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American Academy of Pediatrics faces internal split over gender transitions

'The secretive attitude surrounding this year’s conference is in keeping with the AAP’s treatment of transgender issues in recent years.' Credit: Getty

October 2, 2024 - 10:00am

Members of the American Academy of Pediatrics who have pushed back against the organisation’s official endorsement of cross-sex medical treatments for minors have been met with a culture of secrecy and intimidation from the leadership, according to AAP insiders.

Ahead of its annual conference this past weekend, the AAP denied a press pass to journalist Benjamin Ryan, and denied trans-sceptical organisation, the Foundation Against Intolerance and Racism, the opportunity to host an exhibit. A group of detransitioners — individuals who underwent medical transitions in adolescence but now seek to live as their birth sex — hosted a booth at this year’s conference, and were ultimately kicked out of the event by security. The conference’s LGBT affinity group session, slated to last more than five hours, did not allow recording, required attendees’ electronic devices to be shut down, and requested that attendees not share the content of the programming with outsiders, Ryan reported. Even the session’s agenda was password protected.

The secretive attitude surrounding this year’s conference is in keeping with the AAP’s treatment of transgender issues in recent years. In December 2023, the AAP sent an email to its members in leadership roles urging them to use personal email addresses for AAP communications to “keep internal communications under the control of the AAP and its member leaders… including in response to subpoenas or Freedom Of Information Act (FOIA) requests.”

Dr. Julia Mason, an American paediatrician, AAP member, and vocal critic of the AAP’s handling of the trans issue, reached out to various members requesting a copy of the email. A week later, she received an email from AAP CEO Mark Del Monte which she characterised as “vaguely threatening”.

“If, in the future, you have questions about AAP operations or policies, please feel free to reach out to me directly. I will provide you whatever information I am able to share,” the email read. He did not, however, share the email Mason had been seeking.

This secrecy, and the organisation’s eagerness to stifle dissent on the gender issue, impedes the scientific process, according to Dr. Patrick Hunter, a paediatrician and AAP member, who spoke in his own capacity and not on behalf of the Florida Board of Medicine, of which he is a member. “They are not interested in dialogue and discussion which, in the past, was an integral part of science and academic progress,” he told UnHerd. “Through the years I have emailed Mr. Del Monte and AAP presidents, Sandy Chung and Moura Szilagyi. I have left voicemails with Mr. Del Monte on several occasions. I have never had a response.”

Hunter resigned his AAP membership in the late 2010s over his objection to their handling of the transgender issue, but has since rejoined “to have a voice in the organisation.” Annual dues for AAP membership exceed $600, a motivating factor for some gender-critical doctors to leave the organisation.

An issue that arose repeatedly in interviews with AAP members was the sense of mystery surrounding the organisation’s policy on youth transitions. A 2018 paper by Dr. Jason Rafferty, which represents the official position of the AAP, supports “comprehensive gender-affirming care” for youth, to include “medical, psychological, and, when indicated, surgical gender-affirming interventions”. The policy was adopted despite a lack of consensus among members and a lack of empirical evidence supporting these medical procedures. The AAP’s policy is a cornerstone of the perception of consensus within the medical community, and is frequently cited by opponents of legal restrictions on youth medical transitions.

Numerous systematic reviews have found insufficient evidence for cross-sex medical interventions for minors. The AAP pledged last August to conduct its own systematic review of the evidence on cross-sex medical interventions. The organisation has not released any new information on the review in the year since, and did not respond to a request for comment on the issue. “There was such a sense of relief when they said they would look at the data,” one paediatrician and AAP member, speaking anonymously, told UnHerd. “And now, a year later, they still haven’t published the inclusion criteria.”

The World Professional Association for Transgender Health (WPATH) similarly pledged to commission a systematic review in 2020, and leaked emails reveal they found “little to no evidence” to support cross-sex treatments for minors. WPATH then blocked researchers from publishing the findings and continued to publicly endorse the procedures.

The AAP now finds itself in a difficult position, as international evidence increasingly weighs against their longstanding position of support for irreversible cross-sex treatments for minors. A policy reversal or a refusal to update their policy both risk damaging doctors’ trust in the institution, whose medical guidelines serve as the gold standard for paediatric medicine in the US.

“You cannot overstate the importance of the AAP to paediatrics,” the anonymous paediatrician told UnHerd. “It’s difficult to function without their role, because they give us the guidelines for everything, and they’re supposed to be evidence based.” Medical guidelines typically follow the Chain of Trust, in which information travels from university researchers to medical societies to practitioners. In the case of the AAP and gender medicine, the doctor argued, this trust has been broken. “The quality of evidence needed to justify these life changing, irreversible, harmful interventions is just not there.”


is UnHerd’s US correspondent.

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N H
N H
2 hours ago

Even the idea of calling these interventions “treatment” for anyone, at any age, is misguided. This is nothing more and nothing less than cosmetically-driven body modification.

It makes as much sense to prescribe these interventions to people experiencing psychiatric distress about their natal sex as it would to offer nose jobs or surgical sculpting to people who are body dysmorphic or extremely anxious about their appearance. Actually, it’s even crazier, because rhinoplasties are at least an established procedure which do not tend to result in infertility, risk of infection, loss of sexual function, or organ damage.

How these interventions ever became codified as medical guidelines for any group of patients — let alone minors — is a scandal of our times.

Last edited 1 hour ago by N H
Talia Perkins
Talia Perkins
25 minutes ago
Reply to  N H

“Even the idea of calling these interventions “treatment” for anyone, at any age, is misguided.”
Except it is perfectly accurate, because it is the gender of any person that naturally drives them to be perceived as men or women, or neither in particular, and to feel that. The brain of the person is in charge of them, not their left elbow or right earlobe, or their sex. Neither is your perception of the importance their sex should in your eyes have to them what has any right to control them at all.
The changes surgically made are function, not appearance only. I do know that.
How these interventions became the standard of care for nearly three decades now with a better than 99% accuracy rate is because your claim this is a psychiatric condition is false. It is physical difference in development occurring in utero no more psychiatric than is a harelip or a clubbed foot. It was once presumed it was a psychiatric problem, and probably before then presumed to be the torment done by demons — and both presumptions are proven to empirically to be false.
Treating the matter as a physical variance in fetal development has proven to be very successful — because it is that.

Last edited 17 minutes ago by Talia Perkins
Paul Thompson
Paul Thompson
21 minutes ago
Reply to  Talia Perkins

Gender is nonexistent. Only pervert trannies like you, Talia, believe in this complete shit.

Talia Perkins
Talia Perkins
9 minutes ago
Reply to  Paul Thompson

“Gender is nonexistent.”

Thank you for revealing your delusion plainly.

“Only pervert trannies like you, Talia, believe in this complete shit.”

On the basis of evidence — that which you are bereft of — also well over 99% of all persons in the medical practice and biological research fields.

Last edited 9 minutes ago by Talia Perkins
Jeremy Bray
Jeremy Bray
1 hour ago

The problem is that those who passionately promote trans surgery for minors are either ideologically captured or making a lavish living of them and are eager to suppress any evidence against such surgery. This is not science and unfortunately those not directly involved have little incentive to get involved and push back.

Talia Perkins
Talia Perkins
17 minutes ago
Reply to  Jeremy Bray

No, you are merely a child abuser dedicated to supporting the child abuse you love, because getting away with carrying out that abuse affirms your delusional worldview to you — and — one of these two delusional opinions you hold.
1) that gender does not physically exist at all
2) that if it does it is always physically identical to the sex of a person.
You believe this despite the objectively measured and physical facts proving you wrong, because for reason as yet undelved in in your psychology, you can not deal with the actual complexity of the world, and you are prepared to advocate grotesque child abuse for the sake of those lies you love.
That child abuse you love is to force some boys to grow up with breasts and periods, and to force some girls to have beards and deep voices.

Alex Lekas
Alex Lekas
1 hour ago

The profession has moved quite a ways from ‘do no harm.’ And you have to admire the display of openness and tolerance for anyone who is not completely on board with the dogma. When you are in favor of life-altering medical procedures that are in no way life-saving, you are no longer practicing medicine.

Talia Perkins
Talia Perkins
11 minutes ago
Reply to  Alex Lekas

“The profession has moved quite a ways from ‘do no harm.’”
Not that you have any evidence of that.
You just feel it so strong you think you need no evidence.

UnHerd Reader
UnHerd Reader
1 hour ago

This is truly one of the ugliest happenings of my 66 year lifetime!
Any medical professional involved with this macabre show should have their balls (or other appropriate body parts) removed and put in jail for life! Yes! I feel strongly about this!

Talia Perkins
Talia Perkins
12 minutes ago
Reply to  UnHerd Reader

And you have A) lied here to claim you are a physician in the United States or B) denied that only 1 in 825 physicians in the US agree with you, and that that 1 in 825 includes a dentist identifying as a physician who saw fit in the church they ran, to try to raise the dead by the power pf prayer.
The pollution in you of what should be rationally considered scientifically arrived at medical care, with your religious faith, merits your license being revoked, and your records exposed for discovery by litigants, along with the whole of your wealth divided up for recompense to your victims.
If you are actually a physician at all, incited of only your being a liar on the internet.

Paul Thompson
Paul Thompson
1 hour ago

The AAP is now fully captured by the grooming pervert wing of physicians. These are mostly young, mostly trannies who justify their self-perversion by capturing others into the foul stupidity of this cult. Every time a child becomes a trannie, this justifies the perverted status of current trannies. What must happen is that ANY physician who is a trannie, who is sexually ambiguous, must lose their medical license.

Daniel Lee
Daniel Lee
44 minutes ago

Slowly and haltingly, once reliable institutions corrupted by various forms of wokism are beginning to purge themselves of its toxic precepts. Unfortunately, the parasites controlling them are fighting back.

Talia Perkins
Talia Perkins
4 minutes ago
Reply to  Daniel Lee

You managed to miss the fact Duggan provided no evidence of actual division in the APA?
You are the corrupt parasite, believing your evidence-less delusions are more important than facts, you are possessed of the delusion you know relevant facts, and for the sake of the lies you love, you seek here advocate for the monstrous abuse of some children.
There is no more, no less, no other to you here.

Talia Perkins
Talia Perkins
55 minutes ago

No, Duggan — it does not. That is because only 1 in 825 physicians is temporarily insane or permanently evil or stupid enough to imagine there is any reason to oppose it.