March 14, 2023 - 10:36am

I don’t suppose President Biden reads the British Medical Journal. If he did, he might not be so keen on defending all sorts of invasive procedures for children with gender dysphoria, including surgery. In a ground-breaking editorial, the BMJ has acknowledged that US guidance for treatment of young people is not based on evidence. 

An investigation of the practice in the US has found that “more and more young people are being offered medical and surgical intervention for gender transition, sometimes bypassing any psychological support”. Such practices are supported by guidance from medical societies and organisations, but the BMJ says the strength of the recommendations is not matched by the strength of the evidence — and “the risk of overtreatment of gender dysphoria is real”. 

Not according to the President, however. In a TV interview broadcast on Monday evening, he condemned a proposed measure in Florida to ban medical interventions for under-18s as ‘cruel’. Adopting the folksy rhetoric he favours when speaking about the trans issue, Biden sounded like a regretful preacher looking out at a world that’s disappointed him. “What’s going on in Florida is, as my mother would say, close to sinful,” he said.

Florida’s boards of medicine and osteopathic medicine recently carried out an evidence review and voted to restrict hormonal and surgical treatment for minors, although patients already receiving cross-sex hormones are exempt. In the UK, many people are uncomfortable with the prospect of teenage girls being referred for treatments such as double mastectomies, euphemistically known as ‘top surgery’ by trans activists. 

The climate in the US is very different, as Biden’s incoherent ramblings attest:

It’s not like a kid wakes up one morning and says, ‘you know, I decided I wanted to become a man or want to become a woman’ or ‘I want to change’. I mean, what are they thinking about here? They’re human beings. They love. They have feelings. They have inclinations. 
- Joe Biden

‘Inclinations’ are hardly a reliable guide to treatment. Yet the affirmative model favoured in the US demonises doctors who ask questions, sometimes putting children and adolescents on an irreversible path before they’re old enough to understand the consequences. Last year, in a major policy shift, NHS England warned that most children who identify as transgender are going through a ‘transient phase’. It recommends a policy of ‘watchful waiting’ to avoid the risk of unnecessary interventions. 

It’s the polar opposite of what’s happening in the US, where a clamour for young people’s ‘gender identities’ to be affirmed has led to an exponential increase in double mastectomies in teenagers. They rose from around 100 in 2016 to almost 500 in 2019, with an age range from 12 to 17. The testimony of detransitioners is barely heard, allowing the treatment of young people with dysphoria to become a bitterly contested political issue. 

Democrats support gender-affirming care for ‘trans kids’ and denounce anyone who argues against it as a MAGA-loving Trump supporter. It’s a very different situation from this country, where the opposition to extreme gender ideology has been led by Left-wing feminists. The BMJ’s anxiety that “there is little room for constructive dialogue” applies more to the US than it does here, where the harm done by encouraging children to transition is widely recognised.

The BMJ points out that the best interests of young people require “evidence-informed” care. The widespread use of invasive treatments in the US without that evidence is a scandal. But it’s what happens when influential people like the President prefer quasi-religious nonsense to science.


Joan Smith is a novelist and columnist. She has been Chair of the Mayor of London’s Violence Against Women and Girls Board since 2013. Her book Homegrown: How Domestic Violence Turns Men Into Terrorists was published in 2019.

polblonde