by Eliza Mondegreen
Friday, 26
August 2022
Analysis
11:28

The American Academy of Pediatrics is denying reality

Frustrated doctors are beginning to go public
by Eliza Mondegreen
“The AAP has bent and broken its own rules in order to enforce the party line” (Photo by Romy Arroyo Fernandez/NurPhoto via Getty Images)

The American Academy of Pediatrics has a gender problem. But it really doesn’t want to talk about it. And it doesn’t want its 67,000 members to talk about it eitherThe Academy, the top professional organisation for paediatricians in the United States, has gone all in on “gender-affirming care” in recent years, publishing “evidence-based” guidance on pubertal suppression (which the Academy describes as “reversible”), cross-sex hormones, and “gender-affirming surgeries”. It has condemned alternative perspectives and approaches as bigoted, harmful, and futile. 

There were good reasons to question this approach back when it became official policy in 2018. There’s even more cause for concern now, with dissidents within the field raising concerns about affirmative care and calling for a systematic review of the evidence. Rather than listen, however, the AAP has bent and broken its own rules in order to enforce the party line. So much for “evidence-based”. 

But the Academy may not be able to contain the issue for much longer, as frustrated critics have started to take their concerns public. Last week, the controversy broke out on the editorial pages of the Wall Street Journal, where paediatrician Julia Mason and researcher Leor Sapir charged the AAP with “ignor[ing] the evidence that has led Sweden, Finland and most recently the U.K. to place severe restrictions on medical transition for minors” and with “stifl[ing] debate on how best to treat youth in distress over their bodies”.

Academy President Moira Szilagyi responded that the AAP takes an open, “developmentally appropriate” approach to gender-questioning children that “allows questions and concerns to be raised in a supportive environment.” “This is what it means to ‘affirm’ a child or teen,” Szilagyi insists: “it means destigmatising gender variance and promoting a child’s self-worth. Gender-affirming care can be lifesaving. It doesn’t push medical treatments or surgery; for the vast majority of children, it recommends the opposite.” On Twitter, the Academy’s social media team went further: gender affirmation “has never been about pushing medicines or surgery. Medicines or surgery are options that may be considered by families and their care team on a case-by-case basis, but are not the goal of gender-affirming care, contrary to how critics have often mischaracterized the AAP’s recommendations.” 

There may be compelling strategic reasons to take the AAP at its word when it insists that gender-affirming care recommends “the opposite” of drugs and surgery. Doing so might require them to explain why so many American paediatricians, inspired by AAP guidelines, are rushing gender-distressed youth into social and medical transition. But Szilagyi’s defensive statement doesn’t mark a “reversal”, as Mason and Sapir claim in a follow-up letter. Rather, it’s just the latest move by affirming advocates to shut down debate by pretending there’s nothing to talk about. Drugs and surgery are “not the goal of gender-affirming care”, the Academy insists. But of course drugs and surgery aren’t the goal. The goal is to “affirm” a child’s gender-variant identity. Drugs and surgery are just the means by which this identity can be affirmed. 

The playbook is familiar by now. Advocates for a more cautious, exploratory approach want to talk about specifics: what is the relationship between social transition and medical interventions? How does the AAP square its condemnation of “watchful waiting” with Szilagyi’s call for “developmentally appropriate care that is oriented toward understanding and appreciating the youth’s gender experience”? Rather than answering these questions, proponents of affirmative care retreat behind abstractions like “promoting a child’s self-worth”.

What the AAP can’t and won’t engage with is the possibility that their recommendations around gender-affirming care aren’t neutral, that affirmation may solidify a child’s sense that they really are in the wrong body, and that the cascade of interventions that often follow a youthful self-declaration amount to an unregulated medical experiment on underage patients, with unknown consequences for cognitive, psychosocial, physical, and sexual development. When professional associations like the AAP dismiss good-faith critics as “anti-transgender activists” and bend or break their own rules to prevent open dialogues from taking shape, entire fields can lose their way and harm in the name of healing. 

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Johann Strauss
Johann Strauss
3 months ago

The situation regarding gender affirmation is really very straightforward. Nothing should be done until the individual is a fully grown adult – that means at a minimum 18 years of age at which time they can make decision without parental agreement. The fact of the matter is that children are not in a position to take such momentous decisions and it is not appropriate for ideologically motivated parents to push their children towards gender reassignment rather than simply pass through a rather normal developmental stage.

philip kern
philip kern
3 months ago
Reply to  Johann Strauss

In much of the US, they can’t legally buy a beer until they’re 21.

Tara Fink
Tara Fink
2 months ago
Reply to  philip kern

In ALL of the US you can’t buy alcohol until you’re 21. You can’t rent a car until you’re 25. You can’t sign a legally binding contract until you’re 18. But you want a double mastectomy at 16 – go for it! It’s madness.

William Shaw
William Shaw
2 months ago
Reply to  Johann Strauss

Some children are suicidal well before 18. Those that are not are often severely depressed and cease to engage socially and educationally.
The simplistic solution you propose might do more damage than the existing approach.

Phillip Bailey
Phillip Bailey
2 months ago
Reply to  William Shaw

I realise this is of course a non-question, but one wonders also how many people who undergo some form of supported treatment may then go on to regret such later in life, having been supported in their choices in teenage years, and God forbid – go on to be suicidal adults as a result of their choices… there are no easy answers here, for sure, time will sadly tell…

Warren Trees
Warren Trees
2 months ago
Reply to  William Shaw

On the contrary, allowing children to manage their own psychoses is rather astonishing. These mentally damaged children need mental health care more than anything else.

Aphrodite Rises
Aphrodite Rises
2 months ago
Reply to  William Shaw

What was the suicide rate amongst children for non-transitioning before such a thing was possible? I don’t remember ever hearing of a child committing suicide for any reason when I was young.

Emre 0
Emre 0
2 months ago

All this feels like (yet another) attempt to conceal the failure of the scientific establishment to support a meaningful life for youngsters and those youngsters’ linked growing mental destabilisation. They are moving the goal post in what’s needed so they stay relevant in the conversation.

R Wright
R Wright
2 months ago
Reply to  William Shaw

Given that transition is actually associated with increased rates of attempted suicide, it would be doing them a favour.

Alison Wren
Alison Wren
2 months ago
Reply to  Johann Strauss

The final maturation of the brain happens around 25 years, when risks can be accurately balanced. There’s a reason why armies love young recruits…… so I’d say nothing irreversible until 25.

Jane Watson
Jane Watson
2 months ago
Reply to  Johann Strauss

I know several sets of parents who are desperate for their child not to be ‘affirmed’ by GIDS. They are accused of being transphobic and sidelined. Some parents may be ideologically motivated but I would hazard a guess that most family members of trans children are traumatised.

Allison Barrows
Allison Barrows
3 months ago

I used to wonder how the surgeons involved in making monsters of Michael Jackson and Jocelyn Wildenstein weren’t in jail, and now look where we are. The Mengeles who sexually mutilate children and proclaim themselves to be “affirming” are like eugenicists telling depressed and disabled people death will be good for them.

Andrew F
Andrew F
2 months ago

But why should surgeons operating on consenting adults be in jail?
It is completely different from surgeons operating on minors.
Maybe some lawyers can explain how is it legally possible?

Last edited 2 months ago by Andrew F
M. Jamieson
M. Jamieson
2 months ago
Reply to  Andrew F

Consent isn’t the only arbiter of what is ethical. There are all kinds of areas we don’t allow adults to “consent” to.
Doctors are not supposed to make patients less healthy unless there is a weighty reason such as stopping a cancer that is more dangerous than the cure. Cosmetic surgery in general is on the line, and many would say, over it, risking the patient’s health for aesthetic choices.

Richard Craven
Richard Craven
2 months ago

I’m mystified as to why the law doesn’t treat these people and their procurers as sadistic paedophiles.

Linda Hutchinson
Linda Hutchinson
2 months ago
Reply to  Richard Craven

Sorry, but I don’t understand this comparison of gender-affirmation and gender surgury with gooming and paedophiles. There are a shed load of problems with what they are doing – but paedophilia? Could someone explain it to me?

Liz
Liz
2 months ago

I would recommend the website Reduxx for the best explanation of the links with paedophilia and trans. There is apparently a male member of the WPATH board that also runs/ contributes to a fictional child pornography story site. They glorify forced feminisation of boys, ie castration. Members also share a fetish for their own and others castration.
Also, if children never go through puberty, they remain children with no sexual function.

James Thomas
James Thomas
3 months ago

The lawsuits will break the doctors involved and other organisations (maybe even patents) when the damaged children reach adulthood and can act on their own behalf.

John Pade
John Pade
3 months ago
Reply to  James Thomas

Settlements forced upon aligned organizations are paid by the public purse. That way they avoid responsibility and are free and even encouraged to proceed to the next objective.

laurence scaduto
laurence scaduto
2 months ago
Reply to  John Pade

This doesn’t sound right. Can you give an example?

Hardee Hodges
Hardee Hodges
2 months ago
Reply to  James Thomas

Sadly the children who were forever harmed are not likely to ever use the law. They are more likely to die in dispair.

Call Gretchen
Call Gretchen
2 months ago
Reply to  James Thomas

The doctors can’t be sued on this one. These are experimental surgeries and experimental hormonal treatments. The patients all signed off on this saying they understood that. Who knows if anything really went wrong? It’s experimental surgery. Who knows? It’s not like open heart surgery or hip replacement.

M. Jamieson
M. Jamieson
2 months ago
Reply to  Call Gretchen

I don’t think it’s that simple – even having signed off, doctors can be shown to be negligent. And arguably minors can’t agree to something like this anyway.

Mark Kerridge
Mark Kerridge
2 months ago

As has been said before, a trans child is like a vegan cat – it’s not the cat that has made the decision..

Jane Walsh
Jane Walsh
3 months ago

« an unregulated medical experiment on underage patients, with unknown consequences for cognitive, psychosocial, physical, and sexual development« 
Exactly.

R Ec
R Ec
3 months ago

much pro-trans is pure homophobia.

Joan Pearson
Joan Pearson
3 months ago
Reply to  R Ec

And misogyny.

Richard Craven
Richard Craven
2 months ago
Reply to  Joan Pearson

And paedophilia.

Linda Hutchinson
Linda Hutchinson
2 months ago
Reply to  Richard Craven

As I asked above – wheredoes the paedophilia come into it?

Sharon Overy
Sharon Overy
2 months ago
Reply to  R Ec

Apparently, the Tavistock had an in-joke that soon there’ll be no homosexuals – because they’d have got rid of them!

Martin Smith
Martin Smith
2 months ago

If gender is just a social construct, why does physical and hormonal makeup matter at all?

Ian Stewart
Ian Stewart
3 months ago

A few successful medical malpractice lawsuits by incorrectly treated children should make the AAP change its stance. Expect we’ll start seeing these happening soon.

Anonymous
Anonymous
2 months ago

William Shaw….are you personally affected or have a family member who has been? And, how do you know all people commenting are on the sidelines without asking?
I do agree with you though in your comment that if you are not personally affected, it is difficult to grasp the lived experience. One can empathize, but to embody the experience would be very very challenging.
I will not speak for others here, this is my concern…..children who are still developing their minds/bodies/sense of self identity, making a decision in a child’s mind/body state and adults going forward with altering their minds/bodies. We have laws to protect children for a reason, they are children. Once they reach the age and majority where they live, as an adult, then start down the road to transitioning.
Children make decisions all the time that are child like, adults are to be there to safe guard and protect until the child is an adult.

William Shaw
William Shaw
2 months ago
Reply to  Anonymous

I do agree with you though in your comment that if you are not personally affected, it is difficult to grasp the lived experience. One can empathize, but to embody the experience would be very very challenging.”
That’s all I was saying and apparently you agree with me.

Brian Villanueva
Brian Villanueva
2 months ago

The number of American children in gender treatment has, even by conservative estimates, increased by 20X in the last decade. The vast majority of these are in puberty blockers or cross-sex hormones (A leads to B in 96%+ of all cases).
You can scream that “gender affirming care” doesn’t push kids into irreversible actions until you’re blue in the face, but actions speak louder than words. And your actions say you do and are doing exactly that.

Sharon Overy
Sharon Overy
2 months ago

The thing that doesn’t get pointed out is the difference in attitude by the trans-activists depending on whether they’re talking about children or adults.

For adults, the call is to de-medicalise the issue. That medical intervention, or even a gender dysphoria diagnosis, is unnecessary. Self ID is sufficient. Presumably because the vast majority don’t follow that route – they merely change how they present and what they call themselves.

Simultaneously, we’re told that children must be hyper-medicalised. That it is vitally important to stuff them full of harmful chemicals, a lifetime of synthetic hormone analogues and fast-track them for surgery. I suspect it’s because, if allowed to go through natural puberty, the vast majority of trans-presenting kids change their minds. As their hormones settle into a new equilibrium, so does their sense of self. They may simply realise/accept that they’re gay. Puberty blockers seem intended to prevent this process.

R Wright
R Wright
3 months ago

It’ll take a legion of personal injury lawyers to end this farce.

Charles Lewis
Charles Lewis
3 months ago

The AAP have been unfit for purpose for years.The scandal they have been supporting ranks with the horrors of the craze for lobotomy and with the madness over false memory syndrome. They will have a heavy reckoning to pay.

Caroline Minnear
Caroline Minnear
2 months ago

As a young teenager I was absolutely 100% certain I wanted a massive dragon tattoo running down my back, curling its tail around my waist…my mum (without judgement) told me just to wait. Good work mum!
As young people we have all been certain of something, most of us played out in different identity groups, goth, punk, ravers, surfers, hippies etc. It’s a sense of wanting to belong to something. To have a tribe.
I am the mother of three boys & as very little people they ALL loved to wear the “girl things” the frills and sparkles and silky and feathery and floaty. These were fun and tactile and waaaaaay more interesting than boring grey shorts with green dinosaurs. But I never thought they were going to be gender confused kids, I’m not sure they even thought about “being boys” particularly. They were children being children.
I do feel concern for the medicalization/ surgery for young people. But I also can’t identify with the feeling that I don’t belong in my body. That must be an incredibly uncomfortable feeling.
And I these humans need tender care and support and acceptance until they are old enough to make their own permanent decisions about their bodies.

Richard Craven
Richard Craven
2 months ago

Yet another institution captured by sadistic paedophilia and its pandars.

Linda Hutchinson
Linda Hutchinson
2 months ago
Reply to  Richard Craven

sadistic paedophilia and its pandars.
Please explain the connection between these terms and what is happening to children who are being medicalised?

Michael Friedman
Michael Friedman
2 months ago

Thank you.

William Shaw
William Shaw
2 months ago

I’m currently rating -33 on this topic, which must be something of an achievement relative to opposing groupthink.

Julian Farrows
Julian Farrows
2 months ago
Reply to  William Shaw

I think a lot of people just don’t understand it. Me personally, I view it the same as alcohol and tobacco. Fine if adults want to engage in it, but just please don’t push it on to children who have no concept of sexual desire. What I gather from reading the comments here is that no one is against transgender individuals per se, but most are dead set against having transgender ideology legitimized through government language and hate speech laws.
The idea of a group of adults being paid to surgically and irrevocably alter a child’s genitalia is totally macabre to me.

Derek Smith
Derek Smith
2 months ago
Reply to  William Shaw

I’ve check all comments settings and I still cannot read the comment you posted.

William Shaw
William Shaw
3 months ago

There seem to be a lot of comments on this topic from people on the sidelines. People not affected personally are expressing opinions about how others should live and behave.
I suspect that if you are not personally affected it’s impossible to fully understand the topic.

Last edited 3 months ago by William Shaw
Ian Stewart
Ian Stewart
3 months ago
Reply to  William Shaw

So you support censoring people’s views then? Strange forum to be doing this.

William Shaw
William Shaw
2 months ago
Reply to  Ian Stewart

No, of course not and that’s not what I wrote.
I simply stated that, as far as this subject is concerned, if you are not personally affected then you probably don’t know what you are talking about.

Hardee Hodges
Hardee Hodges
2 months ago
Reply to  William Shaw

When you see a child being abused, what then? You are not the parent, you are not the child. Children being brain washed by certain elements is abuse.

Warren Trees
Warren Trees
2 months ago
Reply to  William Shaw

I’m not personally affected by many things, such as prostitution, human trafficking and child abuse. That doesn’t mean I can’t figure out that they are simply wrong.

Max Price
Max Price
2 months ago
Reply to  William Shaw

This is the worst type of argument. I imagine you don’t disregard people who aren’t affected who agree with you. Also, what of the experiences of people in the rapidly expanding de-transition movement.
Are they to be silenced/sacrificed on the alter?
At the very least you must be able to see that we have a massive over diagnosis issue? Rapid onset, peer group clusters.
What about the over representation of spectrum kids, kids with trauma, eating disorders, gay kids?
Does none of this bother you at all?

Last edited 2 months ago by Max Price
Richard Craven
Richard Craven
2 months ago
Reply to  Max Price

The best way to counter the “you can’t comment without lived experience” wing of wokery is bluntness. I find that the following formulation usually silences them:-
“I say what I like, when I like, to whom I like.”

Max Price
Max Price
2 months ago
Reply to  Richard Craven

My line is “I reserve the right to comment on whatever I like”. It’s such a childish anti-intellectual argument.

Richard Craven
Richard Craven
2 months ago
Reply to  William Shaw

Ugh! Woke! How disgusting.

0 0
0 0
2 months ago
Reply to  William Shaw

William Shaw….are you personally affected or have a family member who has been? And, how do you know all people commenting are on the sidelines without asking?
I do agree with you though in your comment that if you are not personally affected, it is difficult to grasp the lived experience. One can empathize, but to embody the experience would be very very challenging.
I will not speak for others here, this is my concern…..children who are still developing their minds/bodies/sense of self identity, making a decision in a child’s mind/body state and adults going forward with altering their minds/bodies. We have laws to protect children for a reason, they are children. Once they reach the age and majority where they live, as an adult, then start down the road to transitioning.
Children make decisions all the time that are child like, adults are to be there to safe guard and protect until the child is an adult.

William Shaw
William Shaw
2 months ago
Reply to  0 0

So basically we agree on the point I was making.

Aaron James
Aaron James
2 months ago
Reply to  William Shaw

“I suspect that if you are not personally affected it’s impossible to fully understand the topic.”

Are you basically saying if you have not been personally involved in child abuse you do not understand it enough to hold opinions on it?

Richard Craven
Richard Craven
2 months ago
Reply to  Aaron James

Thanks for dealing with the lived experience nazi.