נוער), המועצה סקרה קיימות טיפול, מטילה ספק בראיות בעקבות עלייה במקרים.
• ממצאים מרכזיים על ראיות: ראיות חלשות להטבות ארוכות טווח; מדגישה קומורבידיות, חרטה פוטנציאלית וצורך במחקר טוב יותר על השפעות חוסמי התבגרות.
• דאגות לגבי פרקטיקות: מבקר רפואה מהירה; מציין דילמות אתיות בהסכמת קטינים ושינויים תרבותיים המשפיעים על הפניות.
• המלצות: גישה זהירה יותר עם מיקוד פסיכו-חברתי; סקירה מתמשכת כדי להנחות הנחיות, פוטנציאלית מגבילה התערבויות מחוץ לניסויים.
• השפעה: עוררה דיון לאומי, עם קריאות לבדיקה; מתיישבת עם השפעות Cass Review.

בברכה
דוד ר. הרץ

סיימו את הטבח עכשיו

If You Won't Lead, at Least Represent

There is no question of capture of large portions of our medical, educational, even juridical establishments, by the ideology that informs “gender-affirming medicine.”

Most of us know that neither boy nor girl can be chemically and surgically turned into the other. We know it is wrong even to try. We do not need a medical degree or even a class in biology.

You can ask any farmer if he thinks you could transplant the sexual organs of his animals to those of the other sex and expect there would be any chance these would function.

Most of us would be shocked to learn that children are taught that maybe they are born into the wrong body.

Most of us can remember the disorientation we felt going through puberty. Some of us will know that as having been complicated by sexual abuse, bullying, any off inclination being caught by our peers and made fun of.

We can imagine that we might have grasped at anything that promises to save us. “Gender-affirmation" makes those promises, but can't keep them. Proto-gay, sexually abused, non-conforming, ADD, ADHD, Autism Spectrum Disdorder, the simply depressed, are told that their discomfort can be solved. They just need to understand they are in the wrong body.

And there is a euphoria in a girl getting her first dose of Testosterone. It's a powerful drug. But like many others, ultimately destructive.

We, You and I, See Where this is Going

For some, the evidence is clear that we have been lead down a path that is leading to the destruction of our children. Gender Ideology presents more as religious belief than as medical/scientific theory to be tested.

The normal safeguards have been ignored.

At the very least, sufficient questions have been raised that any such treatment, at any age, should be halted until we know more, which will likely reveal that forever is the appropriate period of restriction.

You can not undo castration, or the removal of healthy breasts, or the effects of a course of powerful cross-sex hormones.

If you survey Israelis, I expect most, given only a minor briefing in this topic, would react strongly against this course of “treatment.”

Even to allow it to “adults,” this should be seen as what it is, cosmetic surgery to address psychological problems. This should not in any way be covered by Israeli Health Funds, and the Ministry can not ethically convene a board to pass on this without a validated protocol.

The Emperor has no Clothes

President Trump, in a January 28, 2025 executive order “Protecting Children from Chemical and Surgical Mutilation,” established a U.S. policy against funding, sponsoring, promoting, assisting, or supporting gender-affirming care for children under the age of 19.

Children's hospitals across the western world are stopping this. They may object, but I expect many are happy that Trump called out that the emperor has no clothes.

They, and we, have been badgered into submission by the activists parading as medical providers.

You, who should have lead the inquiry, chose not to, so far. I invite you to find that little bit of courage that I pray still exists in the heart of most politicians, and stand up. The wind is finally at your back. The experts, the tailors of “gender-affirmation" are being revealed as charlatans.

And I get that you are busy. We are at war. I have a son at or near the front lines as well. I have another a victim of this Ideology. I see the business the Knesset attends to, making site visits and taking field trips, discussing saving the children of the Lev Tahor cult (in Guatemala), which doesn't touch as many Israelis in their lifetime as does the Gender Ideology Cult in Israel every day, battling road accidents, failing to address intentional ongoing damage of our children/young adults by the medical establishment.

You are lined up for a win most Israelis will align on. Don't pass this up. Don't allow another one of our children to be hurt by this.

You have not lead us on this, at least you can represent us.

Please be in touch about next steps.

Yours Truly,

David R. Herz

Bet Rimon, Israel and Bridgeport, Connecticut

The End State of a Lie:
The Cowardice of the Court of Justice in a Bureaucratic State

It is the exhortation of Orwell, Solzhenitsyn, Peterson. It is one of Adam's first lessons: Don't lie.

The end state of a lie, the pain it causes, is papered over again in the Israel Supreme Court opinion Jane Doe v. the Ministry of Health, HC-35584-01-25.

A young lady turned to the court because the systems that should have protected her failed her. She was introduced to the idea that a girl could be a boy, she allowed herself to believe she might be a boy stuck in a girl's body. Those who should have been the caretakers and gatekeepers along the way instead affirmed this fantasy. If her parents weren't on board right away, they would have been counseled that “a live son is better than a dead daughter.”

She was referred to a surgeon to cut off her healthy breasts. She was given powerful drugs used for purposes they were never intended along the way. She changed her sex designation on her Identity Documents, with the review and approbation of the Ministry of Health.

Then she grew up a little. She realized tha all the interventions did not change that she was a girl. She asked that here Certificate of Identity be restored to reflect her biology.

The Court dealt with this like any other case of bureaucratic procedure. If she wants to “change her sex” again, she must go back to the medical system and get the appropriate letter from the committee at the Ministry of Health that determines such things.

The court has the ability to claim jurisdiction in matters that manifest such injustice that there is no other reasonable course. As the Israeli court has a greater ability to make it up when it wants to, it is more responsive to modern currents and mores than those bound by strong constitutions and stricter notions of stare decisis (respect of precedent).

When dealing with a case like this then, I would expect the court to understand the context in which it makes its decisions.

If it were a true Court of Justice, it would see the unfathomable pain of a young lady who is maybe just beginning to see the hell she has been sold: she will never be able to breastfeed, assuming she can still have children. She may always have to deal with a five o'clock shadow. She may have a permanently changed voice. She may be unable to enjoy sex. She will have permanent damage to erogenous zones. She may always be seen as a freak.

The Court of Justice would also see that the house of cards that is “gender-affirming care” is rapidly beginning to collapse. In March of 2024, journalist Michael Shellenberger's Environmental Progress published The WPATH Files: Pseudoscientific Surgical and Hormonal Experiments on Children, Adolescents, and Vulnerable Adults, followed in April by the publication of the four year study The Cass Review: Independent review of gender identity services for children and young people: Final report. in the United Kingdom, headed by Dr. Hilary Cass, OBE.

But this wasn't the first notice of this collapse. A 2020 review in Finland suggested a cautious approach with significant additional data gathering. Recommendation of the Council for Choices in Health Care in Finland (PALKO / COHERE Finland). In February of 2022, the Swedish National Board of Health and Welfare, adopted “a more cautious approach that prioritizes non-invasive interventions…due to recognition of the importance of allowing ongoing maturation and identity formation of youth.

International organizations have formed to address this issue: GenSpect, the Society for Evidence Based Gender Medicine,, Beyond Trans, Do No Harm, Gays against Groomers, and LGB Courage Coalition. Of particular interest should be the last two, who would suggest that this Jane Doe is a victim of the medical system rather than its beneficiary.

One would expect the Court to be aware of the April case For Women Scotland Ltd. v The Scottish Ministers [2025] UKSC 16, and June case United States v. Skrmetti, 605 U.S. ___ (2025), and the US Department of Health and Human Services report Treatment for Pediatric Gender Dysphoria: Review of Evidence Best Practices issued in May.

If the court had scratched the surface just a little, it would have seen that the health system that Ms. Doe must turn to, and particularly its “Gender Reassignment Board” will be peopled by activists who won't want to face the wrongness of their prior path. If this breast should not have been taken off, how many other regretful breast removals does this case suggest the board was a part of.

The court would see that the unravelling of the “gender-affirming care” standard that Ms. Doe's request represents will not be celebrated by these doctors/therapists/social workers. Instead, the court is asking Ms. Doe to go to battle to acknowledge what everyone knew in the first place, but some found it convenient to forget: He made them in the likeness of G-d, He created them male and female. Genesis 5:1-2.

Perhaps the Court would or could not do this because it would reveal its own complicity. It could instead have taken the high ground and recognized its own humanity, and the current state of affairs.

We have been taken in by a call to compassion for trans people. Instead, as in all calls to victim/oppressor ideologies, we have been duped by those sociopaths who would take advantage of one trans person's anguish to undermine the system. The result is that this court is willing to go along with 2+2=5 until a doctor's letter says otherwise.

As in every call of crisis—economic, feminist, black lives, environment, overpopulation, viral outbreak, judicial, democratic, immigration—there will be the hustlers and demons who use it to undermine the system, grab a little more power, or resist the urge to balance it, for their own aggrandizement, to spit in the face of G-d, I don't know.

My hope would be that a Court of Justice could and would take the care to understand what it is supporting. Maybe if it truly reflected the ethical and moral compass that a Jewish State might, it would have seen this affront to both science and G-d a long time ago and never counselled it in the first place.

Instead, it hides behind the language of bureaucratic process to avoid the horrible truth until another day.

How many of our children will be sacrificed for this? We don't know, but the number is not zero.

David Herz, Bet Rimon, Israel

Presentation of Dr. Miriam Grossman:

For the full Federal Trade Commission Program: FTC Conference

Workshop on “Gender-Affirming Care”
Federal Trade Commission Protecting America's Consumers
On July 9, the FTC hosted and livestreamed a workshop focusing on unfair or deceptive trade practices in “gender-affirming care” for minors.
lightly edited for ease of reading.

Section five of the FTC Act says...that fraud and deceptive practice means representing as facts things that are entirely unproven or demonstrably false, thereby misleading the consumer in a material way.

When I examine gender-affirming care and the history that led up to it, I see fraud and deceptive practice everywhere. Going back decades, I see it in the landmark experiment on Bruce Reimer when he was a toddler and John Money instructed his parents to socially and medically transition him. This was to be Dr. Money's proof for a concept he'd come up with in 1966 called Gender Identity. Dr. Money announced to the world that the experiment was a resounding success. And for years, the world believed it. But in fact, it was a catastrophe from the start. Decades after Dr. Money, consumers were misled again when gender specialists took the results of one tiny Dutch study, whose subjects were carefully chosen and led parents to believe that every child distressed about their sex could benefit from that model of care.

Now, families are told there's a consensus among clinicians about the best way to help these children, but there is no consensus. What there is, is the silencing of opposition. There are many more examples that you will hear today, but I think it's fair to say that the fraud is wide and it is deep.

I will focus on three topics: deceptive practice in language, in medical records, and in therapist's letters for support of hormones and surgeries.

Before discussing fraud and deception, I'll remind you of what's true.

Humanity is divided into two biological categories. Male and female are established at conception. While there are many ways of being male or female, sex does not change and cannot be changed. These are universally acknowledged facts. “Gender-affirming care” is based on their denial. The premises of gender-affirming care are every person knows best who they are, regardless of their age, development, or mental health. All gender identities should be rubber-stamped by parents, doctors, therapists, and teachers. Medical interventions, including the removal of healthy organs, must be available on demand.

Gender Affirming Care's denial of biological facts is right in front of us. We don't need to make any Freedom of Information Act requests to see it. All we need to do is examine the language. Look how aggressively the proponents of gender-affirming care compel the language of doctors.

This is from a course given by a Doctor Erica Metz, medical director of transgender health for Kaiser Permanente in San Francisco. In this course, doctors learn that there are acceptable and unacceptable terms. For example, sex change operation is not acceptable. Doctors must say gender-affirming surgery. Born male is unacceptable. The proper term is assigned male at birth.

From the same course: Always use the pronouns the patient asks you to use, regardless of what they look like to you or what their name is....

Why is it so critical to Kaiser to control their doctor's speech? They know what George Orwell taught us: language is an instrument. It can be shaped for a particular purpose. It can change the way we think.

I will go through some of the vocabulary of gender-affirming care and demonstrate how this language is designed to change the way we think about male and female and to mislead consumers in a material way. So what I am suggesting today is that all of these terms are Section 5 violations.

Gender identity

We are told that whether we know it or not, we all have an inner sense of being male, female, both or neither. And that's represented by the brain in this slide, which by the way, comes from a sex education course. And we're told that that sense not only is untethered to material reality, but it overrides it, which is the body there. The brain overrides the body. You can have, for example, a girl's brain in a boy's body, and that boy is actually a type of girl, a trans girl. This belief is the cornerstone of gender-affirming care. It is represented as factual. It is not up for discussion.

Science studies the material world, the world that can be directly observed, measured and verified. The proponents of gender-affirming care declare that a person's inner sense, something that cannot be directly observed, measured, or verified, is more authentic than the material world. Now, what would you call that? Is that a philosophy? Is that a religion? I'm not sure, but I am sure that the idea is entirely unproven and unprovable in the same way that we can't prove the existence of a soul, even though we might believe in one. There is no objective evidence of being born in the wrong body and saying so misleads and takes advantage of consumers, and it impacts their medical decisions.

I know from my patients and many others, that when young people hear the idea that their feelings are more consequential than their bodies, and when they hear this idea endorsed with great certainty by therapists and doctors, echoed by professional organizations and government agencies, they believe it. They believe that this is bona fide science and that they have a medical condition whose only cure is pharmaceuticals and surgeries.

There's Dr. Gallagher, our favorite Miami surgeon. Girls see the language on her website, female to male procedures, and they genuinely believe that Dr. Gallagher can turn them into boys. And here's Johns Hopkins telling boys they can get female genitals.

Boys see this and they think they can get an actual vagina and be a woman just like any other. But Johns Hopkins and Dr. Gallagher cannot do these things. Their claims are demonstrably false. They deceive and exploit vulnerable and misinformed consumers and their families.

Preferred pronouns.

If you can pick your pronouns, it means that your feelings determine who you are. And it means, again, that biology is inconsequential. Preferred pronouns are part of social transitioning, and we know that social transitioning increases the odds that gender dysphoria will persist. Nevertheless, the captured American Association of Child and Adolescent Psychiatry instructs parents, “Use the name and pronouns your child prefers.” Chicago Children's Hospital have pronoun stickers for staff, and the pressure is intense. Trust me, I've talked to a lot of people working in hospitals.

The pressure is very intense for staff to wear these pronoun stickers. In my opinion, using opposite sex pronouns endorses something that can never be. It supports a patient's false belief and it impacts their medical decisions. So that's fraud right there.

Sex assigned at birth.

The purpose of that phrase is to lead people to think that male and female are a random designation, a doctor's whim. This is utterly false. I don't have time to discuss intersex. You're going to be hearing about it later. But the sex assigned at birth term, which we hear 24/7 everywhere, is designed to change the way that we think about male and female. Instead of it being a inherent quality of every one of the billions of cells in our body.

Cisgender and non-binary.

The word cisgender was invented in 1994 by a graduate student at the University of Minnesota. The inventor explained, “There did not seem to be a way to describe people who were not transgender without inescapably couching them in normalcy and making transgender identity automatically the other.” This student was unhappy, in other words, about how the transgender identity was perceived. And the goal of creating the word cisgender was to change that perception. So again, the goal was to change how we think. We are given the impression that cisgender is a scientific classification of people, but it's not.

Non-binary

We are told this is a valid identity for people who are both male and female, neither male and female, or some other combination of male and female. Kaiser Permanente provides this menu of non-binary options.

We might think this is silly and it is, but to vulnerable youth, it means that they can have a new identity every day of the month. If identity is based on feelings and you feel different from day to day, then why not? Do you see why so many young people are confused? I once had a 15-year-old patient who identified as non-binary. I asked him to explain what that meant. He thought for a moment, and he gave me hands down the best definition of non-binary I have ever heard.

It means you haven't figured this shit out yet.

Excuse the language. I would never speak this way, but it's refreshing to hear the truth.

Wrong puberty

That's a disturbing one. Puberty is not a disease. You're going to hear more about that from Dr. Lappert. Using that phrase is profoundly misleading, as if someone can go through the wrong puberty.

Top and bottom surgery

These are dangerous euphemisms. They're meant to distract you from what they really are. The removal of healthy organs causing disfigurement and a laundry list of serious medical problems, as you've just heard, and you'll hear more about that from Dr. Lappert. Justice Thomas called top and bottom surgery sanitizing language. And he got that right.

Genital reconstruction

Reconstruction means that particular genitals were once there. That's demonstrably false. A surgical procedure that creates a faux vagina is not reconstruction, it's construction. Same with hormone replacement therapy. You're not replacing anything. It's not the same as giving estrogen to a post-menopausal woman, and it misleads the consumer.

Chestfeed

The CDC (Centers for Disease Control) until recently—their site was scrubbed and this page is no longer there—endorsed the idea that men can lactate. Well, the female body is designed to lactate. The male body is not. Men do not lactate unless they have a medical disorder or they're pumped full of drugs that cause a nipple discharge. This is altogether different from the natural process of lactation that occurs in women. The term chestfeed, aside from erasing women in a most offensive way and dehumanizing all of us, misleads boys and men.

To summarize. The language of gender-affirming care seeks to deny the primacy of biology in determining male and female. It advances the notion that feelings override the objective reality of our sexed bodies. Such beliefs can harm patients and are not consistent with science in the 21st century.

Fraudulent Language in Medical Records

I'm going to tell you about this case that was reported in The New England Journal of Medicine. I'm not giving you all the details. This is a very concise review. And this article in The New England Journal called this woman a man and he/him pronouns, so I'm going to go ahead and do that, even though I normally wouldn't. 32-year-old Sam came to the emergency room. He had intermittent lower abdominal pain and high blood pressure. He told the triage nurse that he was a transgender man. His electronic medical record indicated he was male.

The nurse noted that Sam was an obese man, and he was comfortable between his bouts of pain. She assessed his condition as non-urgent. Lab tests were ordered, including a pregnancy test. It took several hours for Sam to finally be seen by a physician who took a detailed history, reviewed his lab results, and did a physical exam. He determined that Sam was in labor and had pre-eclampsia, which is an emergency that can be fatal for mother and child. A heartbeat could not be found on the ultrasound. And soon thereafter, Sam delivered a stillborn baby. Though he had obviously not planned or expected the pregnancy, he was heartbroken, and the loss of his baby produced a major depressive episode.

The language of medical records must be accurate. There was once a standard way to indicate a patient's sex in medical records, but no longer. And I want to give a shout-out to Dr. Carrie Mendoza for pioneering the work on safety in electronic health records and writing a model policy. With her help, Texas passed legislation requiring not gender identity, not legal sex, but actually just sex, male or female, on medical records.

Why is it so critical to accurately indicate a patient's sex on medical records?

We can see from Sam's story, of course, what happened, but there is much more. The X and Y chromosome have a deep and lifelong impact on each organ system. In fact, on each cell. There are significant differences between male and female in health and disease, and there are thousands of examples of this. For example, women are more likely to develop certain heart arrhythmias. 80% of autoimmune diseases are in women. Certain drugs are more powerful in one sex than in the other. It is potentially life-saving to have the correct sex identified on medical records, not gender identity and not legal sex, because that can be changed. But here's what's going on, and this is from NYU Langone Hospital. In 2018, a child was identified as a female, but two years later, this same child was identified as a male. At the Oregon Health and Science University, this is a surgeon's entry for a man, Forrest, who you're soon going to meet, who came in for breast implants, and it says the sex is female. And even more, well, equally incredible is that this surgeon's note for purposes of insurance coverage stated that this is a woman with underdeveloped breasts who needed a more feminine shape to her breasts in order to help with her gender dysphoria. Again, this is for the insurance companies to cover the cost of the prosthetic breast insertions. And if someone wasn't careful in reviewing these records, they would've thought that this is a young woman who simply has underdeveloped breasts.

This is back to Kaiser again, Kaiser Permanente in California. This was an admission note for Layla Jane, who you just met. She came in for her bilateral mastectomy. And it's indicated here that she is a 13-year-old male.

Now, more from Kaiser Permanente. This patient is identified as non-binary. A non-binary patient. Now, this is not someone's Facebook page. This is not Instagram. This is a legal document identifying a person as non-binary. Boston Children's has something interesting: You'll note it says legal sex up there on the top right. But that means that someone whose legal sex had been changed to a different sex, it would just say that up there. And then they have something very interesting.... They have an organ inventory. An organ inventory. Now what's that? All right. You see a list of organs, okay? Breasts, cervix, ovaries, penis, testes. And what's supposed to happen here? I guess, is that I don't know if they were indicating that Simon had all these organs, or whether someone forgot to make a check mark next to the ones that he actually has. This is not medical care. This is dehumanizing. I mean, that's a judgment call, I guess. But as a doctor, okay, this is not medical care.

The Diagnosis Endocrine Disorder, not otherwise specified

This is an example of a lab request for estrogen that was written by a Dr. Grace Evins, MD in North Carolina. Now, this is a male patient who is on estrogen, and the doctor, for probably insurance purposes, has indicated diagnosis E34.9. The lawyers in this room, take note. E34.9. I want to explain that to you. It means endocrine disorder, not otherwise specified.

Here's another example. Dartmouth College Health Service. You see below that endocrine disorder, unspecified. And this is another one for feminizing HRT (Hormone Replacement Therapy).

What is diagnosis code E34.9? In the International Classification of Diseases, they have thousands of diagnoses. They've categorized all the endocrine, these are medical diagnoses.... The endocrine diagnoses are between E00 and E89. These are endocrine, nutritional and metabolic diseases. So for example, there's hyperthyroidism, type 1 diabetes, polycystic ovaries. These are all medical diagnoses that are between E00 and E89. But then you have E34.9, endocrine disorder, unspecified.

What is that? It says that this is an acceptable diagnosis when clinical information is unknown or not available for a particular condition. Okay? It's preferable to use a more specific code, but you can use that code when they accurately reflect what is known about a patient's condition. Now, all these people here, these medical records that I showed you, and I'll show you some more, these are physically healthy people. They have no medical diagnosis whatsoever. They have a psychiatric diagnosis. But this E34.9 is being used in a fraudulent way, I would say, in order to get payment for the services.

This is what Planned Parenthood of Southeast Pennsylvania says. “In order to meet the needs of most insurance companies and patients, we typically use the code E34.9. We recognize that much of the language around billing for gender-affirming care is troublesome.” What they mean by that is that it's called a disorder. When you say endocrine disorder, they're objecting to the word disorder. “We recognize this is medically necessary care and will work to decrease barriers to get folks the care they need.” So they're explaining why they use that diagnosis.

What I'm going to do now is go into the fraudulent notes that are written for individuals who need letters from therapists in order to get their cross-gender hormones, opposite-sex hormones or surgeries, and how these letters are fraudulent.

So this is actually Prisha's note. You're going to meet her soon. On the first day that she saw this therapist, the therapist indicated that she had a major depressive disorder, recurrent, moderate. That is a serious psychiatric condition. It is a condition that impairs one's functioning and day-to-day life. She also indicated that Prisha had an eating disorder, doesn't go more than two days without eating.

That's a serious eating disorder if she sometimes goes two days and doesn't eat. Yet on the same day that this therapist indicated this in her chart, she wrote a letter for testosterone saying there is an absence of problems related to mood. She just wrote the same day she has a major depression, an eating disorder.... And she writes later on in the second paragraph, “There is no evidence of psychopathology.” What? And the diagnosis, gender dysphoria, anorexia in remission. Nothing about the depression.

Nothing about having not that long ago had serious self-injury and cutting, and a whole host of other mental illness diagnoses. So she writes for the testosterone the same day, day one.

This is another therapist's letter for to a surgeon. And this therapist wrote, “He presents with no apparent residual psychiatric symptoms and is quite stable.” This is Laura Becker, the letter that her therapist wrote to the surgeon. And Laura had been hospitalized for suicidality just two months before this letter to the surgeon for her bilateral mastectomy. Two months. You cannot say that someone that's just two months out of a serious psychiatric hospitalization has no residual psychiatric symptoms and is quite stable.

It's misleading. It's misleading to the surgeon. The therapist also wrote that Laura demonstrated excellent insight into transition. Well, Laura was under the impression at that time, that this is the only thing that would cure her symptoms. This was the only thing that would prevent her from committing suicide. That is not excellent insight. That is not informed consent. So these letters omit critical information about the patient's mental health, information that impacts their ability to provide informed consent, and information that one would hope might make the surgeon think twice before using the scalpel.

So to wrap it up, here's what Admiral Levine said about gender-affirming care. Whoops. Oh. Oh, I messed up the letters. Well, you know what? They're all the same. They're all the same in the same bad way. So Admiral Levine said, “Gender medicine is a medical field like any other. It's all very carefully done.” No, Admiral Levine, I don't think so. I don't think it's done carefully at all. I think this WPATH doctor put it more accurately. Dr. Marshall Dahl at a WPATH meeting. He said, “Not only are the medications off-label, the whole field is off-label, right? But that's all good.”

I'm here to say, all of us are here to say that that's not good. It's not good at all. No more misleading the consumer. No more representing facts, things that are entirely unproven or demonstrably false. Families deserve much better, and today is a great start. Thank you for listening.

Select portions of Judge Thomas' concurring opinion in United States v. Skrmetti, 605 U.S. ___ (2025).

The complete opinion here: United States v. Skrmetti, 605 U.S. ___ (2025).

[T]here are particularly good reasons to question the expert class here, as recent revelations suggest that leading voices in this area have relied on questionable evidence, and have allowed ideology to influence their medical guidance.

* * *

Puberty Blockers. Puberty blockers are powerful synthetic drugs “designed to slow the development of male and female physical features.” 83 F. 4th, at 467. The Food and Drug Administration (FDA) initially approved these drugs “to treat prostate cancer; endometriosis, a painful disease that causes uterine tissue to grow elsewhere in the body; and the unusually early onset of puberty,” also known as “precocious puberty.” M. Twohey & C. Jewett, Pressing Pause on Puberty, N. Y. Times, Nov. 14, 2022, pp. A14–A15 (Twohey 2022).

For purposes of treating gender dysphoria, however, puberty blockers generally are administered “off-label,” meaning without FDA authorization for the specific use. See 2 App. 838–839; 83 F. 4th, at 478. Although it is neither unusual nor unlawful for drugs to be used off-label, the FDA has recognized that “just because a drug has been approved for one class of patients doesn't mean it's safe for another.” Twohey 2022, at A15. That admonition is important here: To treat precocious puberty, puberty blockers are administered until the age appropriate for puberty; to treat gender dysphoria, however, puberty blockers are administered to stop puberty throughout the years it would normally occur. See 2 App. 677. The “use of drugs to suppress normal puberty has multiple organ system effects whose long-term consequences have not been investigated.” Ibid.

This absence of evidence is a “major drawback” in assessing the effects of puberty blockers on children with gender dysphoria. G. Betsi, P. Goulia, S. Sandhu, & P. Xekouki, Puberty Suppression in Adolescents With Gender Dysphoria: An Emerging Issue With Multiple Implications, Frontiers in Endocrinology 16 (2024). “The existing studies are limited in number, of small sample size, uncontrolled, observational, usually short-term, [and] potentially subject to bias.” Ibid.; see also, e.g., C. Terhune, R. Respaut, & M. Conlin, As More Transgender Children Seek Medical Care, Families Confront Many Unknowns, Reuters (Oct. 6, 2022), https://www.reuters.com/investigates/special-report/usa-transyouth-care (“No clinical trials have established [puberty blockers'] safety for such off-label use”).

It is undisputed, however, that these treatments carry risks. Research suggests that, aside from interrupting a child's normal pubertal development, puberty blockers may lead to decreased bone density and impacts on brain development. See, e.g., 2 App. 678–680; M. Cretella, Gender Dysphoria in Children, 32 Issues in L. & Med. 287, 297 (2017). And, “[d]espite widespread assertions that puberty blockers are ‘fully reversible,’” it is unclear whether “patients ever develop normal levels of fertility if puberty blockers are terminated after a ‘prolonged delay of puberty.’” 2 App. 678. At bottom, “[t]here remains considerable uncertainty regarding the effects of puberty blockers in individuals experiencing” gender dysphoria. A. Miroshnychenko et al., Puberty Blockers for Gender Dysphoria in Youth: A Systematic Review and Meta-Analysis, Online First, Archives of Disease in Childhood (Jan. 24, 2025) (draft, at 1), https://adc.bmj.com/content/110/6/429.

Cross-sex hormones. Following puberty blockers, the next stage of sex-transition treatments for children involves cross-sex hormones. This treatment is also typically “off-label,” 2 App. 780, and requires “very high doses” of hormones of the opposite sex, Id., at 769. For example, one of the organizations that sets standards for pediatric sex-transition treatment recommends raising transitioning females' levels of testosterone “6 to 100 times higher than native female testosterone levels.” Id., at 774. For males seeking to transition into females, the organization recommends raising levels of estradiol, a type of estrogen, to “2 to 43 times above the normal range.” Id., at 780.

Prescribing such high doses of testosterone to girls induces “hyperandrogenism,” which can cause increased cardiovascular risk, “irreversible changes to the vocal cords,” “clitoromegaly and atrophy of the lining of the uterus and vagina,” as well as “ovarian and breast cancer.” Id., at 772– 779. Giving high doses of estrogen to boys induces “hyperestrogenemia,” which can produce similarly severe side effects including, among other things, increased cardiovascular risk, breast cancer, and sexual dysfunction. Id., at 779– 781. And, for girls and boys alike, “it is generally accepted, even by advocates of transgender hormone therapy, that hormonal treatment impairs fertility, which may be irreversible.” Id., at 520–521; accord, W. Hembree et al., Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline, 102 J. Clinical Endocrinology & Metabolism 3869, 3882 (2017) (ES Guidelines).

Surgery. SB1 also bans “[s]urgically removing, modifying, altering, or entering into tissues, cavities, or organs” as a treatment for gender dysphoria. Tenn. Code Ann. §68–33–102(5)(A). The District Court concluded that the plaintiffs lacked standing to challenge SB1's ban on sex-transition surgery for minors, see ante, at 6, and the parties do not address this provision's constitutionality here. But, the United States has taken the position that “surgery is essential and medically necessary to alleviate gender dysphoria.” Amended Complaint in Intervention in Boe v. Marshall, No. 2:22–cv–00184 (MD Ala., May 4, 2022), ECF Doc. 92, p. 9, ¶39. The practice therefore warrants brief discussion.

Sex-transitioning surgeries for girls include “the surgical removal of the breasts” and “phalloplasty,” that is, an “attemp[t] to create a pseudo-penis” by transplanting “a roll of skin and subcutaneous tissue” from another area of the body “to the pelvis.” 2 App. 784–785; see also Lange v. Houston Cty., 101 F. 4th 793, 802 (CA11) (Brasher, J., dissenting) (“[A] natal woman's phalloplasty ‘involves removal of the uterus, ovaries, and vagina, and creation of a neophallu[s] and scrotum with scrotal prostheses,’ which ‘is a multistage reconstructive procedure’”), vacated and reh'g en banc granted, 110 F. 4th 1254 (CA11 2024). For boys, surgical interventions include “removal of the testicles alone to permanently lower testosterone levels,” as well as an “attempt to create a pseudo-vagina” by “surgically open[ing]” the boy's penis, removing “erectile tissue,” and then “clos[ing] and invert[ing the penis] into a newly created cavity in order to simulate a vagina.” 2 App. 784. These surgical interventions are irreversible, entail significant complications, and, in some cases, result in permanent infertility. Id., at 782–786; see also ES Guidelines 3893.

…

In 1998, the World Professional Association for Transgender Health (WPATH)—which is regarded by some as “the leading association of medical professionals treating transgender individuals,” Brief for United States 3—revised its treatment standards to “endorse the Dutch Protocol.” 83 F. 4th, at 467. Originally, WPATH's guidelines permitted puberty blockers at the onset of puberty, cross-sex hormones for those 16 or older, and sex-change surgery only for adults. Ibid. WPATH relaxed its recommendations in 2012, and began permitting cross-sex hormones for children under the age of 16. Ibid. WPATH further relaxed its recommendations when it published the eighth (and current) version of its standards of care in 2022. See E. Coleman et al., Standards of Care for the Health of Transgender and Gender Diverse People, Version 8, 23 Int'l J. Transgender Health (2022) (WPATH 2022 Guidelines or Guidelines). These Guidelines endorse using puberty blockers and cross-sex hormones at the onset of puberty and allowing children to receive many surgical treatments previously reserved for adults. See Id., at S64–S66. “On the whole, the standards of care for minors ‘have become less restrictive over the course of time.’” 83 F. 4th, at 468.

At the same time, the number of children identifying as transgender has surged, and medical professionals have increasingly expressed doubts over the quality of evidence supporting the use of puberty blockers, cross-sex hormones, and surgery to treat them. See ante, at 3. Over the past several years, public health authorities in different countries have concluded that these sex-transition treatments are experimental in practice, and that the evidence supporting their use is of “‘very low certainty,’” “‘insufficient,’” and “‘inconclusive.’” Ibid. “In countries like Sweden, Norway, France, the Netherlands and Britain—long considered exemplars of gender progress—medical professionals have recognized that early research on medical interventions for childhood gender dysphoria was either faulty or incomplete.” P. Paul, Gender Dysphoric Kids Deserve Better Care, N. Y. Times, Feb. 4, 2024, p. 9 (Paul 2024); accord, Tenn. Code Ann. §68–33–101(e) (“The legislature finds that health authorities in Sweden, Finland, and the United Kingdom… have found no evidence that the benefits of these procedures outweigh the risks”); 1 App. 332–342 (describing countries' skepticism over the use of puberty blockers and cross-sex hormones as treatments).

The Cass Review, published in April 2024, offers an influential example of the degree to which the debate over pediatric sex-transition treatments remains unsettled. See H. Cass, Independent Review of Gender Identity Services for Children and Young People: Final Report (Cass Review). After witnessing a 40-fold increase in the number of referrals to its centralized clinic for sex-transitioning services, the United Kingdom's National Health Service (NHS) commissioned this report to conduct a “thorough independent review of the use of puberty blockers and cross-sex hormones” to treat children with gender dysphoria. 1 App. 333–334. The report concludes that “we have no good evidence on the long-term outcomes of interventions to manage gender-related distress,” and highlights the lack of reliable evidence to support the use of puberty blockers and cross-sex hormones in treating transgender kids. Cass Review 13, 32–33 (observing “insufficient/inconsistent evidence about the effects of puberty suppression,” and “ ‘a lack of high-quality research assessing the outcomes of hormone interventions in adolescents with gender dysphoria/incongruence’”); see also ante, at 23. Among other things, the Cass Review determined that the “evidence [the researchers] found did not support th[e] conclusion” that “hormone treatment reduces the elevated risk of death by suicide” among children suffering from gender dysphoria. Cass Review 33; see also Id., at 187 (“[T]he evidence does not adequately support the claim that gender-affirming treatment reduces suicide risk”).

This shifting scientific landscape has forced governments to act quickly under conditions of uncertainty. In the months following the Cass Review's publication, for example, NHS imposed new restrictions on the use of puberty blockers and cross-sex hormones for sex-transition treatments. See ante, at 23. And, just a week after oral argument in this case, the United Kingdom indefinitely banned new prescriptions of puberty blockers to treat children with gender dysphoria, except in clinical trials.…

* * *

Recent revelations suggest that WPATH, long considered a standard bearer in treating pediatric gender dysphoria, see Brief for United States 3, bases its guidance on insufficient evidence and allows politics to influence its medical conclusions. Beyond the lack of consensus over the efficacy and ethics of pediatric sex-transition treatments, these developments provide States even stronger bases for treating supposed authorities in this area with skepticism.

WPATH itself recognizes that evidence supporting the efficacy of puberty blockers, cross-sex hormones, and surgical intervention for treating gender dysphoria in children is lacking. In its most recent Guidelines, for example, the group notes that “[a] key challenge in adolescent transgender care is the quality of evidence evaluating the effectiveness of medically necessary gender-affirming medical and surgical treatments…over time.” WPATH 2022 Guidelines S45–S46 (emphasis added). A contributor to the Guidelines underscored this challenge, explaining that, “‘[o]ur concerns, echoed by the social justice lawyers we spoke with, is that evidence-based review reveals little or no evidence and puts us in an untenable position in terms of affecting policy or winning lawsuits.’” Eknes-Tucker, 114 F. 4th, at 1261 (opinion of Lagoa, J.).

Nevertheless, WPATH publicly represents that “[g]ender-affirming interventions are based on decades of clinical experience and research,” and are “safe and effective” treatments. Guidelines S18. WPATH appears to rest this conclusion on self-referencing consensus rather than evidence-based research, which may help explain the group's confidence in the face of concededly inadequate evidence. See Cass Review 130. In its analysis of several “guidelines” for transgender medicine—including not only the WPATH 2022 Guidelines, but also those from groups like the Endocrine Society—the Cass Review notes that “most of the guidelines described insufficient evidence about the risks and benefits of medical treatment in adolescents,” but nevertheless “went on to cite this same evidence to recommend medical treatments,” or to base their recommendations on “other guidelines” prescribing the same course of action. Ibid. (emphasis added). This approach was particularly pronounced in the WPATH 2022 Guidelines, which “cited many of the other national and regional guidelines to support some of its recommendations, despite these guidelines having been considerably influenced by WPATH 7,” the prior version of WPATH's Standards of Care. Cass Review 130.

States would also have good reason to question whether WPATH has a basis for believing that children can provide informed consent to sex-transition treatments. “[I]n a leaked recording of a WPATH Panel,” for example, an endocrinologist acknowledged the difficulty of explaining cross-sex hormones and puberty blockers to children, noting that “ ‘the thing you have to remember about kids is that we're often explaining these sorts of things to people who haven't even had biology in high school yet.' ” Eknes-Tucker, 114 F. 4th, at 1268–1269 (opinion of Lagoa, J.). “‘[I]t's always a good theory that you talk about fertility preservation with a 14 year old,’” the endocrinologist continued, “‘but I know I'm talking to a blank wall.’” Id., at 1269. Analogizing a teenage patient's comprehension to that of a blank wall should raise serious concerns regarding the patient's ability to provide informed consent. Given WPATH's recognition that “[c]onsent requires the cognitive capacity to understand the risks and benefits of a treatment,” Guidelines S38, States thus might reasonably question whether WPATH could be “genuine in its claim that these treatments are safe, effective, and well understood, particularly for minors,” Eknes-Tucker, 114 F. 4th, at 1268 (opinion of Lagoa, J.).

Other “recent revelations” might reinforce the conclusion that “WPATH's lodestar is ideology, not science.” Id., at 1261. For example, newly released documents suggest that WPATH tailored its Standards of Care in part to achieve legal and political objectives. In one instance, the chair of WPATH's guidelines committee testified that it was “ethically justifiable” for the authors of the WPATH 2022 Guidelines to “advocate for language changes [in these Guidelines] to strengthen [their] position in court.” Boe, ECF Doc. 700–3, p. 42. One of the Guidelines' contributors was more direct: “My hope with these [Guidelines] is that they land in such a way as to have serious effect in…law and policy settings.” ECF Doc. 700–13, p. 25; see also Brief for State of Alabama as Amicus Curiae 11–15 (Alabama Brief ) (describing similar statements from other WPATH contributors).

Worse, recent reporting has exposed that WPATH changed its medical guidance to accommodate external po- litical pressure. See Brief for Respondents 9–11; Alabama Brief 15–23. Unsealed documents reveal that a senior official in the Biden administration “pressed [WPATH] to remove age limits for adolescent surgeries from guidelines for care of transgender minors” on the theory that “ ‘specific listings of ages, under 18, will result in devastating legislation for trans care.” A. Ghorayshi, Biden Officials Pushed To Remove Age Limits for Trans Surgery, N. Y. Times, June 27, 2024, p. A17. Despite some internal disagreement, WPATH acceded and “removed the age minimums in its eighth edition of the standards of care.” Ibid.; see Alabama Brief 17–20.

Over a decade ago, one of WPATH's contributors explained that “‘WPATH aspires to be both a scientific organization and an advocacy group for the transgendered,’” and admitted that WPATH's Standards of Care “‘is not a politically neutral document.’” Kosilek v. Spencer, 774 F. 3d 63, 78 (CA1 2014). WPATH's apparent willingness to let political interests influence its medical conclusions highlights this reality. States are never required to substitute expert opinion for their legislative judgment, and, when the experts appear to have compromised their credibility, it makes good sense to chart a different course.9

* * *

This case carries a simple lesson: In politically contentious debates over matters shrouded in scientific uncertainty, courts should not assume that self-described experts are correct.

Deference to legislatures, not experts, is particularly critical here. Many prominent medical professionals have declared a consensus around the efficacy of treating children's gender dysphoria with puberty blockers, cross-sex hormones, and surgical interventions, despite mounting evidence to the contrary. They have dismissed grave problems undercutting the assumption that young children can consent to irreversible treatments that may deprive them of their ability to eventually produce children of their own. They have built their medical determinations on concededly weak evidence. And, they have surreptitiously compromised their medical recommendations to achieve political ends.

The Court today reserves “to the people, their elected representatives, and the democratic process” the power to decide how best to address an area of medical uncertainty and extraordinary importance. Ante, at 24. That sovereign prerogative does not bow to “major medical organizations.” Post, at 5, n. 5 (opinion of SOTOMAYOR, J.). “[E]xperts and elites have been wrong before—and they may prove to be wrong again.” Students for Fair Admissions, Inc., 600 U. S., at 268 (THOMAS, J., concurring).

It makes me sad to see that a “Committee on the rights of the child” pays attention to Sexual assault, and fails to understand that that castration or mutilation of a child or even a young adult by a doctor is violence of an even greater nature, leave alone the irony that the negation of ones sexual identity might have been triggered by the assault experienced as a youth.

It would be comical, were it not so tragic, that the Committee on Young Israelis speaks of the impact of “the climate crisis” on future generations when sterilization of confused individuals by doctors insures that certain people won't beget future generations.

The ideology that gives us trans-genderism is a mind virus that no Member of Knesset should abide, I don't care what committee you belong to.

Please be in touch that we can sort this out.

Sincerely
David R. Herz

End the Butchery Now

Ruth's (and my) call:
Stand for the truth. Save a generation.

In the Spirit of Shavuot and the Heroic Call of Jewish Values

Esteemed Members of the Knesset and Medical Policymakers,

As we gather to celebrate Shavuot, commemorating the giving of the Torah at Mount Sinai, we are summoned to embody the heroic Jewish values that define the State of Israel: the sanctity of life, the pursuit of truth, and the courage to defend the divine dignity of every soul. Like Ruth, whose grit and loyalty we honor in the Shavuot megillah, you stand at a pivotal moment to be heroes in a critical battle — one against the advocates of so-called “gender-affirming” care and sexual trait reassignment surgeries. We implore you to seize this opportunity, aligning Israel's medical policies with the Torah's wisdom and our nation's sacred foundation.

The Torah declares that every human is created b‘tzelem Elokim – in G-d's image (Genesis 1:27) — a truth that demands we protect the body and soul as divine masterpieces. The command to “guard your souls diligently” (Deuteronomy 4:15) is a clarion call to shield our people, especially our youth, from harm. Yet, advocates of “gender-affirming” surgeries push irreversible procedures despite mounting evidence of their risks: chronic pain, loss of function, and profound regret, particularly among minors and young adults. Studies from Europe and beyond show no consistent mental health benefits, challenging the narrative of these interventions as compassionate. This is a battle for the well-being of our children, and you have the power to lead with the principle of pikuach nefesh – the preservation of life – as your sword.

Ruth's story, read on Shavuot, is one of fearless commitment to truth and divine purpose, defying societal pressures to forge a path of righteousness. Today, you face a similar challenge: to stand firm against vocal advocates who prioritize ideology over evidence, risking the futures of vulnerable souls. Be the heroes who champion chesed (loving-kindness) by redirecting resources to holistic mental health care — support that affirms the inherent worth of every individual without altering their G-d-given form. Your courage can turn the tide, protecting our youth from the irreversible consequences of experimental medical trends.

As leaders of a nation rooted in Jewish ideals, you are called to emulate King David, whose legacy we celebrate on Shavuot, wielding mishpat (justice) and tzedeq (righteousness) to build a legacy of moral clarity. By halting these surgeries and enacting policies grounded in science and Torah, you can inspire a generation, proving that Israel upholds the sanctity of life against all odds. This is your moment to rise as heroes, not only in the eyes of your constituents but in the annals of our people's history.

This Shavuot, as we renew our covenant with the Torah, we call on you to renew Israel's commitment to its Jewish foundation. Be the champions who safeguard our future, wielding the grit of Ruth to defeat the misguided push for “gender-affirming” care. Act boldly to end these surgeries, and let Israel shine as a beacon of truth, compassion, and divine purpose.

With unwavering respect and hope for your heroic leadership, I wish you a

Chag Shavuot Sameach
David R. Herz

End the Butchery Now