Hitting the brakes on transgender treatments for youth

The 202-year-old National Academy of Medicine in France on Feb. 28 called for medical practitioners to exercise “the greatest caution” in administering puberty blockers or cross-sex hormones to French youth struggling with gender dysphoria.

In a statement addressing transgender treatments for children, the academy acknowledged an “epidemic-like phenomenon” among adolescents seeking transgender medical interventions — puberty-blocking drugs, cross-sex hormones, and invasive surgeries — which it said could be tied to social media usage and social contagion. It advised more psychological support and said medical workers who administer hormone treatments should consider the side effects, including growth impact, bone weakening, sterility, emotional and intellectual consequences, and for girls, menopause-like symptoms. Medical workers should emphasize that surgeries such as mastectomies or genitalia-altering procedures are irreversible, the academy wrote.

In recent months, medical groups and establishments in multiple countries have called for putting the brakes on hormone and surgical interventions for youth. But in the United States, by contrast, the medical establishment continues to promote an “affirmation-only” model of treating childhood gender dysphoria while stifling debate over evidence-based treatments.

On Feb. 22, following a review of scientific evidence, Sweden’s Board of Health and Welfare released long-awaited guidelines for the care of gender dysphoric children. The government agency said “uncertain science and new knowledge” had prompted it to recommend restraint in using hormone treatments except in “exceptional cases.” It advised psychological and psychiatric support as the first line of treatment. The board said it could not explain a 1,500 percent increase in gender dysphoria diagnoses among 13- to 17-year-old girls between 2008 and 2018.

Sweden’s biggest gender identity center, Karolinska University Hospital in Stockholm, announced last year it would no longer prescribe puberty blockers and cross-sex hormones to minors, except in a clinical trial setting. Finland similarly updated its treatment guidelines in 2020 to prioritize psychological help for youth experiencing gender distress.

Meanwhile, a new independent review of the pediatric gender identity services within England’s government-run health care system expressed concern that hormonal interventions may not be the best approach for the youth seeking them out. The National Health Service-commissioned Cass Review found that clinicians often “feel under pressure to adopt an unquestioning affirmative approach … at odds with the standard process of clinical assessment and diagnosis.”

In an updated position statement, the Melbourne-based Royal Australian and New Zealand College of Psychiatrists last year underscored the importance of mental health evaluations of gender dysphoric youth over an “affirmation only” approach.

Still, while other nations raise cautions about transgender treatments for children, medical establishments in the United States, including the American Academy of Pediatrics, continue to maintain that affirmation-only model.

“European countries that have treated gender dysphoric youth much longer than we have are saying ‘No … stop,’ to hormone interventions and surgeries,” said Dr. Quentin Van Meter, an Atlanta-based pediatric endocrinologist and president of the American College of Pediatricians, which opposes such interventions for children. “We must ask why we are continuing on in the United States at breakneck speed.”

Conservative U.S. lawmakers are seeking to curtail the gender industry with state legislative efforts. At least 18 states are considering bills restricting or criminalizing transgender medical interventions, according to the American Civil Liberties Union. A 2021 law in Arkansas, the first of its kind restricting pediatric transgender interventions, has been tied up in legal challenges.

The Texas Children’s Hospital announced last week it halted its “gender-affirming services” for children following formal declarations from Republican Gov. Greg Abbott and Attorney General Ken Paxton stating pediatric transgender medical interventions, including hormones and surgeries, constitute child abuse. The hospital said its cautionary approach was taken to “safeguard our health care professionals and impacted families from potential criminal legal ramifications.”

Texas courts have temporarily halted one criminal investigation into whether a 16-year-old boy’s parents committed child abuse by helping him obtain puberty-blocking drugs in order to identify as a female.

“We are in a position in the United States where the debate is out of the realm of medicine and into the realm of ideological politics,” Van Meter said.