Pledge to Care

Gender-diverse youth deserve love, acceptance, and high quality healthcare. The practice of routinely providing youth with poorly-evidenced endocrine and surgical "gender affirming" interventions is poised to risk future health and reproductive rights of the 5-10% of young people who currently identify as gender-diverse. Physicians, mental health specialists, social workers, teachers, and other professionals working with youth and their families have a responsibility to help gender-diverse young people thrive, while prioritizing their long-term mental and physical health outcomes.

As a professional who is concerned about young gender-diverse people, the following statements reflect my position:

  • I embrace human diversity. Feminine boys and masculine girls represent the beauty of human diversity. Pathologizing gender-atypical thoughts or behaviors in youth as problems that need medical interventions will lead to medical harm and growing rates of regret. Gay and neuro-diverse youth, who are often gender nonconforming, are especially at risk.
  • I recognize the vital developmental role of adolescence and young adulthood. It is developmentally-appropriate for youth to explore, experiment, and challenge conventions. It is professionally incumbent upon clinicians to affirm the youth’s sense of dignity and self-worth, while safeguarding their long-term health.
  • I affirm the importance of psychological support for gender-distressed youth.Young people suffering from gender dysphoria deserve access to psychotherapy that ameliorates their distress while exploring developmental, social and cognitive factors and addressing psychological comorbidities. I do not support practices that aim to either stigmatize gender nonconformity or reinforce gender dysphoria in young people—regardless of the labels applied to such practices.
  • I believe that extraordinary medical interventions require a high-quality evidence base.; "Gender-affirming" hormonal and surgical intervenitons that modify the body in order to alleviate gender dysphoria are widely recognized to be based on very low quality evidence. Given their known potential to harm future reproductive ability and physical health, and their unknown effect on long-term psychological health, such interventions for young people should only be provided in clinical trial settings with stringent ethical safeguards.
  • I call for open evidence-based discussion.Professionals with diverse views about how to best care for gender-variant youth should be encouraged to engage in civil and respectful dialogue, rising above ad hominem attacks, to inform each other and others to provide the best possible individualized care.
I Pledge to Care

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