Child doctors in America are standing firm in their support for transgender healthcare services for minors under 18, despite concerns about potential long-term risks. The American Academy of Pediatrics (AAP), a highly influential organization, has voted to uphold its 2018 guidance, which endorses access to counseling, hormone therapy, puberty blockers, and, in some cases, surgery. However, the AAP has also commissioned a review of these treatments due to their increasing prevalence among minors diagnosed with gender dysphoria. This decision has put the US at odds with countries like the UK and Sweden that have paused these interventions pending the conclusions of their reviews.
The AAP’s decision comes at a time when issues affecting trans youth have become a divisive cultural battleground. In the US, 19 states have passed laws banning or severely restricting minors’ access to gender-affirming drugs, while another 20 states heavily restrict or ban gender-affirming care altogether. Numerous bills are currently under consideration to further limit access to care. A study published in JAMA illustrates the impact of these restrictions on travel time to the nearest gender-affirming clinic.
The 16 members of the AAP, representing a collective 67,000 pediatricians, unanimously expressed confidence in the available evidence showing the clinical benefits of gender-affirming care for trans youth. They maintained that children should have access to comprehensive, developmentally appropriate healthcare that affirms gender identity. This type of care often begins with robust social support, including the use of preferred pronouns and psychological counseling. Clinical interventions, such as puberty blockers, provide temporary relief by pausing the development of secondary sex characteristics. Hormone replacement therapy may also be prescribed to promote physical changes aligned with a person’s gender identity. Rarely, surgery may be recommended, but only after other therapies have been exhausted.
The AAP’s decision reaffirms their belief that gender-affirming care is evidence-based and can be life-saving. They point to studies indicating higher rates of suicidal ideation and attempts among transgender youth compared to cisgender peers. However, it is crucial to note that gender-affirming care does not guarantee a solution for every individual, as there have been cases where individuals who underwent hormonal treatments or surgeries as minors later expressed regret. These anecdotes highlight the need for careful assessment, taking into account mental health issues and individual circumstances before proceeding with irreversible interventions.
The AAP’s vote follows the UK’s National Health Service (NHS) decision to limit the use of puberty-suppressing drugs for trans youth to clinical trials only. The UK’s stance was informed by an independent review that found insufficient evidence supporting their safety and effectiveness as a routine treatment. In the US, access to gender-affirming care for children has been significantly restricted as more states implement bans or restrictions. As of May 2023, 20 states have implemented such measures, with over 100 additional bills under consideration. This wave of restrictions predominantly targets Republican-leaning states and has intensified amid ongoing culture wars.
Despite the contentious nature of these issues, there is compelling evidence showing the adverse mental health impact of unaddressed gender dysphoria in trans youth. The AAP emphasizes that the increased risk of mental illness stems from internal conflict, limited access to supportive healthcare providers, discrimination, stigma, and social rejection. Even non-clinical measures like using preferred names and pronouns can have a profound positive effect on a child’s emotional well-being.
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