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Medical groups are memory-holing their trans guidance

The AAP agreed that a systematic review of youth gender transition was needed. Credit: Getty

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.

elizamondegreen

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Hugh Jarse
Hugh Jarse
8 months ago

One suspects this scandal may not end by way of a quiet voluntary retreat by the guilty, but through a series of litigations and their associated ginormous, profession-busting settlements.

Jim Veenbaas
Jim Veenbaas
8 months ago
Reply to  Hugh Jarse

It could go either way. The lawsuits are coming no doubt. We’ve already seen a trickle – a case in Canada, a few in the US. However, these medical associations are political bodies. I’m sure they see the writing on the wall and will skillfully retreat before they are held accountable.

Noel Chiappa
Noel Chiappa
8 months ago
Reply to  Jim Veenbaas

They’ll certainly try; whether they’ll succeed -we’ll see.

James S.
James S.
8 months ago
Reply to  Jim Veenbaas

I wish that you were wrong, but I know how medical specialty societies work. As the old saying goes, doctors bury their mistakes.

Noel Chiappa
Noel Chiappa
8 months ago
Reply to  Jim Veenbaas

They’ll certainly try; whether they’ll succeed -we’ll see.

James S.
James S.
8 months ago
Reply to  Jim Veenbaas

I wish that you were wrong, but I know how medical specialty societies work. As the old saying goes, doctors bury their mistakes.

Robert Pruger
Robert Pruger
8 months ago
Reply to  Hugh Jarse

In this type of litigation it’s medical liability insurance that first pay. After a few very expensive settlements, these insurance companies will restrict coverage, exposing physicians to financially catastrophic losses. That’s how these surgical and chemical castrations will stop. Too late for the kids harmed. And not soon enough for children exposed to ideological fanatics.

James S.
James S.
8 months ago
Reply to  Hugh Jarse

As a U.S. physician who deplores the whole predatory pediatric trans industry, I would welcome some malpractice suits. They won’t undo the tremendous physical and psychic damage done to many kids, but they may at the least help pay for ongoing care. And chastise the perpetrators.

Hilary Easton
Hilary Easton
7 months ago
Reply to  James S.

Agreed, a couple of beheadings ‘pour encourager les autres’ as they say.

Hilary Easton
Hilary Easton
7 months ago
Reply to  James S.

Agreed, a couple of beheadings ‘pour encourager les autres’ as they say.

Jim Veenbaas
Jim Veenbaas
8 months ago
Reply to  Hugh Jarse

It could go either way. The lawsuits are coming no doubt. We’ve already seen a trickle – a case in Canada, a few in the US. However, these medical associations are political bodies. I’m sure they see the writing on the wall and will skillfully retreat before they are held accountable.

Robert Pruger
Robert Pruger
8 months ago
Reply to  Hugh Jarse

In this type of litigation it’s medical liability insurance that first pay. After a few very expensive settlements, these insurance companies will restrict coverage, exposing physicians to financially catastrophic losses. That’s how these surgical and chemical castrations will stop. Too late for the kids harmed. And not soon enough for children exposed to ideological fanatics.

James S.
James S.
8 months ago
Reply to  Hugh Jarse

As a U.S. physician who deplores the whole predatory pediatric trans industry, I would welcome some malpractice suits. They won’t undo the tremendous physical and psychic damage done to many kids, but they may at the least help pay for ongoing care. And chastise the perpetrators.

Hugh Jarse
Hugh Jarse
8 months ago

One suspects this scandal may not end by way of a quiet voluntary retreat by the guilty, but through a series of litigations and their associated ginormous, profession-busting settlements.

Stephen Walsh
Stephen Walsh
8 months ago

I’ve gone right off the medical profession in the past few years. To put it mildly.

Charles Stanhope
Charles Stanhope
8 months ago
Reply to  Stephen Walsh

You are NOT alone.

Charles Stanhope
Charles Stanhope
8 months ago
Reply to  Stephen Walsh

You are NOT alone.

Stephen Walsh
Stephen Walsh
8 months ago

I’ve gone right off the medical profession in the past few years. To put it mildly.

Studio Largo
Studio Largo
8 months ago

That such odious vermin are entrusted with the care of children is obscene. Everyone involved with this state approved mutilation of children should be criminally prosecuted.

Last edited 8 months ago by Studio Largo
Studio Largo
Studio Largo
8 months ago

That such odious vermin are entrusted with the care of children is obscene. Everyone involved with this state approved mutilation of children should be criminally prosecuted.

Last edited 8 months ago by Studio Largo
Julian Farrows
Julian Farrows
8 months ago

The horror stories of detransitioners are starting to come out. I recently read of one in Canada who wanted to be euthanized but wasn’t allowed to:
https://www.nationalreview.com/corner/transgender-woman-denied-euthanasia-in-canada-over-post-surgical-pain-and-regret/

Romi Elnagar
Romi Elnagar
7 months ago
Reply to  Julian Farrows

There will indeed be suicides, I’m afraid. The transgender folks have made a big deal about suicides by people who wanted to trans. Now, they are going to have to address the suicides by people who DID trans and then regretted it.
I cannot imagine how a boy who wakes up to realize what a crock the whole scheme that led to his castration was, but as he wakes up to the physical consequences day after day and realizes he will have to endure it for the rest of his life, it will be tough to reason him out of committing suicide.

Romi Elnagar
Romi Elnagar
7 months ago
Reply to  Julian Farrows

There will indeed be suicides, I’m afraid. The transgender folks have made a big deal about suicides by people who wanted to trans. Now, they are going to have to address the suicides by people who DID trans and then regretted it.
I cannot imagine how a boy who wakes up to realize what a crock the whole scheme that led to his castration was, but as he wakes up to the physical consequences day after day and realizes he will have to endure it for the rest of his life, it will be tough to reason him out of committing suicide.

Julian Farrows
Julian Farrows
8 months ago

The horror stories of detransitioners are starting to come out. I recently read of one in Canada who wanted to be euthanized but wasn’t allowed to:
https://www.nationalreview.com/corner/transgender-woman-denied-euthanasia-in-canada-over-post-surgical-pain-and-regret/

Jim Veenbaas
Jim Veenbaas
8 months ago

I suppose we will see the same thing with net zero. You can already see the Tories retreating, even though they introduced most of the legislation. They’ll do it incrementally, approve some drilling permits here, argue against driving restrictions there. I’m sure the EV mandates will be pushed back to 2035 and then totally memory holed shortly later.

Steve Murray
Steve Murray
8 months ago
Reply to  Jim Veenbaas

I agree, and i think the relevant expression is “kicked into the long grass” which i must admit, sounds suitably green.

Steve Murray
Steve Murray
8 months ago
Reply to  Jim Veenbaas

I agree, and i think the relevant expression is “kicked into the long grass” which i must admit, sounds suitably green.

Jim Veenbaas
Jim Veenbaas
8 months ago

I suppose we will see the same thing with net zero. You can already see the Tories retreating, even though they introduced most of the legislation. They’ll do it incrementally, approve some drilling permits here, argue against driving restrictions there. I’m sure the EV mandates will be pushed back to 2035 and then totally memory holed shortly later.

Nik Jewell
Nik Jewell
8 months ago

We’ve kept the receipts.

Nik Jewell
Nik Jewell
8 months ago

We’ve kept the receipts.

Derek Smith
Derek Smith
8 months ago

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

This is a great turn of phrase, but if true, it is a good thing that the internet never forgets, and as Nik Jewell has pointed out, there are plenty of receipts.

Derek Smith
Derek Smith
8 months ago

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

This is a great turn of phrase, but if true, it is a good thing that the internet never forgets, and as Nik Jewell has pointed out, there are plenty of receipts.

Jane Awdry
Jane Awdry
8 months ago

“…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?”
If it wasn’t so serious & so tragic, I’d be holding my aching sides at the comedy value of this. How on earth have these once-trusted institutions travelled so far from their scientific roots? And from reality? It’s not as if we haven’t had sufficient warnings from history. Tyranny creeps in via distraction & sleight of hand.

Edward De Beukelaer
Edward De Beukelaer
8 months ago
Reply to  Jane Awdry

it is interesting to try and look for the start of our current medical model: A important turning point can be traced back to the beginning of the 20th century when the Carnegie family sent out their emissaries to find out in which universities/colleges medics were taught to make potions you can sell. (In that time, medicine was practiced in many different ways) They then send their money to promote research to these medical schools who were specialised in the making of potions in order to find/develop ‘concoctions that can be sold’ . Here we are: we consider this high quality modern medicine now.
For the anecdote: Mr Rockefeller thought the world of homeopathy which he used as his medicine and set up his fund to promote research in this approach to health and disease. The guy who ran the fund then joined forces with the Carnegies…..
… and before you start throwing rotten tomatoes: https://www.ikim.unibe.ch/about_us/divisions/classical_homeopathy___potentiazed_substances/index_eng.html ….

Edward De Beukelaer
Edward De Beukelaer
8 months ago
Reply to  Jane Awdry

it is interesting to try and look for the start of our current medical model: A important turning point can be traced back to the beginning of the 20th century when the Carnegie family sent out their emissaries to find out in which universities/colleges medics were taught to make potions you can sell. (In that time, medicine was practiced in many different ways) They then send their money to promote research to these medical schools who were specialised in the making of potions in order to find/develop ‘concoctions that can be sold’ . Here we are: we consider this high quality modern medicine now.
For the anecdote: Mr Rockefeller thought the world of homeopathy which he used as his medicine and set up his fund to promote research in this approach to health and disease. The guy who ran the fund then joined forces with the Carnegies…..
… and before you start throwing rotten tomatoes: https://www.ikim.unibe.ch/about_us/divisions/classical_homeopathy___potentiazed_substances/index_eng.html ….

Jane Awdry
Jane Awdry
8 months ago

“…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?”
If it wasn’t so serious & so tragic, I’d be holding my aching sides at the comedy value of this. How on earth have these once-trusted institutions travelled so far from their scientific roots? And from reality? It’s not as if we haven’t had sufficient warnings from history. Tyranny creeps in via distraction & sleight of hand.

Andrew Buckley
Andrew Buckley
8 months ago

Hugh Jarse is on the right track. Mot until the various medical insurance providers get involved will there be a “forgetting”.
Once the wallet is exposed quite a lot will change.

Jane Awdry
Jane Awdry
8 months ago
Reply to  Andrew Buckley

Not so easy for them to ‘forget’ their previous stance when it’s all out there in cyberspace…

Jane Awdry
Jane Awdry
8 months ago
Reply to  Andrew Buckley

Not so easy for them to ‘forget’ their previous stance when it’s all out there in cyberspace…

Andrew Buckley
Andrew Buckley
8 months ago

Hugh Jarse is on the right track. Mot until the various medical insurance providers get involved will there be a “forgetting”.
Once the wallet is exposed quite a lot will change.

Susan Grabston
Susan Grabston
8 months ago

Meanwhile, ongoing collateral damage.

Charles Stanhope
Charles Stanhope
8 months ago
Reply to  Susan Grabston

Which WILL be simply enormous.

Charles Stanhope
Charles Stanhope
8 months ago
Reply to  Susan Grabston

Which WILL be simply enormous.

Susan Grabston
Susan Grabston
8 months ago

Meanwhile, ongoing collateral damage.

Mike Downing
Mike Downing
8 months ago

See Milan Kundera’s novel / Black comedy ‘The book of laughter and forgetting’ which in part references living in a dystopian society built on lies.

Last edited 8 months ago by Mike Downing
Mike Downing
Mike Downing
8 months ago

See Milan Kundera’s novel / Black comedy ‘The book of laughter and forgetting’ which in part references living in a dystopian society built on lies.

Last edited 8 months ago by Mike Downing
Daniel Lee
Daniel Lee
8 months ago

Shorter: The Left tells lies and then lies about having told them.

Richard Craven
Richard Craven
8 months ago
Reply to  Daniel Lee

Quite so. Even shorter: the Left lies and then metalies.

Romi Elnagar
Romi Elnagar
7 months ago
Reply to  Daniel Lee

“Be careful when you point a finger. Remember: you’re pointing three back at yourself.”

Richard Craven
Richard Craven
8 months ago
Reply to  Daniel Lee

Quite so. Even shorter: the Left lies and then metalies.

Romi Elnagar
Romi Elnagar
7 months ago
Reply to  Daniel Lee

“Be careful when you point a finger. Remember: you’re pointing three back at yourself.”

Daniel Lee
Daniel Lee
8 months ago

Shorter: The Left tells lies and then lies about having told them.

Edward De Beukelaer
Edward De Beukelaer
8 months ago

In relation to medicine in general and certainly valid in this particular case, Ian McGilchrist wrote: It is significant that the ’normal’ scientific materialist view of the body is similar to that found in schizophrenia” (The Master and his emissary P439)
Luckily trends such as System view of life, One health, Integrative medicine may change our medical approaches for the better, unless the industry of health (illness) appropriates these concepts. Up to the people to stand up for a different kind of medicine…

Richard Craven
Richard Craven
8 months ago

Fine, as long as it doesn’t mean prescribing psychotherapy for appendicitis.

Richard Craven
Richard Craven
8 months ago

Fine, as long as it doesn’t mean prescribing psychotherapy for appendicitis.

Edward De Beukelaer
Edward De Beukelaer
8 months ago

In relation to medicine in general and certainly valid in this particular case, Ian McGilchrist wrote: It is significant that the ’normal’ scientific materialist view of the body is similar to that found in schizophrenia” (The Master and his emissary P439)
Luckily trends such as System view of life, One health, Integrative medicine may change our medical approaches for the better, unless the industry of health (illness) appropriates these concepts. Up to the people to stand up for a different kind of medicine…

Judy Englander
Judy Englander
8 months ago

Excellent article.

Judy Englander
Judy Englander
8 months ago

Excellent article.

Brendan O'Leary
Brendan O'Leary
7 months ago

Being memory-holed and recast as a minor adjustment (if it’s acknowledged at all) is probably the best one can hope for. Accountability is for the little people.
At best it will be seen as a minor issue that only far-right conspiracy theorists want to make a big deal of , and not one that should threaten the “but it’s just about being kind!” gender-affirmation model.