Guidance Appraisals · Programme
Appraising the guidelines
Every guideline, every ruling, one method. Eighty-five documents that shape gender-affirming care around the world, each appraised the same way and each given a published finding.
Clinical guidelines, position statements, government evidence reviews and court rulings on gender-affirming care now point in different directions, and readers are often told that one of them is the authoritative one. We think each should be judged on how well its claims are supported, by the same rules, whichever way it points.
So we are appraising all of them. We are not choosing which documents to examine by whether we expect to agree with them. The list is public, the order was fixed before any appraisal began, and nothing is removed from it.
What we are trying to do
- Give every major document a checkable finding. Readers, clinicians and policymakers should be able to see, for any guideline they are pointed to, how well its claims are actually supported.
- Apply one standard in every direction. Guidance that restricts care and guidance that supports it go through the same pipeline, with the same rules, at the same depth.
- Separate the evidence from the policy. We grade what a document says the evidence shows. We don’t grade whether its policy is right. That is a different question, and often a legitimate choice evidence cannot settle.
- Credit what documents get right. Every appraisal has a section on what the document gets right, stated at full weight.
Where the programme stands
- Method registeredThe programme standard and the appraisal protocol, one method, one list and a fixed order, registered publicly on the Open Science Framework. 7 October 2026.
- First appraisals set upWPATH SOC-8 resumes under the registered method. AAP 2018 and the Endocrine Society guideline are each registered before anyone opens them.We are here
- AppraisalOne document at a time, in the published order.
- Verification and depositEach appraisal independently verified, then deposited with a DOI.
How every document is appraised
Every document passes through the same stages, in the same order. No stage is skipped, and no document gets a lighter or heavier route by choice.
- Confirm and freezeThe exact document and version, held and fingerprinted before any new reading.
- Read in fullEvery statement recorded verbatim, with its page, and given a verdict.
- Decide the depthFixed rules pick which claims need their sources checked.
- Check the sourcesEvery source for those claims read in full, or marked as not checked.
- The wider recordHow others have appraised the document, criticism and defence at the same weight.
- VerifyA verifier who has not seen the drafting checks the counts, quotes, pages and verdicts.
- PublishThe verdict and the full ledger, then the deposited appraisal with a DOI.
What every appraisal will contain
A one-page verdict
The first thing a reader sees: the version appraised, how its statements were graded, the most consequential findings for and against it, and a one-sentence headline.
Every statement, graded
Not a sample. Every recommendation and finding in the document is recorded and judged good, bad or indifferent, with the reason and the page.
What it gets right
A section stating, at full weight, what the document does well. A critique without one would not be a fair appraisal.
The direction of our findings
How the findings split: overstating benefit, overstating harm, understating either, or neither. The same tally for our own corrections.
Sources read, not summaries
No claim about what a source says unless the source itself has been read in full. Otherwise it is marked as not checked, and the gap is listed.
Its own correction record
Errors in the appraisal are logged and published on the same terms as errors we find in the documents we appraise.
Controls on our own bias
We are not neutral, and we say so. Eden is a transgender woman with a declared view in favour of access to gender-affirming care, filed as a competing interest. She also founded a non-profit organisation that teaches its own standards of care, which address the same questions as many of these documents; that interest can pull the other way, and it is declared too. A programme like this is only worth anything if it holds against its author’s interests, whichever way they pull.
A list we didn’t pick
A document is in scope if it is a guideline or evidence review, a professional statement that makes evidential claims, or a court or regulator decision that makes findings about the evidence. Opinion pieces and advocacy reports, on either side, are not.
An order that ignores direction
Order is set by how influential, current and high-stakes a document is. Whether it supports or restricts care is not recorded and plays no part.
Rules fixed before looking
Anything that could be tuned to a result, such as which statements count or which sources get checked, is fixed and timestamped before the material that would reveal the result is read.
The ordinary explanation first
Our own past errors have tended to run towards finding more fault than is there. So every negative verdict is tested against its ordinary explanation before it stands.
An independent verifier
Every appraisal is checked by a verifier who did not draft it, and by a human verifier who is not shown our findings, before anything is released. Every finding the verifier raises is resolved and logged.
The law is never graded
For court rulings, we appraise only what the court found about the evidence. The outcome, the legal test and whether the court was right in law are never graded.
These controls reduce the risks of a single-author programme. They do not remove them.
The registered method
The method is fixed in two documents, registered together, publicly, on the Open Science Framework on 7 October 2026: the Verdict Series Standard, which says what the programme is, what enters it and in what order, and the Guideline Appraisal Protocol, which says exactly how each document is appraised, stage by stage and form by form. Both are version 0.6. The registration also holds the earlier versions, as superseded records, and a log of every independent review of the drafts and how each finding was resolved.
The registered texts govern. Where this page and they differ, they win. Each appraisal cites the registration and the exact files it applied, and registers its own frozen records before the work that could reveal its results begins.
→ Registration 10.17605/OSF.IO/SY4GP · Project 10.17605/OSF.IO/4PGWN
The order
The first three places were fixed first. Every other document is ordered in five bands, with the documents that shape the most care in the most places coming first. Within a band, documents that answer each other are appraised together. Rows are listed in the order they will be appraised.
Fixed places
| Document | Jurisdiction | Status |
|---|---|---|
| 1WPATH Standards of Care, version 8 (2022) | International | In progress · GA‑003 |
| 2American Academy of Pediatrics policy statement (Rafferty 2018; reaffirmed 2023) | United States | Being set up · GA‑004 |
| 3Endocrine Society clinical practice guideline (Hembree 2017, with 2018 corrigendum) | International / United States | Being set up · GA‑005 |
Band 1
| Document | Jurisdiction | Status |
|---|---|---|
| NHS England children and young people’s gender service specification (2026), puberty suppression policy (2024) and under-18 hormones pause (2026) | England | Queued |
| HHS, Treatment for Pediatric Gender Dysphoria (final, November 2025) | United States | Queued |
| United States v Skrmetti (2025) | United States | Queued |
Band 2
| Document | Jurisdiction | Status |
|---|---|---|
| Socialstyrelsen, children and adolescents (2022) | Sweden | Queued |
| Palko/COHERE, minors (2020; legal amendment 2024) | Finland | Queued |
| NICE evidence reviews: GnRH analogues; gender-affirming hormones (2020) | England | Queued |
| AWMF S2k guideline 028-014, children and adolescents (2025) | Germany, Austria, Switzerland | Queued |
| Royal Children’s Hospital Australian Standards of Care, v1.4 (2023) | Australia | Queued |
| Queensland Vine review, Independent Review Advice Report (2025) | Australia | Queued |
| American Society of Plastic Surgeons position statement (2026) | United States | Queued |
| Brandt v Griffin (8th Cir. en banc, 2025) | United States | Queued |
| Gezondheidsraad, Transgenderzorg voor jongeren (2026) | Netherlands | Queued |
| Kwaliteitsstandaard Transgenderzorg – Somatisch (2018) | Netherlands | Queued |
| ESPE and Endo-ERN expert opinion (Hannema et al. 2026) | Europe | Queued |
| Singapore MOH Circular 44/2026, adolescent treatment guidelines | Singapore | Queued |
| CFM Resolução 2.427/2025 | Brazil | Queued |
| Supreme Federal Court: Rcl 84.653; ADI 7806; ADPF 1221 | Brazil | Queued |
| American Psychiatric Association position statement on care for transgender youth (2025) | United States | Queued |
Band 3
| Document | Jurisdiction | Status |
|---|---|---|
| Ukom, patient safety for children and young people with gender incongruence (2023) | Norway | Queued |
| Helsedirektoratet, national guideline on gender incongruence (2020) | Norway | Queued |
| Ministry of Health evidence brief and position statement (2024) | New Zealand | Queued |
| PATHA, Guidelines for Gender Affirming Healthcare in Aotearoa NZ (2025) | New Zealand | Queued |
| Académie nationale de médecine communiqué (2022) | France | Queued |
| Socialstyrelsen, national guidelines 2026: gender dysphoria (adults) | Sweden | Queued |
| NEK-CNE opinion 43/2024 | Switzerland | Queued |
| HAS, Transidentité : prise en charge de l’adulte (2025) | France | Queued |
| SFEDP expert consensus (Brezin et al. 2024) | France | Queued |
| ESSM position statement (T’Sjoen et al. 2020) | Europe | Queued |
| Sherbourne Guidelines, 4th edition (2019; amended 2023 and 2026) | Canada | Queued |
| Canadian Paediatric Society position (2023) | Canada | Queued |
| MinSalud clinical practice guideline for trans people (2025) | Colombia | Queued |
| AusPATH informed-consent standards (2026) | Australia | Queued |
| Pediatric Endocrine Society statement (2025) | United States | Queued |
| American Psychological Association policy statement (2024) | United States | Queued |
| Florida AHCA GAPMS report (2022) | United States (Florida) | Queued |
| State of Oregon v Kennedy (D. Or., 2026) | United States | Queued |
| Federal Administrative Court (CAF) interim order suspending DNU 62/2025 (2026) | Argentina | Queued |
Band 4
| Document | Jurisdiction | Status |
|---|---|---|
| UCSF Guidelines, 2nd edition (2016) | United States | Queued |
| University of Utah DRRC report, Parts I–II (2024) | United States (Utah) | Queued |
| Endocrine Society statement on the Cass Review (2024) | International | Queued |
| WPATH and USPATH comment on the Cass Review (2024) | International | Queued |
| Bell v Tavistock (2020; Court of Appeal 2021) | England and Wales | Queued |
| Cass Review: implications for Scotland (2024) | Scotland | Queued |
| NHS England adult service specifications 1719 and 1780 | England | Queued |
| Levy review of NHS adult gender dysphoria clinics (2025), with NHS England’s response | England | Queued |
| CNB opinion on triptorelin (2018) and AIFA Determina 21756/2019 | Italy | Queued |
| SAHCS guideline (2021), adolescent position (2024) and 2026 update | South Africa | Queued |
| JSPN guideline on gender incongruence, 5th edition (2024) | Japan | Queued |
| IAP Adolescent Health Academy statement (2023) | India | Queued |
| Ontario Health quality standard (2024) | Canada (Ontario) | Queued |
| Ministry of Health guide, 2nd edition (2020) | Argentina | Queued |
| CCINSHAE protocol, 3rd edition (2020) | Mexico | Queued |
| AACAP policy statement (2024) | United States | Queued |
| Florida Board of Medicine rules 64B8-9.019 and 64B15-14.014 | United States (Florida) | Queued |
| HHS Secretary’s Declaration (2025; vacated) | United States | Queued |
| For Women Scotland v Scottish Ministers [2025] UKSC 16 | United Kingdom | Queued |
| Palko adult recommendations (trans; non-binary) | Finland | Queued |
| Ordre des médecins, National Council advice a170021 (2023) | Belgium | Queued |
| NHS Scotland Gender Identity Healthcare Protocol (adults, 2024) | Scotland | Queued |
| SEEN GIDSEEN position (2015) | Spain | Queued |
| SIGIS-SIAMS-SIE position statement (2022) | Italy | Queued |
| CAMH expert consensus (2022) and NHC sex-reassignment norm (2022) | China | Queued |
| Trans Care BC Primary Care Toolkit (2023) | Canada (British Columbia) | Queued |
| Cheung et al., position statement on adult hormonal management (2019) | Australia | Queued |
| Singapore MOH Circular 43/2026, counselling guidelines | Singapore | Queued |
Band 5
| Document | Jurisdiction | Status |
|---|---|---|
| Welsh Gender Service clinical policy CP182 and service specification SS182 (2024) | Wales | Queued |
| SST surgical referral guideline (2023) | Denmark | Queued |
| AWMF S3 guideline 138-001, adults (2019; expired) | Germany | Queued |
| HIS National Standards for Gender Identity Healthcare (2024) | Scotland | Queued |
| GT-GIDSEEN quality standards (2024) | Spain | Queued |
| Thai Handbook of Transgender Healthcare Services (2020/21) | Thailand | Queued |
| IDEA Group consensus (2020) | India | Queued |
| Ministry of Public Health clinical guide to hormone therapy (2016) | Uruguay | Queued |
| Kwaliteitsstandaard Psychische Transgenderzorg (2017) | Netherlands | Queued |
| RCPsych College Report CR181 (2013) | United Kingdom | Queued |
| APTN/UNDP Asia-Pacific Blueprint (2015) | Asia-Pacific | Queued |
| Galen Centre/SEED Malaysia practical guidelines (2020) | Malaysia | Queued |
Waiting for the document to be confirmed
We do not begin an appraisal until we hold the document itself and have confirmed exactly which document, and which version, would be appraised. Appraising the wrong version, or a news report of a document instead of the document, would make every grade that follows unreliable.
Five documents in scope do not pass that check yet. Until they do, they give up their place in the order. Once they clear, they rejoin it within their band.
| Document | Jurisdiction | Status |
|---|---|---|
| AMA House of Delegates, Alternate Resolution 509 (A-26)Waiting for: The text as finally adopted. It replaced two earlier resolutions, and the version introduced is not necessarily the policy that was adopted. | United States | Blocked · Band 2 |
| CNB pronouncement on triptorelin (December 2024)Waiting for: The Committee’s own document. So far we know it only from a press report. | Italy | Blocked · Band 3 |
| Sundhedsstyrelsen guidance on gender identityWaiting for: Confirmation of which guidance is in force. Sources disagree, and a revision is in progress; if the revision is published first, we will appraise that instead. | Denmark | Blocked · Band 4 |
| Ministry of Health Circular N°8 (2025)Waiting for: Confirmation that the circular makes claims evidence can test. It is one of three linked instruments, alongside the PAIG programme and the 2024 postponement, which are largely policy choices. If the circular is purely administrative too, it will be recorded as out of scope, with the reason. | Chile | Blocked · Band 4 |
| Endocrine Society of India adult guideline (2025)Waiting for: Access to the published guideline. Its DOI does not yet lead to the document. | India | Blocked · Band 4 |
Where this comes from
Grading the Guidance: KCSIE 2026
Our first guidance appraisal graded every claim in the 2026 schools safeguarding guidance on children questioning their gender. Version 2.0 made three corrections that changed findings, and all three weakened our own argument.
Appraising the Cass Review
The Cass Review and the York reviews it commissioned are being appraised separately, under their own two-stage registered method, with blind re-scoring and a single release of all findings.
Corrections and questions
If you think a document is missing from this list, or we’ve described one wrongly, please tell us through our editorial contact page. Corrections are logged on our corrections page.
→ All our research · How we evaluate evidence · Independence · Declared interests
Eden Openly is an independent clinical health-education publication. It receives no funding from, and has no commercial relationship with, any provider of gender-related healthcare or any pharmaceutical company. Our full position is set out in our statement of independence, and every interest is listed, with its date, in our register of declared interests.