The American Academy Of Pediatrics (AAP) has announced a review of “gender-affirming care” for gender dysphoric children in a win for those who have long called for such a review.
The country’s leading pediatrician professional association said last week that it will conduct a “systematic review of the evidence” around transgender medical interventions for children.
Such interventions can include puberty blockers, cross-sex hormones, double mastectomies to make girls appear more masculine, and sometimes even genital surgeries for older youth.
The AAP authorized the development of an “expanded set of guidance for pediatricians based on a systematic review of the evidence,” the group said in press release on Friday.
However, AAP leadership also reaffirmed their confidence in the current guidelines and said they remain in the best interests of children.
“The decision to authorize a systematic review reflects the board’s concerns about restrictions to access to health care with bans on gender-affirming care in more than 20 states,” the AAP said. “The AAP opposes any laws or regulations that discriminate against transgender and gender-diverse individuals, or that interfere in the doctor-patient relationship.”
The AAP’s current guidelines for pediatric transgender medical interventions include “social affirmation” of a child who identifies as the opposite gender, puberty blockers during puberty, cross-sex hormones from early adolescence onward, and “top” and “bottom” surgeries “typically” for adults but also for adolescents on a case-by-case basis.
Other surgeries such as “facial feminization” can be considered for adolescents as well, the AAP guidelines say.
Puberty blockers are dubbed “reversible,” and cross-sex hormones as “partially reversible,” the AAP says.
However, both puberty blockers and cross-sex hormones come with serious health risks. Puberty blockers can affect bone growth and density and cause sexual dysfunction, voice damage, and infertility, among other issues. Cross-sex hormones can cause infertility, deadly blood clots, heart attacks, increased cancer risks of the breasts and ovaries, liver dysfunction, worsening psychological illness, and other serious conditions.
Hundreds of teen girls in the U.S., some as young as 12, have gotten elective, gender-related double mastectomies to remove their healthy breasts over the last few years.
Meanwhile, it is more popular than ever for youth to adopt new gender identities. An estimated 300,000 minors aged 13 to 17 identified as transgender as of last year.
The AAP’s updated policy will reflect new data and research on transgender medical interventions. AAP’s board regularly reviews evidence and policies and will invite “other stakeholders” to share input on the new policy, the group said.
Advocates who oppose children being rushed through transgender medical interventions hailed the decision to review the policy.
“As it stands, there is no long-term quality evidence that substantiates the widespread use of puberty blockers. We do not know how this will affect children in the long term. Thankfully, last week’s decision by the AAP to acknowledge this galactic gap in the evidence will highlight how there is no evidence to support the recent surge towards ‘gender-affirmative care,'” wrote Stella O’Malley, a psychotherapist who works with young people.
O’Malley is the director of Genspect, a U.K.-based group that advocates for doctors to start with the least invasive approach for gender distress.
Last year, Genspect wrote an open letter calling on the AAP to update its gender care policy. The letter was signed by doctors, psychologists, and even one former fellow of the AAP.
The AAP is a the largest professional association for pediatricians in the country with 67,000 members.
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