We write to you from Genspect, an international and non-partisan organization which represents thousands of parents of gender dysphoric children, adolescents, and young adults, as well as trans people, detransitioners, clinicians, and allied groups. We want our children to be affirmed as whole human beings, and we want them to be treated with evidence-based interventions which ensure that benefits outweigh risks. We are very concerned that the AAP is currently representing only one set of views on how best to help our children thrive—namely both social (names, pronouns, etc.) and medical transition (puberty blockers, cross-sex hormones, surgeries), which the AAP refers to as “affirmative care.” Many of our children have received this care and are anything but thriving.
This has propelled us to closely read the studies that support these treatments, and we have found that what is claimed about the studies is not at all what the results actually show. We now have several independent systematic reviews of evidence that show that the benefits of these treatments are far from certain. However, the evidence of risks —such as harms to bones and the cardiovascular system, effects on the brain and other organs, sexual difficulties, and a future inability to have kids—are mounting, as evidenced by a growing number of studies. Several countries have now acted on this new information, including Sweden, where “it has been decided that hormonal treatments (i.e., puberty blocking and cross-sex hormones) will not be initiated in gender dysphoric patients under the age of 16. For patients between ages 16 and 18, it has been decided that treatment may only occur within the clinical trial settings approved by the EPM (Ethical Review Agency/Swedish Institutional Review Board). The patient must receive comprehensive information about potential risks of the treatment, and a careful assessment of the patient’s maturity level must be conducted to determine if the patient is capable of evaluating, and consenting to, the treatment.”
Additionally the UK is undertaking a multi-year review of its gender transition program over concerns that harms outweigh benefits. An official interim report distanced itself from the “affirmation model” by emphasizing that this model of care “originated in the USA” and signaling that change is coming to Great Britain.
We have recently become aware that five pediatricians submitted a resolution (#27) to urge the AAP to do a thorough and systematic evaluation of the available evidence and to update the 2018 AAP position paper Ensuring Comprehensive Care and Support for Transgender and Gender Diverse Children and Adolescents, which incorrectly promulgates the notion that “gender affirmative” psychosocial and medical interventions are the only acceptable treatment for gender dysphoric youth. This resolution is timely: thousands of young adults are coming forward on Detrans subreddit and other social media platforms describing their regret. Why is this happening? A recently published peer-reviewed publication warned that the original “Dutch” protocol that is now used to treat dysphoric youth suffers from significant methodological limitations and is not applicable to most of the current cases: namely youth with post-puberty onset of gender dysphoria complicated by mental health or neurocognitive difficulties.
Many Genspect parents have observed such a sudden trans identification in their children, often emerging after an intense and obsessive period of consuming narrowly-focused social media content and watching their friends, one by one, announce a trans identity. Moreover, many of our children suffer from psychological comorbidities (including anxiety, ASD, ADHD, depression, trauma, eating disorders, and more – while many others are trying to understand their sexual orientation), which necessitates the need for differential diagnoses and appropriate therapeutic support, including exploratory therapy.
Some of our kids have since “desisted” and are now back to thriving after a period of confusion and depression that their new trans identification seemed to bring on. Others have become combative and determined to start taking powerful drugs that will permanently change their bodies. Yet others, who no longer require our consent, simply went to a neighborhood Planned Parenthood clinic and received hormones with no assessments at all. We are seeing these latter groups of kids’ mental health spiral down further and further.
Having a combative teenager who urgently insists on something or makes risky choices is not a new development for any parent of an adolescent. What is new is that professionals to whom we have entrusted our kids, rather than safeguarding them from harm and helping heal parental-child rifts so common in teen years, are encouraging our kids to act on their risky, impulsive decisions with irreversible consequences.
It is long past due for the AAP to address this issue, and we were pleased to see that Resolution 27, introduced by several AAP pediatrician members, finally addressed this. However, we were very disappointed to learn that the AAP leadership chose to specifically disallow pediatrician comments on Resolution 27, omitting it from the list in the link sent to pediatricians soliciting their comments. We understand that this is due to a “new rule” that “unsponsored” resolutions cannot be commented on. It is alarming that not a single chapter or committee within the AAP was willing to “sponsor” a resolution that asks to conduct a non-partisan and systematic review of evidence in pediatric gender medicine – something the AAP has never done. It is even more alarming that the AAP appears to be preemptively suppressing debate by not allowing comments on “unsponsored” resolutions, a rule that did not exist last year when a similar “unsponsored” resolution got many supportive pediatrician votes and comments.
We thus call on you to open up comments on Resolution 27 and vote to adopt it at your upcoming August Annual Leadership Conference. It is time to update the 2018 AAP Policy using an open and transparent process, following the example of the non-partisan Cass Review in the UK. Such a process should start with a truly independent, unbiased, thorough review of the evidence—exactly what Resolution 27 asks for. It should then proceed to the AAP membership, carefully listening to all sides of this debate without judgment. However, the AAP should not only listen to doctors, parents, and patients who believe in the benefits of “affirming” social and medical transition for minors. You should also invite those who disagree and those who have been harmed, including detransitioners and desisters, parents of youth whose health plummeted while being medicalized, as well as the clinicians and researchers who, based on the international evidence, question the AAP’s official position. The ranks of all these groups are rapidly growing. The accumulated evidence is also being recognized by important mainstream media such as the New York Times, Washington Post, San Francisco Examiner, 60 Minutes, and others, with more balanced coverage that we hope the AAP is taking into consideration.
We would like to remind you that the American Academy of Pediatrics’ Committee of Bioethics recognizes that “parents…are better situated than others to understand the unique needs of their children and to make appropriate, caring decisions regarding their children’s health care.” Our voices – and our children – deserve to be acknowledged by the AAP. It is our job to protect our children’s health and well-being: it is your obligation to work with us in a thoughtful and respectful way. We look forward to being included in the vital discussions about medical care for gender dysphoric youth, which will shape our children’s entire lives, their physical and mental health, and their ability to have children of their own.
US Regional Head, Fmr. Deputy General Counsel, US Department of Education
Genspect-affiliated US and Canadian parent groups:
Parents of Rapid Onset Gender Dysphoria Kids – 2,100 parents
Cardinal Support Network – 400 parents
Oasis – private facebook group – 358 parents
Our Duty US – 200 parents
Gender Dysphoria Support Network – 500 parents
US and Canadian professionals in support:
Lisa Littman, MD, MPH
Physician, Researcher, President of the Institute for Comprehensive Gender Dysphoria Research
Sasha Ayad, M.Ed., LPC
Carol Tavris, Ph.D.
Social Psychologist and Writer
Leonore Tiefer, Ph.D.
Clinical Associate Professor of Psychiatry (ret.)
NYU School of Medicine
Lisa Marchiano, LCSW
Jungian Psychoanalyst and Author
Miriam Grossman, M.D.
Board Certified in Child, Adolescent and Adult Psychiatry
President, Rethink Identity Medicine Ethics (ReIME)
Kathleen Jennison Goonan, M.D.
Stephanie Winn, LMFT
Lauren H. Schwartz, MD
Kathleen H. Dooley, Esq.
Pamela Garfield-Jaeger, LCSW
Licensed Clinical Social Worker
Sarah Jorgensen, PharmD MPH
Joseph Burgo, Ph.D.
Stephen B. Levine, MD
Clinical Professor of Psychiatry
Case Western Reserve University School of Medicine
Carrie D. Mendoza, MD
Director, FAIR in Medicine
Foundation Against Intolerance and Racism