Transgender Adolescents

"Echoing the U.K.'s landmark Cass Report, the authors [U.S. Department of Health and Human Services (HHS) report] call for gender dysphoria to be 'de-exceptionalized', meaning therapists need to approach treating these young people in the same way they would any other distressed patients."

"Instead of viewing them as 'transgender adolescents' in need of powerful hormones and drastic surgeries, the report suggests that therapists should help these young people 'develop self-understanding, engage with emotional vulnerability, and build practical strategies for managing distress'."

Mia Hughes, senior fellow, Macdonald-Laurier Institute 

White House Deputy Chief of Staff Stephen Miller called gender-affirming care for children "barbaric" at a press conference on Thursday. Press secretary Karoline Leavitt looks on. Evan Vucci/AP

A recently-released 409 page report issued by the U.S. Department of Health and Human Services examined the state of pediatric gender medicine, highlighting exceptionally fragile evidence that has been used in support of puberty blockers, cross-sex hormones and surgeries for young people who claim to identify as transgender. The report exposes the manner in which ideology has managed to eclipse science and persuade large segments of the skeptical public to trust the medical establishment that has failed in its duty to 'do no harm' with vulnerable youth.

 

The report, commissioned by executive order from U.S. President Donald Trump, does not echo his personal inflammatory, bombastic accusatory messaging. It relies instead on the cool-headed intelligence of medical specialists who rely on science and biology in the natural order of genetics and inheritance. Measured and reliant on evidence, it offers recommendations that align with the cautious, evidence-based reaction to gender-affirming care that much of Europe has now adopted in contradiction to major medical associations in the U.S. and Canada's ideological positions.

 

The report's (unnamed/unidentified) authors delved past the ideological screens and their slogans in their delivery of a methodical assessment of the state of pediatric gender medicine as it currently pertains in North America. An 'umbrella review' centers the report, synthesizing existing systematic reviews for interventions in question, reflecting reviews that have taken place in Sweden, Finland, England and Canada. Evidence cited for continuation of the status quo was deemed to be of 'very low' quality.

 

Methodologically weak, lacking control groups or long-term follow-up, this field of research, in particular in reference to claims that hormonal and surgical interventions improve mental health or reduce suicide ideation fail the test of reliability. Known risks of such interventions that include infertility, reduced bone density, disrupted psychosocial development, and impaired sexual function, are documented outcomes of these interventions. It has been found that every systematic review to date in pediatric gender medicine, concludes that risks outweigh any potential benefits.

 

Psychotherapy is one of the most vital sections of the report, in a cultural climate where talk therapy is frequently dismissed or derided as equivalent to gay conversion therapy. The HHS report states a strong belief for a non-invasive approach in place of life-altering medical interventions. The therapeutic approach in fact represents what leading European health authorities have implemented, reflecting a rising awareness that gender dysphoria among adolescents, particularly girls, is a complex symptom of deeper psychological distress.

 

Mounting evidence of a major medical scandal unfolding aside, Canada remains a holdout; not yet prepared to launch a review of the practices in its pediatric gender clinics. Guidelines in Canada are aligned with those of the World Professional Association for Transgender Health, a group discredited for its prioritizing ideological commitments over scientific rigour. Alberta is the first province in Canada to have taken concrete steps shielding vulnerable young people from a medical establishment that abandoned science and ethical principles.

 

Canada, like the United States, has seen a dramatic surge in referrals to gender clinics. Demographic shifts from young boys to predominantly adolescent girls, with Canadian gender clinics among the earliest and most likely to adopt experimental medical interventions. As the number of detransitioners rises there will arise lawsuits to add to the two already underway in a reflection of Canada's inaction on the issue, evidently satisfied to continue placing ideology before evidence, placing youth in harm's way. 

 

A report published this week is the latest in a series of actions—some of which have sparked protest—from President Donald Trump’s administration targeting gender-affirming care for trans individuals.  Stephanie Keith/Bloomberg via Getty Images

“The finger was already on the scale when this report was commissioned,” says Kellan Baker, a health services researcher who serves as executive director of the Whitman-Walker Institute for Health Research and Policy. In recent years, more than half of all states, including Florida and Tennessee, have implemented policies restricting or banning gender-affirming care for minors. Soon after taking office in January, Trump gave HHS a 90-day deadline to publish the review in an executive order titled “Protecting Children from Chemical and Surgical Mutilation,” which claimed without evidence that medical professionals in the United States “are maiming and sterilizing a growing number of impressionable children” and threatened to revoke federal funding from hospital clinics that provide gender-affirming care to minors.

ScienceAdviser