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Leaked discussions reveal uncertainty about transgender care

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FEW AREAS of medicine arouse as strong emotions in America as transgender care. The publication this week of hundreds of posts from an internal messaging forum will add fuel to this fire. The files show members of the World Professional Association for Transgender Health (WPATH), an interdisciplinary professional and educational association devoted to the field, discussing how to treat patients.

The non-profit group that published the files, Environmental Progress, which pushes strong views on more than just the environment, claims that the documents reveal “widespread medical malpractice on children and vulnerable adults”. That claim is questionable. But WPATH’s standards of care have been cited by other medical organisations, particularly in America. WPATH’s president, Marci Bowers, said in response that “WPATH is and has always been a science- and evidence-based organisation.” Yet the discussions show that the provision of so-called gender-affirming care is riddled with far more doubt than WPATH’s message that such treatments are “not considered experimental”.

Shedding light on this field is helpful, even if the leaking of private information—including names of practitioners—is ethically dubious. Because gender-affirming care has become politicised, its practice has retreated into the shadows. It is rare to get a sense of what it entails.

Based on the files, WPATH has members who are worryingly dogmatic. But mostly the exchanges reveal a group of surgeons, social workers and therapists struggling with how best to serve patients. They debate the challenges of gaining informed consent for medical treatments from children and people with mental-health disorders. They exchange tips on how to deal with requests for “non-standard” surgery, such as patients who would like to preserve their penis but also have a “neovagina” (through a procedure known as “phallus-preserving vaginoplasty”).

“I’m definitely a little stumped,” says one therapist about trying to get patients as young as nine to understand the impact that interventions would have on their fertility. (Hormone medications can permanently reduce fertility, and even cause sterility in some cases.) Colleagues agree that talking to a 14-year-old about fertility preservation brings reactions such as: “Ew, kids, babies, gross”, or “I’m going to adopt.” One clinician admits that “We try to talk about it, but most of the kids are nowhere in any kind of brain space to really talk about it in a serious way.” He adds: “That has always bothered me.”

Concerns about making irreversible changes to children’s bodies, and the impossibility of gaining their informed consent for this, have been at the heart of controversy over transgender medicine. In America 23 states have now restricted or banned such care for minors, even though almost all medical associations in America support it—an issue the Supreme Court has been asked to rule on. Much less focus has been on whether adult patients with psychiatric disorders can give informed consent for such procedures. On that matter the files are especially revealing.

In the autumn of 2021 several practitioners mentioned that they had a high number of patients with dissociative identity disorder (DID), formerly known as multiple-personality disorder. The group discussed the challenges of gaining consent from each “alter” (alternative personality) before starting hormone therapy, particularly when the alters had different gender identities. Some members appeared to view DID primarily through the lens of identity. As one therapist put it: “I too would love to hear from others how we as clinicians…can work with these clients to honour their gender identity and fractured ego identities.” For a field sometimes accused of over-medicalisation, such “under-medicalisation” is just as troubling.

Are you sure?

The conversation ventures into the absurd—and sounds more ideological than clinical—when talking about unusual requests for body modifications. “I’ve found more and more patients recently requesting ‘non-standard’ procedures such as top surgery without nipples, nullification [the removal of all external genitalia], and phallus-preserving vaginoplasty,” writes a surgeon from California. Several members recognise this and exchange tips. One asks whether “non-standard” is the best term as “they may become standard in the future”.

The surgeon from California shares his website, which includes a menu of surgical options, and adds that he’s “quite comfortable tailoring my operations to serve the needs of each patient”. This attitude to surgical shopping is uniquely American. Pandering to it will not help gender medicine with its argument that it is medically necessary and non-experimental.

In response to the leaks, the surgeon says he is comfortable performing these operations because WPATH “acknowledges these procedures and has established evidence-based guidelines on how to help a patient who is requesting them.” But a doctor in Canada says that after joining the forum her “expectations of scientific discourse were soon dashed”. Her posts were met with “emotional, political or social reactions rather than clinical ones”.

WPATH, and those arguing for gender-affirming care more broadly, have felt the need to present a level of certainty in an area of medicine full of uncertainty. Bringing frank discussion into the open will surely be healthy.

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Economics

German inflation, March 2025

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Customers shop for fresh fruits and vegetables in a supermarket in Munich, Germany, on March 8, 2025.

Michael Nguyen | Nurphoto | Getty Images

German inflation came in at a lower-than-expected 2.3% in March, preliminary data from the country’s statistics office Destatis showed Monday.

It compares to February’s 2.6% print, which was revised lower from a preliminary reading, and a poll of Reuters economists who had been expecting inflation to come in at 2.4% The print is harmonized across the euro area for comparability. 

On a monthly basis, harmonized inflation rose 0.4%. Core inflation, which excludes food and energy costs, came in at 2.5%, below February’s 2.7% reading.

Meanwhile services inflation, which had long been sticky, also eased to 3.4% in March, from 3.8% in the previous month.

The data comes at a critical time for the German economy as U.S. President Donald Trump’s tariffs loom and fiscal and economic policy shifts at home could be imminent.

Trade is a key pillar for the German economy, making it more vulnerable to the uncertainty and quickly changing developments currently dominating global trade policy. A slew of levies from the U.S. are set to come into force this week, including 25% tariffs on imported cars — a sector that is key to Germany’s economy. The country’s political leaders and car industry heavyweights have slammed Trump’s plans.

Meanwhile Germany’s political parties are working to establish a new coalition government following the results of the February 2025 federal election. Negotiations are underway between the Christian Democratic Union, alongside its sister party the Christian Social Union, and the Social Democratic Union.

While various points of contention appear to remain between the parties, their talks have already yielded some results. Earlier this month, Germany’s lawmakers voted in favor of a major fiscal package, which included amendments to long-standing debt rules to allow for higher defense spending and a 500-billion-euro ($541 billion) infrastructure fund.

This is a breaking news story, please check back for updates.

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Economics

First-quarter GDP growth will be just 0.3% as tariffs stoke stagflation conditions, says CNBC survey

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U.S. President Donald Trump speaks to members of the media aboard Air Force One before landing in West Palm Beach, Florida, U.S., March 28, 2025. 

Kevin Lamarque | Reuters

Policy uncertainty and new sweeping tariffs from the Trump administration are combining to create a stagflationary outlook for the U.S. economy in the latest CNBC Rapid Update.

The Rapid Update, averaging forecasts from 14 economists for GDP and inflation, sees first quarter growth registering an anemic 0.3% compared with the 2.3% reported in the fourth quarter of 2024. It would be the weakest growth since 2022 as the economy emerged from the pandemic.

Core PCE inflation, meanwhile, the Fed’s preferred inflation indicator, will remain stuck at around 2.9% for most of the year before resuming its decline in the fourth quarter.

Behind the dour GDP forecasts is new evidence that the decline in consumer and business sentiment is showing up in real economic activity. The Commerce Department on Friday reported that real, or inflation-adjusted consumer spending in February rose just 0.1%, after a decline of -0.6% in January. Action Economics dropped its outlook for spending growth to just 0.2% in this quarter from 4% in the fourth quarter.

“Signs of slowing in hard activity data are becoming more convincing, following an earlier worsening in sentiment,” wrote Barclays over the weekend.

Another factor: a surge of imports (which subtract from GDP) that appear to have poured into the U.S. ahead of tariffs.

The good news is the import effect should abate and only two of the 12 economists surveyed see negative growth in Q1. None forecast consecutive quarters of economic contraction. Oxford Economics, which has the lowest Q1 estimate at -1.6%, expects a continued drag from imports but sees second quarter GDP rebounding to 1.9%, because those imports will eventually end up boosting growth when they are counted in inventory or sales measures.

Recession risks rising

On average, most economists forecast a gradual rebound, with second quarter GDP averaging 1.4%, third quarter at 1.6% and the final quarter of the year rising to 2%.

The danger is an economy with anemic growth of just 0.3% could easily slip into negative territory. And, with new tariffs set to come this week, not everyone is so sure about a rebound.

“While our baseline doesn’t show a decline in real GDP, given the mounting global trade war and DOGE cuts to jobs and funding, there is a good chance GDP will decline in the first and even the second quarters of this year,” said Mark Zandi of Moody’s Analytics. “And a recession will be likely if the president doesn’t begin backtracking on the tariffs by the third quarter.”

Moody’s looks for anemic Q1 growth of just 0.4% that rebounds to 1.6% by year end, which is still modestly below trend.

Stubborn inflation will complicate the Fed’s ability to respond to flagging growth. Core PCE is expected at 2.8% this quarter, rising to 3% next quarter and staying roughly at that level until in drops to 2.6% a year from now.

While the market looks to be banking on rate cuts, the Fed could find them difficult to justify until inflation begins falling more convincingly at the end of the year.

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Economics

Tariffs to spike inflation, stunt growth and raise recession risks, Goldman says

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U.S. President Donald Trump announces that his administration has reached a deal with elite law firm Skadden, Arps, Slate, Meagher & Flom during a swearing-in ceremony in the Oval Office at the White House on March 28, 2025 in Washington, DC. 

Andrew Harnik | Getty Images

With decision day looming this week for President Donald Trump’s latest round of tariffs, Goldman Sachs expects aggressive duties from the White House to raise inflation and unemployment and drag economic growth to a near-standstill.

The investment bank now expects that tariff rates will jump 15 percentage points, its previous “risk-case” scenario that now appears more likely when Trump announces reciprocal tariffs on Wednesday. However, Goldman did note that product and country exclusions eventually will pull that increase down to 9 percentage points.

When the new trade moves are enacted, the Goldman economic team led by head of global investment research Jan Hatzius sees a broad, negative impact on the economy.

In a note published on Sunday, the firm said “we continue to believe the risk from April 2 tariffs is greater than many market participants have previously assumed.”

Inflation above goal

On inflation, the firm sees its preferred core measure, excluding food and energy prices, to hit 3.5% in 2025, a 0.5 percentage point increase from the prior forecast and well above the Federal Reserve’s 2% goal.

That in turn will come with weak economic growth: Just a 0.2% annualized growth rate in the first quarter and 1% for the full year when measured from the fourth quarter of 2024 to Q4 of 2025, down 0.5 percentage point from the prior forecast. In addition, the Wall Street firm now sees unemployment hitting 4.5%, a 0.3 percentage point raise from the previous forecast.

Taken together, Goldman now expects a 35% chance of recession in the next 12 months, up from 20% in the prior outlook.

The forecast paints a growing chance of a stagflation economy, with low growth and high inflation. The last time the U.S. saw stagflation was in the late 1970s and early ’80s. Back then, the Paul Volcker-led Fed dramatically raised interest rates, sending the economy into recession as the central bank chose fighting inflation over supporting economic growth.

Three rate cuts

Goldman’s economists do not see that being the case this time. In fact, the firm now expects the Fed to cut its benchmark rate three times this year, assuming quarter percentage point increments, up from a previous projection of two rate cuts.

“We have pulled the lone 2026 cut in our Fed forecast forward into 2025 and now expect three consecutive cuts this year in July, September, and November, which would leave our terminal rate forecast unchanged at 3.5%-3.75%,” the Goldman economists said, referring to the fed funds rate, down from 4.25% to 4.50% today.

Though the extent of the latest tariffs is still not known, the Wall Street Journal reported Sunday that Trump is pushing his team toward more aggressive levies that could mean an across-the-board hit of 20% to U.S. trading partners.

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