Pediatric Association Quashes Debate on Gender Dysphoria Treatment

Pediatric Association Quashes Debate on Gender Dysphoria Treatment

The influential American Academy of Pediatrics (AAP) told an international nonprofit group of more than 100 pediatric clinicians and researchers that it could not set up an information booth at AAP’s annual conference in October. 

The Society for Evidence-Based Gender Medicine, which questions the AAP’s “gender affirming care” protocols for kids with gender dysphoria, registered for a booth at the conference and paid in full. However, on Aug. 2, it received an email stating, without explanation, that its application was rejected and its registration canceled. 

AAP has 67,000 pediatricians on its membership rolls and is considered the leading authority on pediatric care.

“I hope this was in error,” SEGM wrote in a letter appealing AAP’s decision, “as the information SEGM aims to share with AAP fellows is of vital significance for all practicing pediatricians … This rejection sends a strong signal that the AAP does not want to see any debate on what constitutes evidence-based care for gender-diverse youth.”

SEGM’s members object to the widespread use of “affirmative care” protocols, which mandate that adolescent and even pediatric patients who claim to have gender dysphoria—severe discomfort with their biological sex—receive immediate “affirmation” from their physicians. These young people are then frequently encouraged along a path of rapid “transition” via hormone treatments and surgery. 

“The risks of ‘gender-affirmative’ hormones and surgeries include not only the immediate adverse effects of these interventions, but also the lasting negative effects on bone, cardiovascular health, and fertility, as well as unknown effects of life-long cross-sex hormonal supplementation,” SEGM said in an article on its website.

“There is also a growing risk of misdiagnosing and wrongly treating young people whose gender dysphoria is a temporary phase of their identity formation,” the article said. “It is not yet known how many of the young people treated today will regret their medical transition, but there is already evidence of a growing number of young detransitioners: youth who underwent gender reassignment in their teens and young adult years, and who have since come to regret their gender transition and no longer identify as transgender.”

The so-called Dutch protocol, a widely adopted standard of care that has been used to justify starting gender-dysphoric minors as young as 8 on puberty blockers, is based on a study of a narrow population, SEGM co-founder Will Malone told The Wall Street Journal: “children with severe gender dysphoria since early childhood and no other mental-health comorbidities. The protocol is now being applied to a wildly different demographic—teenage girls who seem to have had no prior history of dysphoria, and who have high rates of anxiety and depression.” Many of these young women are among the “detransitioners.”

The AAP is “working very hard to give an appearance that everything’s been decided and there’s no debate,” Julia Mason, a pediatrician, SEGM advisor and AAP fellow, told The Wall Street Journal. “The growing numbers of detransitioners suggests that [pediatricians] don’t really know what we’re doing in this case.” 

The debate on how to best care for gender-dysphoric youth has intensified worldwide in recent months, with at least three of the world’s major gender clinics (all pioneers in pediatric medical transition) sharply reversing their course toward far more caution. 

The Karolinska Hospital, affiliated with the Karolinska Institute—which awards the Nobel Prize in Medicine—suspended all pediatric medical transitions outside of clinical trials as of May 1. Finland, which has one of the most respected gender clinics in the world, issued new practice guidelines in June 2020, stating psychotherapy, rather than hormones and surgeries, should be the first line treatment for gender dysphoric youth. 

The U.K. is undertaking a review of pediatric gender transitions practice, following the country’s high court ruling that concluded that minors can rarely consent to “affirmative” puberty blockade, which in turn initiates a cascade of progressively irreversible hormonal and surgical interventions. 

AAP’s assertion that “gender-affirmative” interventions with puberty blockers, cross-sex hormones and surgeries are the only appropriate treatments for gender dysphoria in minors stands in stark contrast to the much more nuanced approach that has emerged among the leaders in pediatric gender medicine.

Clinicians across the West are acknowledging that the evidentiary basis supporting medical transition for kids is shaky and that hormone treatments on adolescents don’t produce significant mental-health benefits. Yet “there’s no home for that message inside U.S. medical societies,” according to endocrinologist and SEGM co-founder Will Malone.

The U.S. and the rest of the world need to wake up, said another SEGM researcher, who asked that her name not be used because she has a family member experiencing gender dysphoria.

“When the home of the Nobel Prize in medicine stops transitioning children as a matter of general practice, and pulls it back into tightly controlled research settings, is this not a wake-up call for the rest of the world?” she told The Wall Street Journal

The American College of Pediatrics (ACPeds) is also wary of the approach to gender dysphoria treatment. 

“Currently, there is a vigorous debate among physicians, therapists, and academics regarding what is fast becoming the new treatment standard for GD in children,” ACPeds says on its website. “This new paradigm is rooted in the assumption that GD is innate, but a review of the current literature suggests that this claim is founded upon an unscientific gender ideology and lacks an evidence base.” 

And recent action suggests there is at least concern among members within the AAP. Just days before the association turned down SEGM’s application to attend its annual conference, AAP members voted on a resolution regarding evidence in pediatric gender medicine.  

The resolution, proposed by one of its own, asks AAP for more debate and discussion of the risks, benefits and uncertainties inherent in the practice of medically transitioning minors. More than 80% of AAP members voted in favor of a resolution, SEGM reported, showing that “AAP members are eager to learn more about the state of evidence for pediatric medical transition.” 

SEGM contends that the politicization of the field of gender medicine must end, if doctors care about gender-variant youth and their long-term health. 

“Other countries, more liberal countries, have already come to the conclusion that we should have come to as a country years ago,” said Dr. Malone, the SEGM co-founder. And yet, because we can’t open this debate in any form … the debate is not occurring and kids are being harmed.”

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