Five Countries Agree: No gender therapy

When will the US follow the evidence?

After the Dutch began to treat children identifying as transgender with puberty-blocking medications in the 1990s, many Western countries quickly jumped on the idea that halting puberty would allow children time to be sure a sex change was right for them. Even though the Dutch Protocol was based on a single cohort of patients and wasn’t measured against accepted scientific rigor, health organizations in Finland, Sweden, Norway, England, and the United States quickly adopted the strategy.

Pediatrician members of the American Academy of Pediatrics (AAP), like me, were in disbelief in 2018 when the organization adopted gender-affirming positions and recommended halting puberty, giving cross-sex hormones, and performing irreversible surgeries for children.

In 2020, the American Psychiatric Association (APA) published a similar position statement.

Not only was there no good evidence to support these recommendations, but the doctors and scientists leading these organizations seemed to ignore the numerous ethical questions surrounding encouraging children to alter their physiology, disfigure their bodies, and risk long-term side effects, including infertility.

The AAP and the APA ignored the precautionary principle and chose to support treating children based on cultural ideology with very little curiosity about the possible harm.

Even worse, debating this policy position wasn’t allowed, forcing many physicians to stay silent or challenge the dogma publicly and risk their careers.

In essence, we experimented on children by ignoring every ethical principle we’ve regarded in modern science.

It is unbelievable that after learning about experiments like the Tuskegee syphilis experiment, I am alive to witness this shameful history repeated on such a vulnerable population as children!

It is no surprise that more than twenty years after the Dutch Protocol was published, the evidence has mounted against the approach. Accordingly, northern European countries, including the Netherlands, updated their policies to reflect the evidence.

Last week, the National Health Service of England published the final Cass Review of the scientific data for gender services in children. In a guest post, Dr. Kristopher Kaliebe highlighted the review’s key findings, which are that most children will not have gender distress as adults, and hormones and other treatments do not alleviate the distress or suicidality in most cases.

England is the fifth European country to scale back their recommendations.

Sadly, I do not expect the AAP or APA to publicly acknowledge that this has been a failed experiment or that harm has been done.

However, I do expect the AAP and APA to acknowledge new European guidelines on gender services and to follow the European nations by issuing new evidence-based policy statements.

As of this writing, neither the APA, AACAP, nor the AAP have mentioned the Cass review in their newsletters and neither has acknowledged any of the updated guidelines on gender care in the other European countries.

I urge the US medical organizations who claim to advocate for children’s health and well-being to recommend a complete physical, psychological, and behavioral evaluation of children presenting with gender distress, along with treatment that (1) addresses psychological, social, and cultural factors that contribute to a child’s desire to change sex and (2) avoids medical and surgical interventions until adulthood.

I urge our medical and scientific communities to return to practicing the ethical and moral standards of research and medical care that, first, do no harm.