Dispatches from Deutschland: No Evidence and an Illusory Consensus in Germany
David Allison reports on Germany's disastrous new gender guidelines
The long-awaited S2k German-language guideline on Gender Incongruence and Gender Dysphoria in Childhood and Adolescence has finally been released. Intended for use in Germany, Austria, and Switzerland, this document is notably light on evidence and fails to reflect a true professional consensus on its recommendations.
The guideline overwhelmingly endorses a gender identity affirmation approach for minors with gender dysphoria. This translates to the swift prescription of puberty blockers, followed closely by cross-sex hormones and surgery. It explicitly excludes any exploration of the underlying causes of gender dysphoria, offering a one-track path to medical transition.
Relying heavily on the widely criticized WPATH Standards of Care, the guideline sets no age limits for medical interventions. In stark contrast to the UK’s Cass Review, which emphasized holistic and non-invasive options, it presents transition as the sole solution. Even more troubling, it deems pre-treatment psychotherapy incompatible with human dignity and personal autonomy, effectively dismissing it as unethical.
The "Born That Way" Assumption
The guideline distinguishes between stable “gender incongruence” and temporary “gender non-contentedness” but provides no diagnostic tools to differentiate the two. Professor Zepf, from the Clinic of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy at Germany’s Jena University Hospital, questions the feasibility of applying the guideline’s core assumption: that gender identity is an immutable trait fixed at birth (a “true trans” state) and distinguishable from transient cross-gender identification. “This novel distinction rests on flawed reasoning and disregards critical evidence,” he argues.
Psychotherapy Labeled Unethical
By branding exploratory psychotherapy as an unethical form of “conversion therapy,” the guideline puts parents in a precarious position. Questioning a child’s trans identity could potentially expose them to legal repercussions. Without a clear definition of a child’s best interests, families already face the risk of having children removed from their care if they resist social or medical transition. Where therapists are involved, their role is narrowly defined: to support young people in emancipating themselves from parental influence and aligning their lives with their stated “gender identity.”
A Guideline Marred by Delays and Dissent
Thirteen years in development, the guideline’s release was strategically timed, appearing just two weeks after Germany’s federal elections. This delay conveniently kept transgender issues out of the election spotlight. Yet timing wasn’t the only issue. The development team abandoned efforts to include systematic evidence for gender-affirming procedures post-2020 and struggled to secure full agreement from all participating professional bodies. The result is a lower-status “consensus guideline” that lacks unity.
A detailed dissenting opinion from the German Society of Psychiatry, Psychotherapy, and Psychosomatics (DGPPN), included in the appendix, sharply criticizes the guideline’s unwavering commitment to affirmation. The DGPPN notes that the guideline hinges solely on self-diagnosis, bypassing standard medical practice, which typically requires diagnostic or therapeutic steps before proceeding to advanced interventions. As Helen Joyce succinctly puts it, this approach isn’t just a departure from medicine—it’s “anti-medicine,” fostering harm and ill-health.
Indecisive Conservatives and Political Stalemate
The guideline’s fate now rests with Germany’s new government. The victorious Christian Democrats (CDU) seem unlikely to fulfill the previous Social Democrat/Green/Liberal coalition’s plan to fully fund gender reassignment treatments under statutory health insurance. However, their resolve remains uncertain. Weakened and indecisive, the CDU is trapped by its own political maneuvering. After flirting with the far-right Alternative für Deutschland (AfD) on migration policy, the party now clings to a “firewall” against the AfD, leaving it with little choice but to coalition with the Social Democrats. Further complicating matters, the CDU needs Green Party support for constitutional changes to fund rearmament and infrastructure projects through debt.
Caught between the left and an aversion to the right, the CDU’s tepid pledge to repeal Germany’s recent Self-ID law may falter. While pressure from feminist groups led to the quiet removal of “gender identity” from a late-2024 law bolstering women’s refuge funding, the move was framed as financial housekeeping—avoiding any public mention of transgender issues. Unlike the UK or US, German media offers virtually no critical scrutiny of “gender identity services” or the new guideline.
A Farce of a Debate
Just before Christmas, the AfD tabled a parliamentary motion challenging the medicalization of gender-questioning youth. The resulting half-hour debate was a fiasco. CDU members sidestepped the issue, waxing poetic about LGB rights and insisting that “everything is fine” and “the experts know best.” Green and Social Democrat MPs seized the opportunity to grandstand on unrelated pet causes.
No Culture Wars, Please
In German politics, guilt-by-association with the AfD stifles debate. Good Germans reject everything the AfD represents—and, by extension, anything linked to Trump or right-wing “culture wars.” Transgender issues and the medicalization of youth remain largely untouchable topics. Sandwiched between the subtle influence of the EU and state-funded NGOs on one side, and the weight of national historical trauma on the other, centrists recoil from anything resembling a conservative backlash.
A Fractured Consensus
Consensus is crumbling in German politics. Resistance to activist-driven transgender healthcare is emerging beyond the right-wing fringes. Yet Germany’s ultimate direction may hinge on external developments. Desperate to align with the “right side of history,” the country struggles to define what that entails. For now, the new guideline stands as a shaky edifice—built on scant evidence and a fractured professional accord—leaving gender-affirming therapists seemingly unchecked, at least until the political winds shift.
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