>
America’s top child health authority is under fire for pushing the over-use of puberty-blockers and hormones on transgender youth, and for stifling debate over whether a non-drug therapy approach is better.
Critics say the American Academy of Pediatrics (AAP) is blocking efforts to review its influential policy on ‘gender-affirming care’ for teens who identify as transgender at its leadership meet, which starts in Chicago on Thursday.
The AAP says its guidelines — to reinforce the gender a youth selects, including through gender-affirming drugs, hormones and eventually surgery — are evidence-based, widely supported and offer the best chances for a suicide-prone group.
The academy’s advice guides the work of some 67,000 AAP-affiliated childcare specialists and the gender-affirming policies of President Joe Biden’s administration.
Clinicians told DailyMail.com the AAP policy was shoehorning trans-identifying teens towards life-altering drug cocktails and that an opportunity to thoroughly review its approach was being squandered.
‘There are other ways to treat gender dysphoria, and AAP seems to be ignoring these other approaches,’ said Stella O’Malley, a psychotherapist and member of Genspect, a global coalition of clinicians and parents.
The AAP’s policy of doubling down on a child’s selected gender, rather than focussing on psychological problems they may face, too often sees them ‘fast-tracked’ into the ‘nuclear option’ of drugs and hormones, said O’Malley.
Gender transitions place a ‘heavy medical burden on the body’, leading to everything from sterility to anorgasmia and osteoporosis, she added. Many who undergo treatment later wish ‘they’d gone for a gentler approach’.
America’s top child health authority is under mounting criticism over policies on using puberty-blockers and hormones on transgender teens, and shutting down debate over whether non-medical therapy-based treatment is better.
Chloe Cole says her short-lived transition to being a boy, Leo, was a mistake, and that years of treatment from age 13 onwards and the later reversal took a huge toll on her body
Dr Erica Anderson, a trans California-based clinical psychologist who has helped hundreds of teens transition, follows a ‘qualified’ version of affirming youngsters, but says the AAP is not keeping pace with a fast-changing landscape.
Millions of school-age American children have been shut at home during the Covid-19 pandemic, bombarded by online influencers telling them typical adolescent body-image anxiety is a sign of being trans, she said.
‘This is persuasive to impressionable, insecure young people who are searching for answers,’ said Dr Anderson. The AAP approach struggles to differentiate between ‘gender-questioning youth and persistently transgender youth’.
Author, Dr. Erica Anderson is a clinical psychologist with 30 years of experience
Five pediatricians in March issued a resolution calling for a ‘rigorous systematic review’ of the AAP’s 2018 gender affirmation policy, warning of growing numbers of transitioners who come to regret their treatment and seek a reversal.
The paper describes ever-more clinicians and parents of trans-identifying youth now ‘expressing deep concerns about the use of medical and surgical interventions without sufficient exploratory psychotherapy’.
Like policy rethinks in Britain, Finland and other European nations, the review should cover the ‘safety, efficacy, and risks of childhood social transition, puberty blockers, cross sex hormones and surgery’, it says.
The resolution can be voted upon at the leadership meeting, but a recent AAP procedural rule means it will not be debated. Critics say the academy is stifling discussion of an important issue.
The Chicago meet comes after Britain’s health service decided to close the country’s only gender identity clinic for children, after a damning review and a slew of allegations by former staff and patients about rushing young people onto treatment.
A major Swedish clinic last year stopped giving puberty blockers and hormones to children, and Finland’s health chiefs decided that psychotherapy, not drugs and hormones, should be the first-line treatment for gender-dysphoric youngsters.
While transgender issues have been politically divisive in Britain, they have developed special significance in the U.S. and frequently feature in ferocious ‘culture war’ rows between liberals and conservatives.
Republicans have passed several bills this year directed at transgender youth, including measures to stop classroom debates on gender identity, restrict participation in sports and blocking access to drugs for transitioning.
Laws in Arizona, Texas and Alabama are aimed at stopping doctors from performing gender-reassignment surgery or deterring parents from providing gender-affirming care to their transgender children. Some face legal challenges.
Polls show Americans are divided, but hew to traditional gender norms.
A Pew Research Center poll in May found that most Americans — 60 percent — said sex was determined at birth, rather than by an individual’s choice, while 46 percent favored laws against providing children with medical care to transition.
An NPR/Ipsos survey the following month found that 31 percent of respondents supported state laws preventing transgender youngsters from undergoing medical transitions, while 47 percent opposed them.
The spotlight fell on trans-identifying Sunny Bryant, 8, earlier this year, when Texas lawmakers declared illegal the hormone treatments she was planning to take upon reaching adolescence
U.S. parents often support a child’s decision to transition, but many others describe being shocked at how fast doctors nudge them towards puberty blockers when, they say, the youth may just need time to make emotional adjustments.
California teenager Chloe Cole last month told a medical panel how she was encouraged as a 13-year-old to take puberty blockers and later have surgery that ‘irreversibly and painfully’ damaged her body as she transitioned to Leo, a boy.
In her testimony, she warned of the dangers of online LGBTQ+ activism, unreliable therapists and a medical process and its reversal that left her unlikely to be able to have children and unable to breastfeed.
Aaron Kimberly, a mental health nurse who medically transitioned in 2006, rejects the AAP’s ‘medicalization’ of trans-identifying youngsters and says the academy has fallen victim to America’s polarized politics and urgently needs a policy review.
‘The responsibility of our clinical governing bodies isn’t to participate in a culture or political war,’ Kimberly, also a director of the Gender Dysphoria Alliance, told DailyMail.com.
‘It needs to provide us with evidence-based information and evidence-based clinical practices.’
The AAP said in an email there was ‘strong consensus’ support for its ‘gender-affirming care’ model, which is also backed by the World Professional Association for Transgender Health, the American Psychological Association, and other bodies.
The academy’s treatment for trans-identifying teens involves ‘repeated psychological and medical evaluation’, involves parents and ‘does not necessarily lead to hormone therapy or surgery’, the academy said.
‘Robust evidence demonstrates that access to gender-affirming care decreases risk of suicidal ideations, improves mental health, and improves the overall health and well-being of transgender and gender-diverse youth,’ the AAP said.
A research paper published by AAP’s Pediatrics journal on Wednesday took aim at conservative criticism of its gender-affirming care model.
The proportion of adolescents who identified as transgender declined between 2017 and 2019, and there was no evidence of social-media driven ‘contagion’ to identify as trans, said University of California San Francisco researchers.
New Yorkers took to the streets of Manhattan to participate in the Reclaim Pride Coalition’s (RPC) fourth annual Queer Liberation March, which in June focussed on transgender rights among other issues