Earlier this month, the Supreme Court upheld Tennessee’s ban on pediatric gender treatments, establishing a framework that could affect similar laws nationwide. At places like Northwestern, the case of US vs. Skrmetti has been viewed largely as a setback for vulnerable transgender youth, aligning with far-right agendas. Yet, some of us here see it differently—not as opponents of transgender rights, but as researchers concerned that ideology has overtaken evidence in mental health care.
This ruling gives us a chance to reevaluate some of the widely accepted approaches in our field. To truly capitalize on this moment, academia needs to confront its own deeply rooted biases.
In recent years, incidents of gender discomfort have surged among adolescent girls, reflecting shifts in the roles therapists play. Clinicians are increasingly expected to affirm their clients’ gender identities right away, rather than digging into possible underlying issues. In their eagerness to validate, practitioners sometimes miss alternative reasons for gender-related distress.
Take sexual trauma, for instance. It can lead to feelings of alienation, numbness, or disgust—symptoms that can easily be misinterpreted as transphobia. Emphasizing this as a response may misdirect traumatized girls away from the proper care they need, pushing them instead toward irreversible interventions sanctioned by the Supreme Court in Skrmetti.
It’s clear why some young women might distance themselves from their bodies in ways that don’t align with the activist definition of “gender identity.” Today’s adolescent girls are navigating a culture that often pressures them around sexual norms and can severely impact their self-esteem. In classes at Northwestern, we viewed a video series defining “trans” as someone whose identity conflicts with their sex assigned at birth. But when those definitions are influenced by misogyny that diminishes women’s lived experiences, it’s no wonder some girls seek drastic measures, like double mastectomies, to escape societal expectations.
The mental health field has historically misrepresented women’s trauma. For example, borderline personality disorder is often assigned disproportionately to women who are survivors of sexual abuse. Many of those who transition back report similar experiences. Young women like Prisha Mosley, Chloe Cole, Luka Hein, and Isabelle Ayala articulate their discomfort as stemming from trauma. Simon Amaya Price, a fellow at Do No Harm, noted he hadn’t seen a single individual regret their transition that wasn’t linked to some form of trauma. His observations underline a troubling trend where clinicians skip past trauma treatment and jump right to life-altering gender procedures.
In contrast, other countries are taking these concerns seriously. Long before Skrmetti, some European nations limited pediatric gender medicine to clinical trials due to a lack of supporting evidence and potential risks. This shift was partially fueled by the CASS review, which identified significant flaws in the existing research and recommended psychotherapy as a first-line treatment over hormones or surgery.
The CASS review represents a real challenge for US institutions that maintain a gender-affirming model. Although some have dismissed its findings, notable organizations like the American Academy of Pediatrics are now facing lawsuits—a situation that reveals a divide as they confront the implications of the CASS review.
Even the World Professionals Association for Transgender Health, a body that sets global standards for care, is now under scrutiny. Whistleblower accounts and legal challenges suggest that some organizations have stifled unfavorable data, shortened age limitations for gender surgeries under political pressure, and accepted inadequately studied treatments that could be harmful.
Unfortunately, Northwestern still endorses the legitimacy of these compromised entities, framing a gender-affirming model as a settled issue in science. The university seems more focused on crafting a narrative of expert agreement while promoting experimental practices that serve its hospitals’ interests through gender pathways, raising questions about potential conflicts of interest.
If patient safety isn’t enough to provoke a reassessment, then it’s up to Northwestern as a research institution to do so. However, I’ve seen firsthand how critical research sometimes faces significant pushback. In fact, even though it played a crucial role in the Supreme Court ruling, students are discouraged from citing the CASS review, which some faculty members dismiss as controversial.
Amid increasing scrutiny, censorship is also ramping up. When I submitted an op-ed expressing these views to the daily Northwestern, it was rejected without explanation. Shortly after, the paper updated its submission policy to require adherence to the guidelines set by the Transjournalist Association Style Guide—a document that forbids terms like “biological gender,” “detransitioner,” “trans-identity,” and “gender ideology.”
These aren’t fringe phrases; they appear in academic literature and public policy. Banning them from student journalism feels like an attempt to make certain issues unspeakable, which undermines the academic rigor that Northwestern claims to uphold. It feels like a moral contradiction akin to acknowledging land issues while engaging in exploitative practices.
Given the significant investment in gender-maintaining care models, it’s doubtful that universities will correct course on their own. Nevertheless, Skrmetti’s ruling does shift the landscape.
This decision supports previously silenced voices—clinicians, researchers, and others who have felt threatened—and may finally embolden us to speak out, protecting young individuals and restoring a sense of intellectual integrity to institutions lost in the chaos of cultural debates.
