The allegation emerged during extraordinary courtroom testimony in late October. Amy Tishelman — a clinical psychologist, former research director at GeMS, and leader in the field of transgender health — said, under oath, that GeMS had pressured her to assess minors for possible medical interventions, such as hormones, faster than she thought was safe. The clinic, multiple staffers testified, had shortened its so-called hormone-readiness assessment from four hours to two, and other clinicians shared Tishelman’s concern. “That is crazy in my mind,” the clinic’s founding psychologist, Laura Edwards-Leeper, said of the truncated assessment.

In recent weeks, the Globe spoke with more than a dozen families who have sought treatment for their children at GeMS. Two of the parents echoed Tishelman’s concerns. One father, who brought his transgender son to the clinic in 2021, said the assessment struck him as a “rubber-stamping process.”

But the vast majority — speaking anonymously to protect their children’s privacy — strenuously pushed back against the allegations. GeMS, they said, has a well-earned reputation for caution. Its clinicians, they said, do not prescribe medical treatments until multiple providers are confident it is appropriate. And the psychological assessment that was discussed in court is but one step in a decision-making process that sometimes lasts years.

“The premise that parents or families are being rushed into gender-affirming care . . . without getting full information or supports, that just does not align with the experiences that we’ve had as a family or any of the families we know,” said one mother who volunteers with a support group for parents of LGBTQ+ children and whose transgender son was a patient at the clinic.

She and other parents spoke at a tumultuous — some say terrifying — time for transgender youth and their families. President-elect Donald Trump has vowed to withdraw federal funding for gender medicine, some states have passed bans, and the parents fear that the politicization of transgender issues could put their families at risk. Meanwhile, the relatively new field of what practitioners call gender-affirming care is also roiled by debates about how best to care for youth who are transgender or experiencing gender-related distress. On Wednesday, the Supreme Court will hear arguments in a challenge to a Tennessee ban. The case could have sweeping national implications.

The families shared their experiences — described in dozens of hours of interviews and substantiated by records shared with the Globe — as a counterweight to what they regard as unfounded concerns about US gender clinics and, especially, GeMS. They said they want the public to understand that they and their providers only embarked on the consequential process of medical transition after careful deliberation and with full knowledge of the risks, the potential benefits, and the unknowns.

Medical transition treatments, including puberty blockers, hormones, and surgeries, are generally administered to accomplish two related goals: to align a person’s body with their gender identity, and to relieve gender dysphoria, sometimes described as a deeply distressing sense of having been born in the wrong body.

Transgender rights advocates and American leaders in the field say ample scientific evidence shows medical transition treatments are beneficial for the well-being and mental health of transgender youth. Major US medical associations also support the treatments. But there is a divide between US institutions and health authorities in Europe, where five countries have sharply restricted access to pediatric medical transition after concluding the scientific research supporting it is weak or of low quality.

A yearslong review commissioned by the English National Health Service concluded that the evidence undergirding medical transition treatments for minors is “remarkably weak.” Following the review’s recommendation, the National Health Service said it would limit the use of puberty blockers as a medical transition treatment to experimental settings.

The review, however, is contested. Some US leaders in the field have alleged methodological flaws and some advocates have said the effort, known as the Cass Review, was biased.

The pushback against Tishelman’s testimony about GeMS reflects a broader question debated in the field: How should clinicians decide which minors to treat with puberty blockers and hormones?

Most of the families who spoke to the Globe said that for their children the case for medical intervention was clear. Their children, they said, expressed a transgender or nonbinary identity in childhood and never wavered. One mother said that the initial GeMS assessment in 2016, when her transgender daughter was 10, “was not particularly helpful because we had been doing this for seven years already.” In fact, it felt like an ordeal, as if her daughter was being forced to prove to a stranger that she was who she knew herself to be.

Tishelman said she could “validate” that point of view. She is not primarily concerned, she said in an interview, about families who have been known to GeMS for years and whose children have expressed a transgender identity since childhood.

Her greater concern, she said, is about patients who first reach GeMS as adolescents and who, in some cases, have “significant psychiatric challenges or neurodevelopmental disabilities,” such as autism. Those types of cases have become more prevalent since GeMS was founded in 2007, she said, and may require a longer psychological assessment before it is prudent to recommend medical interventions. (The Cass Review was launched, in part, after the population of minors seeking gender care shifted after 2014, with more adolescents coming forward.)

After the assessments were shortened, at a time when demand for the clinic’s services was growing, Tishelman said the process was rushed, especially in complicated cases, such as when parents disagreed about their child’s care.

“An individualized approach to assessment is needed,” she said.

Tishelman sued Boston Children’s in 2020, alleging discrimination, and the hospital fired her in 2021. Last month, a jury found the hospital liable for retaliating against Tishelman, but not for discrimination, and awarded her nearly $2 million.

Two parents said they shared Tishelman’s concerns. One of them, the father who brought his 14-year-old to GeMS in 2021, about a year after the teen came out as a transgender boy, said he supported his son’s identity. But he said that, in his view, GeMS clinicians did not sufficiently explore his son’s previous mental health struggles, including an anxiety diagnosis. The process felt like “a conveyor belt” toward medical intervention, he said. His son is no longer a patient at the clinic.

Most of the parents, including some whose children have been patients at the clinic for years, said their experience was the opposite. Far from a conveyor belt, the process included multiple opportunities for families or clinicians to suspend or change the course of treatment.

One mother in Boston said her 9-year-old transgender daughter has been a patient at GeMS since she was 6. The parents took her to the clinic after she asked to use female pronouns and change her name. By then, her mother said, she had been “express[ing] herself in a much more feminine way,” including by preferring girls’ clothing, since she was a toddler. They went to GeMS looking for “reassurance that this was what it seemed” or an alternate explanation, the mother said.

They only began discussing medical options — specifically puberty blockers, which pause puberty — in the past year, the mother said. During a recent appointment, the psychologist “explain[ed] to my daughter how it all works medically and what would happen if she did take them, what would happen if she didn’t take them,” the mother said. It was “very clear and educational [with] no pressure at all.”

The daughter is not yet eligible for puberty blockers because that treatment is only available at GeMS after puberty has begun and, generally, with the consent of both parents. The family has scheduled an endocrinology evaluation this winter.

Another Eastern Massachusetts mother first took her transgender son to GeMS when he was 7 He started puberty blockers about three years later in 2019. Then, when it was time to consider taking the next step — testosterone injections to induce male puberty — a GeMS endocrinologist made clear that all options were still on the table, including suspending medical intervention altogether, according to doctor’s notes shared with the Globe.

In those notes, from the October 2022 appointment, the endocrinologist wrote: “I spent a lot of time discussing with [the son] that if he ever feels like he does not want to move forward with testosterone that is completely reasonable as it is a very personal decision. Just because he has started on this path does not mean that he needs to go down it fully.”

The mother said that GeMS clinicians told her that if they suspended treatment with puberty blockers, her son’s female puberty would resume.

Critics of pediatric medical transition argue that intervening with puberty blockers and hormones can prevent a child from coming to terms with their sex, which they regard as immutable. They point to studies published between the 1970s and 2021 that found that most cases of gender-related distress in children resolved during puberty without medical intervention. Supporters have said that research is antiquated and that the children studied were not comparable to the population of transgender youth who are seen at clinics such as GeMS today. They also charge that encouraging transgender youth to identify with their sex assigned at birth is a form of conversion therapy that harms their mental health.

Some of the parents who spoke with the Globe described what they considered astonishing improvements in their children’s mental health and well-being when they began puberty blockers and hormones.

One father from the Boston suburbs said his teenager, who was assigned male at birth and has identified as nonbinary since childhood, went into a “downward spiral” when the physical changes of puberty began. His child thought about suicide, he said, and was hospitalized. The father said treatment with estrogen — and the bodily changes it induced, such as rounded hips and the growth of breasts — brought relief. Now, “they are thriving and they don’t have severe gender dysphoria,” he said.

About half of states have passed total or partial bans on pediatric medical transition. In the Supreme Court challenge to Tennessee’s ban, the Biden administration has asserted that minors only undergo medical transition in “appropriate cases” and after careful assessment. Tennessee’s attorney general, Jonathan Skrmetti, has argued, in part, that because the scientific evidence undergirding the treatments remains inconclusive, his state had an obligation to intervene.

Kristen Dattoli, a Boston Children’s spokesperson, said, “In Massachusetts, access to gender-affirming care is a fundamental right firmly protected by our state’s constitution and laws.”

Founded in 2007, GeMS was the first hospital-based pediatric gender clinic in the nation. According to Children’s, it has served more than 1,000 families. It includes a multidisciplinary team of psychologists, social workers, and endocrinologists. The clinic requires — or strongly encourages — that patients have an outside therapist to supplement their appointments with GeMS, many parents said.

“Patients and families collaborate with our physicians to develop an approach that reflects the patient’s unique needs and experiences, creating an individualized plan for each patient, just as we would in any of our specialty departments. As part of the consenting process, parents and patients are informed of the risks, and challenges are described at the outset of each stage of care,” Dattoli said.

One mother from the North Shore said GeMS clinicians spoke to her plainly about risks and unknowns. She, her husband, and their 12-year-old transgender daughter have decided to move forward with puberty blockers. Although the blockers have long been used to treat precocious puberty, usually defined as puberty beginning before age 8 or 9, there is scant research on the long-term outcomes of pediatric medical transition treatments.

“Obviously, we’re scared,” she said. “What are the long-term side effects?”

There is also the question of fertility. Blocking puberty early and then progressing to hormone therapy can make it difficult to have biological children later in life or cause sterility.

“I don’t want to make that decision, but I also know that she doesn’t want to be a boy and putting her through that in her middle school years, going through [male puberty], I think it would be worse,” she said.

The mother said one thing that weighs on her is the higher rate of suicide and suicidal ideation among transgender youth.

“I feel like I’m saving her life by giving her the blocker,” she said.

A study based on a 2015 survey of transgender adults in the United States found an association between access to gender-affirming hormone treatments and lower odds of suicidal ideation (the study has been criticized on methodological grounds). The Cass Review found that the available scientific research “did not support [the] conclusion” that “hormone treatment reduces the elevated risk of death by suicide in this population.”

Several of the parents spoke, in sometimes anguished terms, about weighing their children’s long-term fertility against their mental health.

“We really are talking about our kids not being able to have children,” said the father from the Boston suburbs, “and I think that’s the toughest conversation, psychologically, to handle as parents.”

“But it was also very clear that not doing it is far worse than going through with it,” he said.

Mike Damiano can be reached at [email protected].