August 4, 2023 - 5:10pm

This week, the American Academy of Pediatrics (AAP) announced that it was setting out on the long road back to plausible deniability. 

At a meeting this week, all 16 AAP board members voted to reaffirm the organisation’s 2018 guidelines on how paediatricians should support “transgender and gender-diverse children and adolescents” — before agreeing that a systematic review of the evidence supporting youth gender transition was in order. 

The academy’s current guidelines claim puberty blockers are “reversible” (the UK’s National Health Service now warns that “little is known about the long-term side effects of hormone or puberty blockers in children with gender dysphoria”). On the subject of “surgical affirmation” — an Orwellian term if ever there was one — the AAP advises that adolescents may undergo interventions to amputate breasts or genitalia on a case-by-case basis. The guidelines also take social transition — a psychosocial intervention in which a child’s entire social circle is enlisted in a conspiracy to lie to them about their sex — without due seriousness, despite evidence suggesting that social transition makes it harder for children to change their minds and accept their bodies. 

According to the New York Times, Mark Del Monte, the chief executive of the AAP, said: “the board has confidence that the existing evidence is such that the current policy is appropriate. At the same time, the board recognized that additional detail would be helpful here.” This is a change of tune from AAP leadership, which has spent years resisting calls from within its own ranks for just such a review, going to extraordinary lengths to shut down dissent. 

But this is how organisations start to walk back from a medical scandal. Quietly, slowly — ideally so quietly and so slowly that no one notices they’ve retreated from shaky to solid ground at all.  

First, they redefine “gender-affirming care” to deemphasise controversial hormonal and surgical interventions. Moira Szilagyi, then-President of the AAP, tried this move out last year, when she insisted that “destigmatizing gender variance and promoting a child’s self-worth” is “what it means to ‘affirm’ a child or teen”. (Funny that the Academy’s guidelines spilt so much ink on “medical affirmation”, then, while demonising watchful waiting.) On social media, the AAP suggested that gender-affirming care has “never been about pushing medicines or surgery”. We’ve also seen efforts elsewhere to broaden the umbrella of gender-affirming care to the point of meaninglessness, such that taking birth control pills, getting an abortion, and telling little girls it’s okay to wear dresses are all gender-affirming care now. Who knew?

Then they’ll claim that this was all “gender-affirming care” ever meant all along. Who was talking about hormones and surgeries? Who was advocating a massive medical experiment in suppressing pubescent development? Medical professional associations like the American Academy of Pediatrics will magically rediscover everything they used to know about child and adolescent development. They will pretend they never overlooked these things. It’ll just be years too late for kids who transitioned under their guidance. 

Medical scandals don’t tend to end with reckonings. They tend to end with a mass forgetting: with amnesia, not accountability for those who caused harm — no matter how righteous their intentions.

Eliza Mondegreen is a graduate student in psychiatry and the author of Writing Behavior on Substack.