Raymond Alderfer

As a licensed physician with extensive education, training, and work experience in medicine, epidemiology, and psychiatry, I have extensively studied pediatric medical transition and I agree with the positions of the British health service set fourth in the Cass review published in 2024 and the US Department of health and human services which on May 1, 2025, published a report on the treatment of pediatric gender dysphoria. There is no credible evidence that pediatric medical transition, including cross, sex hormones, puberty, blockers and surgeries are beneficial for children with gender dysphoria. Meanwhile, there is substantial evidence of harm including infertility, loss of sexual function, cognitive impairment, increased risk of cancers, cardiovascular disease, hepatic disease, endocrine disruption among other adverse health effects. Many of these harms will not be evident in the first two years following treatments for pediatric medical transitions. Practitioners of pediatric medical transition treat children recklessly without regard to their duty to do no harm. They disregard the principles of evidence based medicine to pursue their political agenda of affirming gender identity. Gender identity is a fiction without any basis in biological reality. Many of these children was gender dysphoria who claim to have a gender identity at variance with their biologic sex have underlying psychiatric problems. I agree with position of the US health and human services and the Cass review by the British health service. These children have a psychological problem which should be treated with psychotherapy, not medicalization of their gender dysphoria. Health professionals who practice pediatric medical transition should not be shielded from liability by a two year limit of liability. Raymond J. Alderfer, M. D., M.P.H. Richmond, VA