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.”

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is UnHerd’s US correspondent.

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