The AAP Silences the Debate on How to Best Care for Gender-Diverse Kids

American Academy of Pediatrics annual 2021 conference blocks SEGM’s participation

Last week, the American Academy of Pediatrics (AAP) rejected SEGM’s application to share the latest evidence regarding the practice of pediatric gender transition at AAP's upcoming annual conference in Philadelphia in October 2021. This rejection sends a strong signal that the AAP does not want to see any debate on what constitutes evidence-based care for gender-diverse youth.

AAP’s decision to reject SEGM’s request for an exhibitor status to share the latest evidence-based information is particularly problematic considering that just days earlier, over 80% of AAP members giving feedback on the resolution "Addressing Alternatives to the Use of Hormone Therapies for Gender Dysphoric Youth," which asked the AAP for more debate and discussion of the risks, benefits, and uncertainties inherent in the practice of medically transitioning minors, signified that they supported the resolution. The benefits of "gender-affirming" care include the possibility of short-term improvements in mental health function of adolescents, although these benefits have been found to be of very low certainty. The risks of "gender-affirmative" hormones and surgeries include not only the immediate adverse effects of these interventions, but also the lasting negative effects on bone, cardiovascular health, and fertility, as well as unknown effects of life-long cross-sex hormonal supplementation. There is also a growing risk of misdiagnosing and wrongly  treating young people whose gender dysphoria is a temporary phase of their identity formation. It is not yet known how many of the young people treated today will regret their medical transition, but there is already evidence of a growing number of young detransitioners: youth who underwent gender reassignment as their teens and young adult years, and who have since come to regret their gender transition and no longer identify as transgender.

The debate on how to best care for gender-dysphoric youth has intensified world-wide in the last 12 months, with at least three of the world’s major gender clinics (all pioneers in pediatric medical transition) sharply reversing their course toward far more caution. The Karolinska Hospital (affiliated with the Karolinska Institute—the home of the Nobel Prize of Medicine) suspended all pediatric medical transitions outside of clinical trials as of May 1, 2021.  Finland—one of the most respected gender clinics in the world—issued new practice guidelines in June 2020, stating psychotherapy, rather than hormones and surgeries, should be the first line treatment for gender dysphoric youth. The UK is undertaking a review of their pediatric gender transitions practice, following the High Court ruling that concluded that minors can rarely consent to “affirmative” puberty blockade, which in turn initiates a cascade of progressively irreversible hormonal and surgical interventions. AAP's assertion that “gender-affirmative" interventions with puberty blockers, cross-sex hormones, and surgeries are the only appropriate treatments for gender dysphoria in minors stands in stark contrast to the much more nuanced approach that has emerged among the leaders in pediatric gender medicine.

Gender-diverse youth deserve respect, compassion, and high-quality, evidence-based medical care. However, because of the low quality of the available evidence, and the marked change in the presentation of gender dysphoria in youth in the last several years (many more adolescents with recently emerging transgender identities and significant mental health comorbidies are presenting for care), what constitutes good healthcare for this patient group is far from clear. Quelling the debate will not help America's pediatricians guide patients and their families based on best available evidence. The politicization of the field of gender medicine must end, if we care about gender-variant youth and their long-term health.

SEGM's appeal to the AAP's annual conference organizers, which was rejected with no explanation, is attached.