Based on scientific analysis of available medical data, much of Western Europe has turned against so-called “gender-affirming care” (GAC) in children, particularly interventions such as puberty-blocking, cross hormones, and mastectomies and other surgeries. Indeed, the U.K., France, Sweden, Denmark, Finland, and Norway, as well as New Zealand — not exactly Bible Belt countries –have substantially restricted such interventions except in the context of bona fide medical studies. Meanwhile, the British Medical Journal has cautioned that GAC remains very much unsettled as an approach to caring for children diagnosed with gender dysphoria.
Finland’s medical authorities explicitly disfavor puberty-blocking and state that it should be the exception, not the rule:
Based on thorough, case-by-case consideration, the initiation of hormonal interventions that alter sex characteristics may be considered before the person is 18 years of age only if it can be ascertained that their identity as the other sex is of a permanent nature and causes severe dysphoria. In addition, it must be confirmed that the young person is able to understand the significance of irreversible treatments and the benefits and disadvantages associated with lifelong hormone therapy, and that no contraindications are present. [My emphasis]
But American so-called scientific/medical journals ignore these and other substantial criticisms and not only push gender-affirming care as noncontroversial but claim that withholding such interventions constitutes neglect. Thus, a new article in Pediatrics, published by the American Academy of Pediatrics, asserts that denying GAC is harmful to gender-dysphoric children. From “Prohibition of Gender-Affirming Care as a Form of Child Maltreatment:”
Although there is no evidence to support the idea that providing GAC constitutes child maltreatment, there is evidence that denying such care results in significant harm to children and meets diagnostic criteria for medical neglect. Medical neglect refers to the failure to provide necessary medical care to a child, which in turn leads to or has the potential to lead to physical or psychological harm.
Further, denying GAC constitutes emotional abuse:
Denying GAC not only represents medical neglect, but it is also state-sanctioned emotional abuse. In addition to the basic physical needs all people require for survival, humans have vital psychological needs. The degree to which these needs are met during childhood impact a child’s identity, capacities, and behaviors into adulthood. Emotional abuse involves actions, either as a repeated pattern or an extreme single incident, that thwart a child’s basic psychological needs. This form of abuse can be especially damaging because it undermines a child’s self-worth and psychological development. Policies that prohibit or limit a caregiver or physician’s ability to provide necessary GAC force caregivers and providers to perpetuate psychological distress.
The article concludes with a blast against state laws limiting GAC and asserts that transitioning children and adolescents is the only way to go:
All children deserve love, acceptance, and care. Parents should be commended, not punished, for accepting their children for who they are. Physicians should similarly be supported, not penalized both professionally and mentally, for practicing evidence-based medicine. By supporting GAC, we can foster a society that promotes healthy parent–child relationships, supports evidence-based medicine, and values the well-being of all children.
But is it really “evidence-based” medicine? Or ideologically driven human experimentation?
Look what a Finnish psychiatrist who has treated such children for years has to say about this, citing studies ignored by the Pediatrics piece. GAC causes harm! From “Gender-Affirming Care Is Dangerous. I Know Because I Helped Pioneer It,” by by Riittakerttu Kaltiala, in the Free Press:
I am also disturbed by how gender clinicians routinely warn American parents that there is an enormously elevated risk of suicide if they stand in the way of their child’s transition. Any young person’s death is a tragedy, but careful research shows that suicide is very rare. It is dishonest and extremely unethical to pressure parents into approving gender medicalization by exaggerating the risk of suicide.
This year the Endocrine Society of the U.S. reiterated its endorsement of hormonal gender transition for young people. The president of the society wrote in a letter to The Wall Street Journal that such care was “lifesaving” and “reduces the risk of suicide.” I was a co-author of a letter in response, signed by 20 clinicians from nine countries, refuting his assertion. We wrote that, “Every systematic review of evidence to date, including one published in the Journal of the Endocrine Society, has found the evidence for mental health benefits of hormonal interventions for minors to be of low or very low certainty.”
My purpose here is not to argue that the Pediatrics article is wrong and the medical authorities in the European countries I listed above, the British Medical Journal, and Dr. Kaltiala are right (although I suspect that to be the case). Rather, the point is that a medical journal is not “scientific” when it ignores contraindications and heterodox expert opinions when claiming that policies against GAC are abusive.
The issue of GAC clearly remains bitterly contentious within the medical community even if the AAP and other American medical associations continue to pretend otherwise. But engaging in pretense is not “science.” Asserting falsely that the science is settled doesn’t make it so. Indeed, the Pediatrics piece is an example of the kind of ideological advocacy that should have no place in a respected medical journal but is of a kind we increasingly see in too many professional publications.
How can we believe anything Pediatrics publishes when it allows such a one-sided and absolutist article to go to press that fails to provide any indication that its conclusions are highly controversial? No wonder the medical establishment is losing the trust of the American people.