Gender medicine after Skrmetti: A call for accountability at Northwestern

The Hill

09-07-2025

Earlier this month, the Supreme Court upheld Tennessee's ban on pediatric gender medicine, setting a precedent for similar laws nationwide. At universities like ours, U.S. v. Skrmetti was framed as a triumph of far-right extremism at the expense of vulnerable transgender youth. But some of us at Northwestern welcomed the decision — not as anti-trans activists, but as psychology researchers alarmed by the extent to which ideology has overtaken evidence in mental health care.
To us, the verdict presents an opportunity to reexamine a clinical dogma that has captured our field. Seizing this moment, however, will require academia to confront its own entrenched orthodoxies—something Northwestern has shown little interest in doing.
Over the past decade, gender dysphoria has surged among adolescent girls, coinciding with a shift in the therapist's role. Clinicians are now expected to affirm clients' gender identities rather than explore the underlying issues. In the rush to validate, practitioners often overlook alternative explanations for gender-related distress.
Sexual trauma, for instance, can produce bodily alienation, numbness, and disgust — symptoms easily mistaken for dysphoria. Labeling caution as 'transphobia' diverts traumatized girls away from appropriate care and toward the very sort of irreversible interventions the Supreme Court ruled on in Skrmetti.
There are clear reasons young women may reject their bodies that have nothing to do with 'gender identity' as defined by activists. Adolescent girls today navigate a pornified culture that commodifies their sexuality and undermines self-worth. In coursework at Northwestern, we were shown a video series defining 'trans' as anyone who deviates from gender expectations for their 'sex assigned at birth.' But when those expectations are shaped by a misogynistic ethos that eroticizes female pain, it's no surprise some girls try to escape womanhood by suppressing puberty or undergoing double mastectomies.
The field of mental health has long misread female trauma. Borderline personality disorder, for instance, is disproportionately assigned to women — especially survivors of sexual abuse. Many detransitioners describe a similar pattern. Young women like Prisha Mosley, Chloe Cole, Luka Hein, and Isabelle Ayala have publicly linked their dysphoria to trauma. Simon Amaya Price, a fellow at Do No Harm, told us he hasn't encountered a single detransitioner whose gender distress had not been trauma-related. While anecdotal, his observation reflects a growing number of cases in which clinicians simply bypass trauma treatment and refer patients directly for life-altering gender procedures.
These concerns are being taken seriously in other countries. Long before Skrmetti, several European countries had restricted pediatric gender medicine to clinical trials due to poor evidence and high risk. This shift was driven in part by the Cass Review, a sweeping independent investigation that found major flaws in the research base and recommended psychotherapy — not hormones or surgery — as the first-line treatment.
The Cass Review poses a serious challenge to U.S. institutions that still champion the gender-affirming model. Many have dismissed the report, but some of the loudest defenders — such as the American Academy of Pediatrics — now face lawsuits from detransitioners. They are therefore conflicted, as acknowledging the Cass Review's findings could expose them to liability.
Even the World Professional Association for Transgender Health, whose Standards of Care shape global policy, is now under fire. Whistleblowers and court filings reveal that the organization suppressed unfavorable data, dropped age minimums for gender-related surgeries under political pressure, and endorsed treatments its own members concede are inadequately studied and potentially harmful.
Unfortunately, Northwestern continues to uphold the credibility of such compromised stakeholders, presenting the gender-affirming model as settled science. The university constructs an illusion of expert consensus while promoting experimental practices — and its affiliated hospital profits from gender procedures through the Gender Pathways program, raising questions about conflict of interest.
If patient safety isn't enough to prompt reflection, Northwestern's responsibilities as a research university should be. Yet in our experience, critical inquiry is actively discouraged. Students have even been barred from citing the Cass Review, which is dismissed by some faculty as 'debunked,' despite its central role in a Supreme Court decision.
As scrutiny grows, so does censorship. When we submitted an op-ed to The Daily Northwestern expressing these concerns, it was rejected without explanation. Days later, the paper revised its policy: All submissions would be reviewed using the Trans Journalists Association Style Guide — a document that prohibits terms like 'biological sex,' 'detransitioner,' 'trans-identified,' and 'gender ideology.'
These are not fringe terms. They appear in academic journals, medical literature, and public policy. Their ban in student journalism signals the rise of a gender-newspeak that punishes dissent by attempting to render it unspeakable. This betrays the academic integrity Northwestern claims to uphold — a moral hypocrisy akin to reciting a land acknowledgment while counting cards at a tribal casino.
Given its institutional investment in gender-affirming care models, it is unlikely the university will self-correct. But the Skrmetti decision changes the landscape.
The ruling legitimizes the voices of clinicians, researchers and detransitioners long silenced by intimidation. It may finally embolden others to speak out — to protect young people and to restore intellectual honesty to institutions lost in the fog of our culture wars.
Forest Romm and Kevin Waldman are clinical psychology researchers at Northwestern University.