The Society for Evidence Based Gender Medicine (SEGM) are an anti-trans psychiatric and sociological think tank. Their members are frequently quoted in the British press without any indication that they are anything other than expert commentators. This has continued to be the case despite the fact that their participation in the field of transgender related medicine is so contentious that in early August they were denied a spot at the annual conference for the American Academy of Pediatrics. SEGM's public members include key figures in the Bell v Tavistock case, and outspoken critics of regulation against conversion therapy on trans people.
Although SEGM state their objectives on their website among other things as "evaluating current interventions for gender dysphoria, [and] providing balanced evidence summaries," when we look at their membership, their promotion of materials from and collaboration with anti-LGBT religious conservatives and their misrepresentation of the mainstream consensus on gender medicine and conversion therapy, this balance and evidence based focus evaporates.
In this article we raise a wide range of our concerns about this organisation, and for anyone relying on them as a source regarding unbiased, scientific medical advice.
Surprising large donations
Trans Safety Network has recently discovered a crowdfund for SEGM run by company secretary William Malone where donations in the tens of thousands of dollars account for the vast majority of their funding. The table below lists the times and amounts for the top 3 donations - these account for $58,500 of the $78,981 currently raised via GoFundMe. This is extremely unusual for a crowd-fund where typically donations are made by individuals. This raises questions about which organisation or organisations are primarily funding SEGM, and what sorts of potential conflict of interest are being hidden by this opaque funding process.
Sadly we were unable to find either a short version form 990-N as is required to be filed for the tax-exempt non-profits like SEGM via the IRS, nor any other accounts filing for last year, even though these 3 donations between them already amount to over the $50,000 threshold, which they clearly passed last year. For diligence we searched both the IRS database under their tax identification number 84-4520593, and the Idaho Secretary of State Business Search.
The only recent document filed publicly is an annual report indicating a change of directors for 2021 with no financial or accounting data.
Campaigning against trans health funding
A ongoing tactic among evangelical and conservative groups in the United States is to build up stables of anti-LGBT expert witnesses, to provide biased evidence to court cases which are not well suited to establishing a clear picture of scientific consensus (absent major professional bodies intervening) and comparing competing scientific evidence from each other. The experts used have valid medical and academic qualifications, but are often operating outside of their primary speciality, and giving evidence out of step with wider scientific consensus.
We have written how this tactic may have been imported to the UK for the original Bell v Tavistock case, and was originally brought by SEGM member Marcus Evans' wife, Susan Evans. The oddities in the use of expert witness have been raised on appeal against the ruling, which is currently pending judgement.
Following on in a potentially similar pattern, SEGM have now made a submission to the court in defence of Arizona's state ban on medicaid for transgender healthcare. In this document they appear to present themselves as unbiased experts on trans health issues, while presenting a startlingly one-sided view of the current evidence on trans healthcare.
For example, on page 9 SEGM advance Lisa Littman's controversial Rapid Onset Gender Dysphoria (ROGD) hypothesis which suggests that gender dysphoria is transmitted through children as a social contagion resulting from social media use.
ROGD has recently been strongly condemned as a non-scientific concept by a broad coalition of major psychological bodies including the American Psychological Association and the World Professional Association for Transgender Health. This broad consensus of bodies
supports eliminating the use of Rapid-Onset Gender Dysphoria (ROGD) and similar concepts for clinical and diagnostic application given the lack of rigorous empirical support for its existence.
They further add:
There are no sound empirical studies of ROGD and it has not been subjected to rigorous peer-review processes that are standard for clinical science. Further, there is no evidence that ROGD aligns with the lived experiences of transgender children and adolescents.
SEGM's use of "vigorous scientific debate" in this passage to describe the context of the Littman study therefore looks like a euphemistic acknowledgement that they are operating far outside of the mainstream consensus on this topic.
The Littman study was originally published as evidence of a purported emerging phenomenon (original paper here) before PLOS One, the journal which published it, radically revised the conclusion and withdrew the suggestion that it provided evidence of any such phenomenon.
Later on page 19 SEGM use a correction against a study which had previously been published with an overly strong conclusion about the evidence in favour of transition surgery, describing complaints about it from "over a dozen scientists", and describing the findings as "invalidated".
In this correction, the authors of this study respond to letters of complaint from members of SEGM (at least two of these signed by SEGM's William Malone), alongside members of anti-LGBT think tank ACPeds, writing to protest the findings.
However unlike Littman's study, where the the correction wiped out the idea that the paper had generated evidence on trans children altogether, this correction merely reduced the strength of the original claims, saying that the study "lends support for expecting a reduction in mental health treatment as a function of time since completing [gender affirming surgery], at least among those who are still living in Sweden."
SEGM's standards for what constitutes a legitimate evidence base, versus what constitutes invalidation of research findings depend on whether the evidence supports banning transition healthcare. On the one hand, Lisa Littman's widely discredited research is advanced as proof of a phenomenon happening (against the revised conclusions) whereas on the other hand, a single downgraded study elsewhere is used to make sweeping and generalised attacks discrediting trans surgical interventions as a whole. This is not an evidence based approach, but an ideological approach.
Ties to evangelical activists
As recently as April 2021, NHS paediatrician Julie Maxwell was one of their "Clinical and Academic Advisors". She was1, and is very open about working for Christian anti-LGBT and anti-abortion sex education charity LoveWise UK. Recordings of her training seminars for LoveWise are available publicly, where she offers to help push abstinence based and anti-LGBT sex education resources into secular schools.
Maxwell was also involved with a DVD campaign run by Creationist science think tank Truth In Science sent last year to every sitting MP and school on the so-called "Transgender Agenda". We covered this last year when we heard about it originally. Creationism is the anti-scientific belief that humans were intelligently designed, and did not evolve as part of biological evolution.
Since 2012, Maxwell has also been, a director for the Family Education Trust, a religiously "family values" campaigning charity who promote anti-LGBT views and smacking children contrary to a growing body of evidence that children are harmed by the use of physical assault as a form of discipline. SEGM launched publicly in early 2020, and so far as we can tell Maxwell was part of their organisation from their inception.
It's alarming that an NHS paediatrician can so openly be associated with such negative campaigning on issues affecting trans children.
Academic conversion therapy advocacy links
This bias against trans affirming healthcare extends also to more immediate connections to conversion therapy advocacy. In 2019, SEGM Secretary William Malone co-authored a letter with Michael K Laidlaw, Quentin Van Meter, Paul W Hruz, and Andre Van Mol to the Journal of Endocrinology and Metabolism challenging the Endocrine Society's clinical practice guidelines on trans healthcare. Other than Malone, the other coauthors of this document have a track record for religiously motivated anti-LGBT campaigns.
- Paul Hruz is named by the SPLC as part of the bulletin warning about dodgy medical expert witnesses intervening on LGBT cases, but managed to be accepted for the first round of Bell v Tavistock, becoming a key expert witness.
- Andre van Mol, Quentin van Meter, Michael K Laidlaw and Paul Hruz are all members of the anti-lgbt hate group ACPeds (with van Meter being its president).
- Quentin Van Meter is also a general board member for the IFTCC, an organisation who very openly promote conversion therapy for lesbian, gay, bisexual and transgender people (who they refer to variously as "suffering from same sex attraction or gender confusion"). Van Mol and Laidlaw have also presented talks at last year's IFTCC conference.
SEGM also frequently collaborate with and promote the work of people with IFTCC and ACPeds links:
- SEGM's William Malone promoting Michael Laidlaw's work.
- SEGM’s Marcus Evans and Richard Byng contributing to a 2019 pamphlet with Michael Laidlaw and assorted other anti-trans activists entitled “First Do No Harm”, with Byng calling for an end to all medical transition support before the age of 25. Also contributing to the pamphlet was Stephanie Davies-Arai, founder of Transgender Trend, a hate group who produce slick schools education materials advocating against trans equality act rights and sex education.
- SEGM's Michael Biggs citing Laidlaw's claims about the dangers of trans healthcare for a blog post at anti-trans hate group Transgender Trend.
- Malone, Mason and Beck (of SEGM) co-authoring another letter with Paul Hruz (of the anti-LGBT hate group ACPeds) against an Endocrine Society policy statement upholding the consensus in favour of trans healthcare.
Non-academic conversion therapy campaigning
Away from academic research and expert witness involvement, SEGM member Stella O'Malley is one of the founder members of Thoughtful Therapists, an organisation which is campaigning against the Memorandum of Understanding on Conversion Therapy in the UK (often known as the MOU2). The MOU2 is a joint policy commitment by British psych professional organisations making a commitment against permitting conversion therapy within the profession. So far the only other public members of Thoughtful Therapists include:
- James Esses, an unqualified student therapist who was in May kicked off of his university course studying psychotherapy for his anti-trans views, and who appears to have been using his position as a childline volunteer to challenge young trans people's gender identities through his own experimental "exploratory" approach without ethical approval or oversight.
- James Caspian, who this year lost a court case supported by the (anti-LGBT) Christian Legal Centre trying to defend his research into detransition which had failed ethics review.
O'Malley recently co-authored an article in the Irish Times with fellow psychotherapist Jackie Grainger where she argued that conversion therapy only describes violent aversion therapies of times gone by. This is counter to evidence in modern research covering many countries that indicate that although violence including corrective rape may be used as forms of conversion therapy, conversion therapy can often take other forms such as prayer, "pastoral support" directed at encouraging a change of sexuality or gender identity or talking therapies, often described as "reparative therapy".
Materials promoting these approaches have in recent years been revealed to be being used in schools in Northern Ireland leading to them being condemned by the Irish Association of Counsellors and Psychotherapists. O'Malley's accrediting body, the Irish Association of Professional Counsellors and Psychotherapists (APCP) has yet to make any public commitments to regulating against conversion therapy.
As Trans Safety Network has covered in the past, international experts have attested to the fact that "All forms of conversion therapy, including talk or psychotherapy, can cause intense psychological pain and suffering."
The supposed gentleness of "reparative therapy" is a core part of the argument now advocated for and defended by open conversion therapy advocacy groups like IFTCC.
O'Malley and her coauthors in the Irish Times article say they "believe the inclusion “suppression of gender identity” in the Bill’s definition risks throwing the baby out with the bathwater. This approach to defining conversion therapy is in danger of unnecessarily restricting the openness, efficacy and ethics of therapy in areas such as gender identity."
Suffice to say, conversion therapy for all LGBT people is internationally discredited, and work is underway to conduct a systematic review to put an end to the idea that there is a legitimate fringe exception to this. Why is an "evidence based medicine" think tank promoting evidence from and collaborating with people associated with promoting or legitimising conversion therapy?
O'Malley is also the founder of an organisation called Genspect, who featured other SEGM members Lisa Marchiano, Sasha Ayad and Roberto D'Angelo during their launch events timed for different time zones. During the North American launch interview with Ayad, she promoted the film "Trans Mission".
The only medical experts interviewed in this film are Paul Hruz, Andre van Mol and Quentin van Meter (of the conversion therapy and anti-LGBT advocacy connections we discussed above). The film's producer Jennifer Lahl is otherwise known for her work running the evangelical linked anti-surrogacy organisation Center for Bioethics and Culture. Lahl elsewhere contributed a chapter to a Christian book against gay parenting. Also featured in Trans Mission is SEGM member and evolutionary biologist Colin Wright.
The crossover in membership between SEGM and Genspect is remarkable. At the time of writing, 7 of SEGM's 11 publicly listed "clinical advisors" are also listed as members of the Genspect "team":
- Stella O'Malley
- Julia Mason
- Avi Ring
- Sasha Ayad
- Roberto D'Angelo
- Marcus Evans
- Lisa Marchiano
Freudian and Jungian pseudoscience
It has to be said that for a group concerned with evidence, key members are not well suited to the scientific method. Marcus Evans is well known for his connections to the Bell v Tavistock case, and describes trans advocacy as a political threat to his exploration as a psychoanalyst, a field of theory based on Freud's theories about the id and the ego and psychosexual developmental complexes which has been notorious for its inability to produce testable hypotheses and challenged as a pseudoscience since the 1960s.
SEGM member Lisa Marchiano is a Jungian analyst, a branch of psychoanalytic theory based largely in the study of mythology for supposed truths about the human mind which is widely described as a pseudoscientific. She came to prominence in the gender debate with an outstandingly popular paper describing the growth in trans children during a period when there was an increase in resources and education about the existence of trans people as a "psychic epidemic", and plumbing the depths of the folk tale of the Pied Piper of Hamelin for evidence in the process, without really contributing anything in the form of testable theories on the topic.
As others have noted, SEGM appear to be among a growing bubble of fringe groups exploiting widespread ignorance about mainstream scientific consensus on gender medicine to push an agenda driven approach to understanding scientific evidence.
While much of this information will be of no surprise at all either to researchers studying organised attacks on trans health and civil rights or to practitioners in the field of gender medicine we hope that by gathering this information together in one place, people outside of these fields such as journalists, editors and parents will be able to see that SEGM and their members are part of a network of agenda driven organisations with a strong bias against conventional trans medical expertise, as well as collaborative ties to members of anti-LGBT hate groups, and connections to conversion therapy advocacy.
It is important that open, serious scientific investigation defeats transphobic scholarship based on solid evidence in academia, but it is equally important that others outside of the sphere of scientific research aren't misled about the nature of these organisations.