Evidence over Ideology: Gender-Distressed Children Deserve Nothing Less
Once again, the United Kingdom is leading the way in choosing evidence over ideology for gender-distressed kids. Over the summer, the UK’s high court deferred to science over activism and upheld an emergency ban on puberty blockers for children under age eighteen.
Many European countries—like Norway, Denmark, England, Wales, Scotland, Sweden, and Finland—are moving away from life-altering hormonal and surgical interventions for children experiencing distress over their biological sex. Their systematic reviews revealed insufficient evidence that these experimental protocols help vulnerable kids. On the contrary, the evidence indicates such protocols actually harm the overwhelming majority of children experiencing distress over their sex.
These countries have shifted their focus to the evaluation and treatment of underlying mental health conditions for gender-dysphoric youth and now recommend psychotherapy as the first-line treatment. The European Society for Child and Adolescent Psychiatry has publicly stated that medical professionals should “not . . . promote experimental and unnecessarily invasive treatments with unproven psycho-social effects, [but should instead] adhere to the ‘primum-nil-nocere’ (first, do no harm) principle.”
To “do no harm,” children’s healthcare must be evidence-led. Europe is headed in the right direction, but the United States is an outlier. In the US, the medical industry is ignoring the evidence that gender transitions are deleterious to young children’s mental, physical, spiritual, emotional, and relational well-being. Too often, ideology trumps biology—and activism and financial incentives trump evidence of what is truly best for children. Gender facilities offering controversial hormones and surgeries to gender-dysphoric children have multiplied in the US in the last decade, and once-reputable medical organizations are endorsing experimental drugs and irreversible procedures for children (like mastectomies on physically healthy girls). These once-reputable medical organizations are disregarding the growing disagreement among medical professionals in the US and worldwide. They are also refusing to confront the clear evidence that hormones and surgeries impact a child’s future fertility and can cause permanent sterilization.
This alarming trend toward prescribing cross-sex hormones and puberty blockers for gender-dysphoric children represents the biggest change in my specialty of pediatrics since I graduated from medical school and completed my residency more than twenty years ago. And I’ve become very passionate about speaking up about the ideology behind it and how it is infecting medicine and hurting kids. I’ve dedicated my career as a pediatrician to helping children thrive and enjoy healthy lives into adulthood. I never imagined the federal government would embrace ideology over biology and mandate unethical, harmful, and experimental treatments promoted by activist organizations like the World Professional Association for Transgender Health.
But that’s exactly what’s happening. The Biden-Harris administration has unlawfully reinterpreted nondiscrimination on the basis of “sex” in the Affordable Care Act to include so-called “gender identity.” This mandate forces doctors to act against sound medical judgment and endanger patients. It coerces physicians to use pronouns that contradict biology and to enter inaccurate information in medical charts. It also censors doctors from informing patients about the dangers of experimental interventions and interferes with doctors’ ability to provide medically appropriate and sex-specific care consistent with the reality that humans are created as biologically male or female. The new mandate forces doctors to perform harmful, life-altering, and experimental procedures on susceptible children—even if their gender dysphoria is likely temporary.
Doctors should not be forced to harm or lie to their patients. So the American College of Pediatricians—where I serve as executive director—is standing up for child patients. With the legal help of Alliance Defending Freedom and Schaerr-Jaffe, we are challenging the Biden-Harris administration’s mandate in court. Physicians must be allowed to recognize biology and follow the evidence. Forcing doctors—and others—to participate in affirming so-called “social transition” is harmful, to the profession of medicine as well as to the children who are exposed to it.
Studies show that so-called “social transition”—calling a child by a different name or an inaccurate pronoun and otherwise treating him or her as the opposite sex—can lead to the persistence of gender dysphoria. Statistically, the vast majority of pre-pubertal children experiencing distress over their biological sex will outgrow it if allowed to progress through puberty without interruption or social transition.
Many gender-distressed children have autism or pre-existing psychological co-morbidities such as anxiety and depression. These conditions must not be ignored in favor of a myopic focus on gender dysphoria. They must be considered and treated, and they must inform every pediatrician’s recommendation as to how best to help a child navigate gender dysphoria—without introducing drugs or procedures with life-altering effects.
Puberty blockers have permanent consequences. They are known to cause low bone density and may impair brain development. Cross-sex hormones are also associated with dangerous health risks. These include cardiovascular disease, blood clots, stroke, and permanent damage to reproductive organs and fertility. Genital surgeries are irreversibly sterilizing, and “have a profound impact on sexual function” as an adult. Our sister site, Biologicalintegrity.org, provides additional trustworthy medical information about such harms in an effort to educate and equip parents, teens, physicians, and policymakers with reliable medical information about gender dysphoria and the best practices for a path forward to health and healing.
We also cannot ignore the rising number of people who detransitioned and regret their attempts to “transition” from their biological sex—a feat that can never be done at the cellular level even if they initially changed their outward appearances. These brave souls are sharing their stories of catastrophic loss—both mental and physical—hoping to dissuade others from being misled down the painful path of regret.
As pediatricians, we took an oath to help kids, not harm them. Our compassionate care of children is based on science, evidence, and ethics. That’s why we, together with seventeen other medical organizations, launched the Doctors Protecting Children Declaration. The coalition represents over 75,000 physicians and healthcare professionals through co-signing medical organizations, more than 5,000 individual doctors, and healthcare professionals in fifty-nine countries. Together, we are a strong voice for children, a vulnerable population in need of the utmost protection from adults. We advocate that US medical professional organizations follow the science—and Europe’s example—and immediately stop the promotion of harmful “gender transition” interventions and surgeries for minors distressed over their biological sex. We champion comprehensive mental health evaluations and therapies that can identify and address underlying psychological conditions that often accompany gender dysphoria.
When it comes to children’s health, ideology should never override evidence. Children who are distressed about their biological sex need evidence-based care that facilitates their journey to adulthood, keeping them mentally and physically intact.
It’s time for the US to follow Europe’s example. Children’s healthcare must be evidence-led. Vulnerable children deserve nothing less.
Image by Iona and licensed via Adobe Stock.