A recently published review paper warning of “emerging safety signals” associated with estrogen use among transgender women is drawing sharp criticism from the LGBTQ+ medical community. While the study presents itself as a neutral medical review, a closer look reveals that several of its authors are affiliated with advocacy groups known for opposing transgender healthcare, particularly for youth.
Published in Discover Mental Health in May 2025, the paper compiles dozens of studies, ranging from large observational cohorts to individual case reports, claiming to show elevated health risks for transgender women on hormone replacement therapy (HRT). These include cardiovascular risks, cognitive changes, increased mortality, and rare cancers.
However, the paper’s findings are not novel, and the review’s methodology has raised significant concerns among both medical professionals and LGBTQ+ advocates.
Genspect Connections Raise Questions About Bias
Among the authors are figures with known affiliations to Genspect, a self-described “gender critical” organization that has publicly opposed gender-affirming medical care. Co-author M. Lal is listed with the Killarney Group in Ireland, which is a known subdivision of Genspect. Another co-author, J. Cohn, is a representative of the Society for Evidence-Based Gender Medicine (SEGM), an organization that promotes many of the same views and has been flagged by the Southern Poverty Law Center as part of an anti-LGBTQ disinformation network.
These groups routinely promote “exploratory therapy” over medical transition and have advocated for policies that restrict access to gender-affirming care. Genspect and SEGM have both testified in legal efforts to ban or roll back care for transgender minors and frequently publish materials questioning the legitimacy of transgender identities and medical needs.
Their involvement casts serious doubt on the objectivity of the paper, which many now view as an ideologically driven attempt to undermine gender-affirming healthcare under the veneer of scientific concern.
What the Paper Claims And Why It’s Misleading
The article compiles research suggesting a range of physiological and neurological concerns associated with estrogen therapy, including:
- Blood clots (venous thromboembolism)
- Stroke risk
- Brain volume changes and cognitive decline
- Autoimmune disorders
- Metabolic changes (including insulin resistance)
- Various cancers (testicular, breast, thyroid)
While these concerns sound alarming, the medical community points out several critical limitations:
- No new data is presented: this is a literature review, not a clinical trial or original research paper.
- Risk comparisons are misleading: the paper frequently fails to contextualize outcomes with known baselines for cisgender populations or for trans women not on HRT.
- Mental health benefits are ignored: despite overwhelming evidence that HRT significantly reduces depression, anxiety, and suicidality among transgender people.
- Many studies cited involve small sample sizes, anecdotal evidence, or case reports: which are useful for generating hypotheses but not for establishing broad conclusions.
What’s more, the authors do not disclose their affiliations with Genspect or SEGM in the manuscript, raising transparency concerns about undeclared conflicts of interest.
What the Broader Medical Community Says
Gender-affirming hormone therapy has been widely endorsed by every major medical body, including:
- The Endocrine Society
- The American Medical Association (AMA)
- The American Psychiatric Association (APA)
- The American Academy of Pediatrics (AAP)
- The World Professional Association for Transgender Health (WPATH)
These organizations agree: when prescribed under clinical supervision, HRT is safe, effective, and life-saving for transgender people. The risks, such as blood clotting or changes in lipid profiles, are well-known and actively monitored as part of standard care.
Furthermore, multiple peer-reviewed studies have shown that HRT is associated with dramatic improvements in mental health, including reduced rates of depression, anxiety, and suicidal ideation.
For Trans Women and Allies: What You Should Know
If you’re a transgender woman currently on HRT, or considering starting, here are the key takeaways:
- The risks discussed in the study are not new. Your doctor is likely already monitoring these markers as part of your ongoing care.
- The study is not a clinical trial or original research. It compiles existing literature but lacks balanced context and omits critical benefits.
- The authors are not neutral experts. They are aligned with organizations that have long worked to restrict trans healthcare access.
- You are not unsafe for being on hormones. With proper medical oversight, feminizing HRT remains one of the most effective tools for improving trans women’s quality of life and mental health.
If you have concerns, talk to your healthcare provider, not a politicized article.
The Bottom Line
This study is part of a growing trend where organizations with ideological goals attempt to use scientific language to reframe gender-affirming care as experimental or harmful. But repackaging old, misrepresented data doesn’t change the facts or erase the lived experiences of thousands of trans women whose health and happiness have improved through HRT.
Transgender people deserve medically accurate, compassionate care, not politically motivated fear-mongering dressed up as science.
