The Professional Association for Transgender Health South Africa (PATHSA) has published an important response to discriminatory and harmful arguments that question the legitimacy of gender-affirming care for transgender and non-binary youth.
In 2024, the South African Society of Psychiatrists (SASOP) published a position paper on psychiatric care for transgender and non-binary youth. The document endorsed internationally recognised standards of care and called for non-discriminatory, evidence-based treatment in a rapidly evolving field of medicine.
The paper was welcomed by many healthcare professionals and advocacy groups for affirming a holistic, patient-centred approach. It recognised that transgender youth may experience elevated rates of depression, anxiety, self-harm and suicidality, particularly where family rejection, social stress or co-occurring mental health conditions are present. SASOP emphasised that guidelines must remain responsive to emerging scientific evidence.
However, the position paper also sparked opposition. First Do No Harm South Africa (FDNHSA), a group describing itself as committed to evidence-based medical practice, published a letter urging SASOP to reconsider its position.
The letter questioned definitions, challenged treatment approaches such as puberty blockers and hormone therapy, and referenced international debates surrounding gender-affirming healthcare.
Professional Association for Transgender Health South Africa’s Response
In a new article published in the South African Journal of Psychiatry, the Professional Association for Transgender Health South Africa (PATHSA) responded to FDNHSA’s letter, criticising the sources the letter cited, as well as endorsing SASOP’s stance.
It systematically challenges the credibility of the arguments raised by FDNHSA and reaffirms the medical and constitutional foundations underpinning gender-affirming care for young people.
Challenging the Use of the Cass Review
In the article, PATHSA criticises FDNHSA for citing The Cass Review — a controversial review of gender-affirming healthcare services in England, which was used to justify restricting young people’s access to puberty blockers in the UK. (It’s worth noting that new data has shown a spike in deaths by suicide of trans young people under 18 following the puberty blocker ban.)
PATHSA notes the Cass Review has been widely criticised – including by the British Medical Association – for its lead author’s lack of expertise in transgender healthcare, a lack of stakeholder accountability, and a lack of input from transgender individuals in the creation of the report.
By raising these issues, PATHSA positions the debate within a broader global context, while also suggesting that imported controversies should not automatically dictate South African clinical practice, especially where local constitutional protections and healthcare realities differ.
Questioning the Credibility of Cited Organisations
They also point out that FDNHSA cites the Society for Evidence-Based Gender Medicine and Genspect, organisations that have been described by the Southern Poverty Law Center as part of an “anti-LGBTQ+ pseudoscience network.”
By drawing attention to these affiliations, PATHSA frames the dispute not merely as a scientific disagreement but as a question of whether advocacy groups with ideological commitments are being presented as neutral scientific authorities.
This distinction is central to PATHSA’s argument that medical policy must be guided by rigorous peer-reviewed evidence rather than politically motivated narratives.
Addressing Misconceptions About Diagnosis and Care
PATHSA reiterates that being transgender is not a disorder and does not require diagnostic criteria. Gender dysphoria, however, is a recognised clinical condition involving significant distress related to gender incongruence.
The organisation affirms that SASOP’s paper aligns with standards developed by the World Professional Association for Transgender Health, which recommend comprehensive assessment and, where appropriate, access to puberty blockers or hormone therapy.
PATHSA maintains that these interventions are evidence-informed and form part of established international practice.
A Constitutional Argument
Beyond clinical guidance, PATHSA anchors its defence in South Africa’s constitutional protections. It argues that access to gender-affirming healthcare is tied to rights to dignity, bodily autonomy and freedom from discrimination.
The association concludes that while research in transgender healthcare continues to evolve, restricting access based on contested or selectively interpreted evidence risks harm.
In backing SASOP, PATHSA positions itself as defending both medical standards and the constitutional rights of transgender and non-binary youth to affirming and dignified healthcare.
