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Doctors Challenge Push for ‘Gender-Affirming Care’ for Children

Updated: Oct 11, 2022

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Doctors and other medical professionals are denouncing a leading association of pediatricians for allegedly refusing to listen to dissenting voices among rank-and-file members who oppose “gender-affirming care” for minors.

A pediatrician using the pseudonym Dr. Grace Clark out of fear of retaliation told The Epoch Times that years ago, when she first learned puberty blockers were used to treat children, she was intrigued. Like other doctors, she said, she assumed a treatment so new and radically different must be based on solid medical research and evidence.

But, she has since lost faith in the specialists and medical institutions she once trusted.

“I feel betrayed by the American Academy of Pediatrics (AAP), honestly, because I came to realize I can’t believe them. They’re telling me something that defies common sense,” she said.

In a recent letter to the AAP, doctors and other supporters raised concerns that the association is supporting only one set of views on how best to treat children who have gender dysphoria—the feeling that their biological sex is different from their gender identity—namely social and medical transition.

“Many of our children have received this care and are anything but thriving,” read the July letter by the organization Genspect.

Chloe Cole, an 18-year-old woman who regrets surgically removing her breasts, holds testosterone medication used for transgender patients, in Northern California on Aug. 26, 2022. (John Fredricks/The Epoch Times)

The group also urged the AAP to adopt a resolution authored by five pediatricians at its annual leadership conference in August that called for a “rigorous systematic review of evidence and policy update for management of pediatric gender dysphoria.” However, in an unusual move, the AAP blocked pediatrician comments on the document, according to Genspect. The resolution was later rejected in a vote at the conference.

A similar resolution in 2021 calling for more debate and discussion on the risks, benefits, and uncertainties of medically transitioning children received 80 percent positive feedback in comments, according to a report by the nonprofit Society for Evidence Based Gender Medicine, although it was also voted down.

AAP Policies

Clark, a member of the AAP and a pediatrician for more than 30 years, said her own daughter once identified as transgender.

“When it’s your own child, you see more clearly what the stakes are. That’s when it becomes a little more real,” she said.

Clark has since rejected the association’s recommended transgender policies. Suggesting to children they may be the opposite gender, putting them on puberty blockers and cross-sex hormones, and allowing gender transition surgeries is “terrible” and is destroying families, she said.

On Oct. 3, the AAP, the American Medical Association, and the Children’s Hospital Association sent a letter urging the U.S. Department of Justice to “investigate and prosecute all organizations, individuals, and entities” that share information deemed to be false about transgender medical treatments for minors. Critics said it’s another attempt to silence dissent.

Opponents of the “gender-affirming care” model for youth are planning a protest on Oct. 8 outside California’s Anaheim Convention Center, where the AAP is holding its next convention.

Dr. Julia Mason, another pediatrician and AAP member who criticized the organization for blocking the resolution asking for a “systematic review” in August, is expected to be at the First Do No Harm Unity Rally in Anaheim.

The organizers say other doctors, parents, and detransitioners—those who regret transitioning and attempt to reverse the process—will attend and demand an end to the gender transitioning of all people 25 and younger.

The AAP did not respond to multiple inquiries. However, Lisa Black, the group’s media relations manager, previously told The Epoch Times via email the association does not promote cross-sex hormone use or sex change surgery for children.

The AAP’s policy guidelines, issued in 2018, state the association recommends insurers offer coverage for transgender and gender-diverse youth including “medical, psychological, and, when indicated, surgical gender-affirming interventions.”

In response to the resolution from August that called for a rigorous review of the evidence on transgender policies, Moira Szilagyi, president of the AAP, wrote a blog post arguing it was unnecessary, since “evaluating the evidence” is already routine for the association.

“Critics of our gender-affirming care policy mischaracterize it as pushing medical or surgical treatments on youth; in fact, the policy calls for the opposite: a holistic, collaborative, compassionate approach to care with no end goal or agenda,” she wrote.

Yet, in its guidelines, the AAP labeled any attempt to encourage children to feel comfortable in their own bodies as “unfair and deceptive” and akin to “conversion therapy,” which has been banned in several states.

A transgender children’s book in Irvine, Calif., on Aug. 30, 2022. (John Fredricks/The Epoch Times)

Meanwhile, an influential international group called the World Professional Association for Transgender Health on Sept. 15 released the 2022 version (pdf) of its recommendations for transgender treatments, which includes an updated section on youth.

According to the document, adolescents should exhibit “several years of persistent gender diversity [or] incongruence” before being given hormones or surgeries. However, the group also removed all age restrictions for transgender surgeries in the updated guidance.

Changes in Europe

Some European countries, such as the United Kingdom, Sweden, Finland, and France, have also recently made changes to their model for treating children diagnosed with gender dysphoria.

In the UK, a critical report (pdf) by Dr. Hilary Cass released in February exposed concerns about safety regarding standards at a gender identity clinic for children in London, prompting the National Health Service to announce in July the clinic would be shut down.

Cass’s review of the Tavistock clinic noted there are “major gaps” in the research regarding appropriate assessment and treatment for children, as well as questions about the strength of the evidence for the use of some medications. She also found primary and secondary care staff felt pressured to adopt an “unquestioning affirmative approach.”

Tavistock is now facing legal action by up to 1,000 families because of the “life-changing and, in some cases, irreversible effects of the treatment they received,” according to the lawyer behind the case. As the UK’s only gender identity clinic dedicated to children, the clinic saw a sharp rise in referrals over the last decade from fewer than 250 referrals in 2011-2012, to more than 5,000 in 2021-2022, according to the National Health Service.

The health service now says it is moving towards a new model of care with “strong links to mental health services.”

The Tavistock Centre in London in an undated file photo. (Aaron Chown/PA)

In February, Sweden’s National Board of Health and Welfare ended the practice of prescribing puberty blockers and cross-sex hormones to gender-dysphoric patients under the age of 18 excluding “exceptional cases,” saying the risks outweigh the benefits.

In 2021, Sweden’s Astrid Lindgren Children’s Hospital had already decided to stop giving such hormone treatments to children under 16.

“These treatments are potentially fraught with extensive and irreversible adverse consequences such as cardiovascular disease, osteoporosis, infertility, increased cancer risk, and thrombosis,” stated hospital officials (pdf).

In 2019, Christopher Gillberg, a psychiatrist and professor at Gothenburg’s Sahlgrenska Academy in Sweden, warned hormone treatments and surgeries on children were “a big experiment” that could prove to be one of the worst medical scandals in history. A documentary called “Trans Train” featuring interviews with detransitioners also swayed public opinion in the country against the transgender movement, according to the Canadian Gender Report, a gender treatment watchdog group.

In 2020, Finland’s health authority announced new guidelines backing psychotherapy rather than puberty blockers and cross-sex hormones for children. And in March of this year, France’s National Academy of Medicine announced “great medical caution must be taken” with transgender treatments for children due to “the many undesirable effects and even serious complications that can be caused by some of the therapies available.”

‘Big Picture’ Approach

Critics of “gender-affirming care” have cautioned that failing to heed these warning signs overseas could have dire consequences for youth and their families in the United States.

Dr. Michael Laidlaw, an endocrinologist who spoke to the House of Lords in British parliament in May 2019, said evidence showed puberty blockers, opposite-sex hormones, and surgeries had harmed children in the Tavistock system.

He questioned whether children as young as 8 who are eligible to receive such treatments “have the capacity to make an informed consent decision as to their future adult choices with regards to bearing children and sexual function.”

Clark, the AAP member, said countries like the UK are moving away from a hyper-focus on gender identity and transitioning, meaning doctors who are not necessarily gender specialists will be expected to examine gender dysphoric children for depression, eating disorders, and autism—ailments that often accompany gender dysphoria—and look at the child’s home life and whether they have a history of trauma.

“Let’s look at the big picture here. That’s what they’re saying,” she said. “We’re going to look at you as a whole person. We’re not going to look at you as a walking gender identity. Of course, that’s the way to do it, but that’s not what’s happening in the U.S.”

Historically, a small number of children with gender dysphoria were primarily prepubescent boys, but in recent years evidence shows there has been an increase in referrals of adolescents—particularly adolescent females—to gender clinics.

Clark defended the work of Dr. Lisa Littman who suggested a “social contagion” especially among girls might have caused the recent surge in the number of children identifying as transgender.

“I think pediatricians are confused, but they just can’t bring themselves to distrust the specialists and the institutions like the AAP,” she said. “They just don’t realize the enormity of what’s going on.”

Clark describes herself as “a liberal—or used to be,” but said in such circles among some of her closest colleagues, she’s often viewed “almost as a conspiracy theorist” for doubting transgender treatments.

“They’re shocked. They’re in denial. It’s like they’ve got their hands over their ears,” she said. “They know I’m not crazy. They know I’m a very diligent, careful, physician.”

Most doctors, including pediatricians, also don’t understand the havoc trans activism and “gender-affirming care” is wreaking on families, she said.

“It’s such a disruption of the parent-child relationship, and the role parents should have in their kids’ lives. It’s heartbreaking to me as a pediatrician and parent myself,” she said. “We know as pediatricians that kids explore their identity at this age. It’s just what they do. It’s just part and parcel of adolescence.”

‘No Guardrails’

The medical community in the United States has largely dismissed the stories of a growing number of detransitioners such as Chloe Cole, 18, who regrets having both of her healthy breasts removed at the age of 15, say critics.

Erin Friday, an attorney and co-lead of the U.S. chapter of the organization Our Duty, who is helping to organize the Oct. 8 protest in Anaheim, also has a teen daughter who once suffered from gender dysphoria.

While European countries are moving away from the “gender-affirming care” model, Friday laments most U.S. states, and especially California, are doubling down on it.

Her efforts to oppose “gender-affirming care” legislation in the state Legislature failed last week when Gov. Gavin Newsom signed into law Senate Bill 107 to make California a trans sanctuary state and Senate Bill 923 to push what’s known as “trans-inclusive care.” Both bills were authored by Sen. Scott Wiener (D-San Francisco).

Friday is outraged by Newsom’s claims that children who aren’t given “gender-affirming care” are at higher risk of suicide.

A study published by the American Urological Association in The Journal of Urology found that in California from 2012-2018, suicide attempt rates more than doubled among transgender patients after vaginoplasty or phalloplasty surgeries—3.3 percent post-surgery compared to 1.5 percent before. Also, the rate of psychiatric emergencies did not decrease in the two years after surgery compared to the two years before.

A Swedish study of 324 transgender individuals from 1973 to 2003 also found sex-reassigned adults, compared to same birth sex controls, were 19 times more likely to commit suicide. The study shows deaths among transgender people increased sharply compared to other adults starting about 10 years after medical interventions.

As a result, the recent increase in transgender medical interventions could result in a surge in suicides within the next decade, said Friday, who is also a leader of the group Parents of Rapid-Onset Gender Dysphoria Kids in California, which aims to educate parents about the transgender issue.

Most of the children in her group suffer from other forms of mental health issues, such as anxiety and depression, obsessive-compulsive disorder, autism, eating disorders, body dysmorphia, and ADHD, she said.

Except for Florida and a few others, most states are “ignoring the science,” she said. “It’s as if they want to transition as many kids as they can before the science catches up to them. It’s a conveyor belt in California.”

In California, a parent can walk into a gender clinic and obtain puberty blockers and cross-sex hormones for their minor child in an hour or less, she said.

“There are no guardrails … not even a requirement in California that there be a diagnosis of gender dysphoria,” Friday said.

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