n the same week that the U.K.’s “equalities minister” launched an inquiry into why there has been a 4,000 percent increase in girls seeking gender reassignment in the past ten years (from 40 in 2009–10 to 1,806 in 2017–18), the American Academy of Pediatrics released its official policy statement on how to ensure “comprehensive care and support for transgender and gender diverse children and adolescents.”
All of this relates to a global child-welfare battle that is being fought in schools and surgeries across the English-speaking world. One of the most successful tactics used by the activists is to pathologize the debate; only “transphobes” question ostensibly pro-trans assumptions.
But whichever side of the transgender debate one falls on — from within the medical community — the following questions ought to be raised in relation to the AAP’s recent statement: (1) To what extent did activists and interested third parties influence this policy? (2) To what extent was the AAP able to hear from all stakeholders? (Especially parents who feel unable to speak up publicly due to concern for their relationship with their child, and professionals who fear animosity from an activist trans community.) And, related, (3) Is this official policy likely to be helpful or harmful to children?
One reason these questions matter so much is that the AAP is a trusted group of around 67,000 pediatricians. Their policy statement refers to an “integration of medical, mental health, and social services, including specific resources and supports for parents and families,” which is a commendable approach. However, in this instance there is more than meets the eye.
First, the AAP policy decisively favors affirming any “child’s self-expressed identity.” Putting this policy into practice means that when a child “comes out” as transgender, regardless of underlying conditions and mental-health concerns, parents are officially advised to affirm and facilitate the new identity. Transgender activists have supported this development.
Which figures: The AAP’s policy statement strongly resembles activist talk. It asserts that transgenderism is an intrinsic identity, related to mental health insofar as it is currently stigmatized. Moreover, again without substantiation, the statement dismisses alternative therapies — i.e. those designed to assist realignment with one’s birth sex — as unreliable and unethical. Citing other groups, the AAP calls these tried and tested approaches “reparative” and “conversion” therapies — and states that they are “inappropriate,” and “unfair and deceptive,” as well as “outside the mainstream of traditional medical practice.” But is there really a medical consensus on the gender-affirmative approach?
Despite these bold assertions, the AAP’s claims are fiercely contested by parents and child-welfare experts, many of whom suspect that their policy has been distorted by impassioned and interested third parties. At this juncture, it is crucial that the AAP listens to these voices. For instance, Dr. Susan Bradley, a child psychiatrist with 40 years of clinical experience and research, who founded the Toronto Gender Identity Clinic at the Centre for Addiction and Mental Health, told National Review:
I’m deeply concerned that AAP’s guidance has gotten so far ahead of the current knowledge base about gender dysphoric children, according to the best research we have that spans decades of clinical practice. We know from multiple studies that around 80 percent of gender dysphoric children will desist from their cross-sex identification in childhood to identify with their natal sex. Most of these will grow up to be gay or lesbian; a substantial minority have also been diagnosed with autism.
Yet the AAP guidance incorrectly dismisses these studies as flawed and outdated. There is no professional consensus on medical treatment of gender-dysphoric children and young adolescents. While some preliminary studies of puberty suppression followed by cross-sex hormones and surgery have shown benefit to gender dysphoric youth, these have had small sample sizes and have only followed patients for a short period of time.
We do not know the long-term effects of medical transition in young people; these effects are mostly irreversible and include sterility and sometimes impaired sexual function. Watchful waiting, which was the treatment of choice for many years, has been dismissed as false and harmful with no evidence for this assertion.
Likewise, therapist Dr. Lisa Marchiano, who is a clinical social worker, a certified Jungian analyst, the author of Outbreak: On Transgender Teens and Psychic Epidemics, and who has been consulting with parents of trans-identifying teens since 2016, told National Review:
We know that part of a teenager’s job is to experiment with identity. Our role as parents and mental-health practitioners ought to be to make such experimentation safe, without permanent negative consequences. I have worked with some parents whose children did indeed desist from their belief that they were trans, even after identifying as transgender for as long as one year.
According to the new AAP policy endorsing “affirmative” intervention, these young people would have qualified for cross-hormone treatment. Would they have been well-served if they had been encouraged to rush into treatment that might leave their bodies altered for life?
While investigating the story, National Review was also contacted by numerous parents and former transgender youth who are deeply upset by the AAP’s latest policy. In the interest of privacy, names have been changed.
One teenager affected by these issues is Caroline. Caroline grew up in a progressive community and first suspected she was transgender after spending time reading about trans issues and celebrities online. Following several “coming out” revelations from friends, she started considering that she, too, might be transgender.
Strikingly, two thirds of the girls in Caroline’s class identified as male. This may appear to be an unusually high number, but some researchers, such as Dr. Lisa Littman of Brown University, have begun to take notice of the “cluster” effect in schools, and consider the possibility of “social contagion” very likely. Clearly, more investigation into this is necessary before a decisive conclusion can be drawn. Again, the AAP would do well to listen to these alternative perspectives.
Nevertheless, Caroline explained that after reading a Tumblr article about the 17-year-old “trans teen” Leelah Alcorn who had committed suicide, “I started getting more into the idea then. We [her friend group] started talking about it more and more.”
There are multiple stages to the process of affirmation. These may include social affirmation, legal affirmation, medical affirmation, and surgical affirmation.
Caroline considered all four but later realized she didn’t want to go through with a medical transition after being introduced to “packers” (stuffed crotches) and “binders” (hidden breasts) at a transgender-youth conference. When Caroline started to share these doubts with her friends, they reacted badly and accused her of “transphobia.” “You know you are a boy because you are a boy,” one told her.
Throughout this time, Caroline and her mother were exploring their options together. In the end her family relocated and they found a therapist with a non-gender-affirming approach, and Caroline now happily identifies as a girl.
Some trans activists have denied “desistance” narratives (i.e. testimonies like Caroline’s) outright. However, their claims are rarely substantiated.
Carrie had a similar experience with her daughter, who had underlying learning difficulties. She told National Review, “In talking with my daughter, I discovered that she had brought the subject [transgenderism] up because of curiosity about other kids at school, and that her therapist had told her that curiosity means you are probably trans.”
“She had been told by the therapist not to tell me yet, because it takes parents a long time to ‘come around.’”
The therapist then denied this. But Carrie found messages on her daughter’s iPhone that confirmed the story. Her trust was shattered, and they took her daughter elsewhere.
“It’s been a year now since the revelation, and my daughter has completely moved on. But I’m terrified to think what fate might have befallen her. We would never in a million years have dreamt such things were going on inside that office while we waited outside.”
Another parent is Katherine. Her daughter first got the idea about transgenderism from a school presentation, at a small school where around 5 percent of the students believed themselves to be transgender. Katherine considered herself to be progressively minded and had chosen a school with such values in the hope that her child (who had some symptoms of autism) might feel included.
“Gender therapists told me not to question my daughter; that to do so was ‘insulting’ and that I must affirm her identity or she would be at high risk of suicide.
“The AAP’s 2016 guidelines under ‘what we know for sure’ state that ‘transgender adolescents and adults rarely regret gender transition, and the process (including social and/or medical changes) substantially improves their well-being.’ I could find nothing that told me of all of the known harms caused by puberty blockers, like Lupron, or the possibility that my daughter’s belief she was a boy was the result of a contagious idea.
“If I had only found one alternative, authoritative source that told me the truth, I would never have taken her to a gender clinic. I would never have supported her social transition. I would have questioned this more. I am angry at myself for trusting groups like the AAP. I am angrier at these doctors for publishing this false and dangerous advice.”
As it is, the AAP’s approach raises serious ethical questions. It is crucial that all voices — especially those that are lost amidst the noisy activists — are heard. The 2016 AAP guidelines that Katherine refers to was lead-authored by a trans activist and recent graduate of gender studies. A biomedical researcher told National Review that responding to activist medical briefings is difficult because of the manipulation of language. Clarifications have been inserted accordingly.
Despite this consensus [what consensus?] some groups — including a minority of healthcare professionals — continue to promote non-affirmative strategies: reparative therapy [the phrase “reparative therapy” is misleading: what is being referred to is assisting a child to feel comfortable with their birth sex] or delayed gender transition [again: misleading. What is being referred to is a “watch and wait” approach to let puberty unfold naturally]. Reparative therapy attempts to “correct” gender-expansive behaviors, while delayed transition prohibits gender transition until a child reaches adolescence or even older, regardless of their gender dysphoria symptoms . . . There is evidence that both reparative therapy and delayed transition can have serious negative consequences for children. [Their emphasis. But why in bold? Could it be to compensate for the fact that this claim is unfounded?]
Moreover when it comes to medical intervention, there are serious negative consequences for the gender-affirmative approach. Dr. Mike Laidlaw, an endocrinologist in Los Angeles, explained to National Review about the dangers of puberty blockers in normal puberty. In some instances this is irreversible and causes infertility.
In light of the evidence, the AAP and other such bodies would do well to carefully review the experiences and research of experts and parents — rather than flippantly disregard them as politically inconvenient. Ultimately, child welfare is a bipartisan issue. Moreover, the AAP would do well to treat the methods and motivations of activists and self-interested gender therapists with the necessary skepticism and due caution. If they fail to do so, parental trust will continue to be shattered and, as always, children will pay the heaviest price.
Editors’ note: If you are a health-care professional, parent, or young person affected by these issues, National Review is very interested in hearing from you. Please email firstname.lastname@example.org.