Docs Say Gender-Questioning Kids Need Better Science

Three separate groups of physicians have recently written to leading medical journals questioning hormonal treatment of children and adolescents with gender dysphoria in countries such as the United States, Canada, Australia, and certain European countries.

They are extremely concerned that current practice is outpacing the science, citing a lack of robust clinical trial evidence to support existing recommendations from groups such as the Endocrine Society, American Academy of Pediatrics, and Royal Children’s Hospital Melbourne, which all support “gender affirmation.”

If deemed appropriate, this allows for treatment with puberty blockers (also called hormonal suppression) as early as age 11 in children who insist that they are not the gender associated with their birth sex, effectively halting puberty associated with the latter. Most of them then proceed to ‘cross-sex’ hormones; that is, they will take estrogen if transitioning from male to female (trans female) or testosterone if they are transitioning from female to male (trans male).

Gender reassignment surgery may follow. This used to be reserved for those over the age of 18, but some procedures are now being performed at even younger ages. Just last year, for example, an article published in JAMA Pediatrics described adolescents aged 13 undergoing double mastectomies, transitioning from female to male.^[1]

This issue has come much more to the forefront in the past few years because the number of youth seeking help for gender dysphoria has mushroomed throughout the Western world.

Some healthcare professionals are thus becoming increasingly uncomfortable with how clinical practice in this field is evolving, arguing that it is proceeding without full consideration of potential harms and in the absence of any long-term evidence of benefit. In effect, they contend that some children are being used as guinea pigs in the rush to embrace early medical treatment of many youths with gender dysphoria.

They call instead for psychotherapy, social transitioning (ie, dressing as and passing for the opposite gender), and/or watchful waiting.

Not surprisingly, many in the transgender community, and experts in the field, are skeptical of those who focus on the negative outcomes of the medical treatment involved in transitioning, arguing that such objections put transgender kids at risk for self-harm and mental distress, setting back all of the recent gains made in acceptance of transgender individuals, at least in Western society.

And, they argue, most of these “armchair critics” have little direct experience treating these kids.

But the consequences of not pausing a moment to figure out the path forward could be significant.

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https://www.medscape.com/viewarticle/909129#vp_1