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The American Academy of Pediatrics (AAP) recently reaffirmed its position on gender dysphoria in children, calling for a systematic review of treatment approaches. As pediatricians, we agree with protecting transgender and gender diverse youth from discrimination and violence. However, we have concerns about the recommendations for comprehensive and insurance-covered health care treatments for transgender youth, especially in light of limited evidence and contrasting practices in Europe.
The current trend of advocating for hormonal treatments and surgeries for minors, along with demands for insurance coverage, raises not only ethical questions but also erodes trust in the U.S. medical system. It is important to consider the potential long-term harms and unknown neurological effects of these treatments.
Despite the lack of evidence, millions of tax dollars have been spent on pediatric gender transition treatments. Medical professionals who question the evidence-base of these treatments are often rewarded with grants, further perpetuating the issue. The increasing numbers of minors seeking hormone treatments and undergoing irreversible surgeries for gender dysphoria are concerning.
When reviewing the evidence, the AAP and other pediatric professionals should critically examine surveys often cited as justification for gender transitions in minors. These surveys have limitations, including biased recruitment and the exclusion of detransitioners. It is crucial to scrutinize the quality and reliability of such data.
The AAP’s systematic review should be transparent, thorough, and honest. It should address previous over-treatment practices and consider the potential perverse incentives involved. Above all, the principle of “do no harm” must guide any decision-making process.
Stickers in the shape of a heart with a trans flag are pictured during a conversation about trans care, equity and access, during National Trans Visibility Month with the Rainbow Room, a program of Planned Parenthood Keystone, in Doylestown, Pennsylvania, U.S., March 29, 2023. REUTERS/Hannah Beier/File Photo (REUTERS/Hannah Beier/File Photo)
The Journal “Pediatrics” relied on a controversial survey for a 2020 paper on transgender healthcare. This survey has been used to justify medical treatments for gender-questioning youth despite its limitations and potential biases. It is important to question the funding sources and conflicts of interest associated with such research.
As the AAP conducts its systematic review, it is crucial for them to address these concerns and prioritize patient well-being. They must engage in open dialogue, consider the potential harms of previous practices, and uphold the fundamental principle of medical ethics: “First, do no harm.”
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