American Academy of Pediatrics Accused of Censoring Concerns about ‘Gender-Affirmative Care’

T he American Academy of Pediatrics (AAP) is facing pushback from medical professionals over its formal endorsement of “gender-affirmative care” for minors and accusations that it silenced internal dissent.

In 2018, the AAP issued a formal policy statement endorsing gender-affirmative care and recommended that “youth who identify as TGD [transgender and gender diverse] have access to comprehensive, gender-affirming, and developmentally appropriate health care that is provided in a safe and inclusive clinical space.” The AAP statement has since been cited by prominent medical organizations and public officials, including the Biden administration, as justification for providing minors with so-called gender-affirming care.

AAP pediatricians are challenging the 2018 policy statement. On March 31, five pediatricians — whose names were redacted from the document — submitted Resolution 27 to the AAP and formally requested that the organization “undertake a rigorous systematic review of available evidence regarding the safety, efficacy, and risks of childhood social transition, puberty blockers, cross sex hormones and surgery” and then “update the 2018 guidelines for the care of gender dysphoric youth, based on the results of this evidence review.”

Resolution 27 points to similar measures taken by the United Kingdom, Sweden, France, Australia, and other countries, where medical guidance has been updated to discourage gender-affirming care, such as hormone therapy and puberty blockers, for minors. The resolution cites concerns about gender-affirming care impairing sexual function and fertility, as well as the “increasing evidence of regret and detransition” among those who have undergone such treatments.

The AAP typically has sent resolutions to pediatricians for comment in preparation for its annual conference. However, the AAP adopted a new procedural rule that effectively insulates Resolution 27 from review. Now, pediatricians are solicited for comments only on “sponsored” resolutions — sponsorship can be granted by certain individuals within the AAP — thus excluding Resolution 27, which is unsponsored.

On July 18, Genspect, an organization dedicated to evidence-based interventions for treating gender dysphoria, published an open letter to the AAP denouncing the new rule, noting that last year, “a similar ‘unsponsored’ resolution got many supportive pediatrician votes and comments.” Calling it “alarming” that “not a single chapter or committee within the AAP” sponsored Resolution 27, Genspect continued: “It is even more alarming that the AAP appears to be preemptively suppressing debate by not allowing comments on ‘unsponsored’ resolutions.”

Genspect encouraged the AAP to enable comments on Resolution 27 in preparation for the annual AAP conference in August. It also condemned AAP’s 2018 policy statement, claiming it “incorrectly promulgates the notion that ‘gender affirmative’ psychosocial and medical interventions are the only acceptable treatment for gender dysphoric youth.”

Asked for comment, the AAP told National Review in an email that “chapter leaders, committee/council/section leaders and other official delegates can sponsor a resolution,” stating: “The pediatricians who are seeking to have a resolution placed on the Leadership Conference agenda regarding gender-affirming care have been unable to recruit a sponsor. This means that there is no one willing to support their proposal.” The AAP noted that unsponsored resolutions are still available for voting but are ineligible for commenting.

The AAP also noted that the new procedural rule was adopted in March, before any resolutions were submitted. This year, there is only one unsponsored resolution — Resolution 27.

The five pediatricians were not the first to raise concerns about the AAP 2018 policy.

Dr. James D. Cantor, a clinical psychologist and sex researcher, published a fact-check review of the 2018 statement. Cantor explains that, worldwide, medical and other professionals who see children with gender dysphoria commonly practice “watchful waiting,” a noninterventionist approach that refrains from interrupting puberty. The AAP 2018 statement suggests that such an approach is “outdated” and “does not serve the child because critical support is withheld,” although there is no citation for this specific claim.

Cantor argues that the AAP, in endorsing the gender-affirming-care model, misrepresented its sources: “These documents simply did not say what AAP claimed they did. In fact, the references that AAP cited as the basis of their policy instead outright contradicted that policy, repeatedly endorsing watchful waiting.”

Despite its questionable assertions and faulty premises, the AAP 2018 endorsement of gender-affirming care has shaped federal policies. The HHS Office of Population Affairs references the AAP 2018 statement under the “additional information” subsection of its PDF “Gender-Affirming Care and Young People,” which argues that “early gender-affirming care is crucial to overall health and well-being.” This PDF is cited in the March 2022 Biden–Harris administration fact sheet, which promotes gender-affirming care for minors. The Justice Department warned state attorneys general that denying “gender-affirming care” to “transgender youth” “may infringe on federal constitutional protections under the Equal Protection Clause and Due Process Clause of the Fourteenth Amendment.”

The Biden–Harris administration’s policies depart from the Obama–Biden administration’s. A 2016 Obama administration memo found that, “based on a thorough review of the clinical evidence available at this time, there is not enough evidence to determine whether gender reassignment surgery improves health outcomes for Medicare beneficiaries with gender dysphoria.” The memo cites inconsistent study results and design flaws, such as “no comparison groups, potential confounding, and small sample sizes.”

High-profile doctors who promote gender-affirming care have alluded to consequences that may not be revealed in short-term studies. Gynecologist and vaginoplasty surgeon Mark “Marci” Bowers, a male-to-female transitioner and the president-elect of the World Professional Association for Transgender Health (WPATH), stated in a Duke University talk that “every single child who was, or adolescent, who was truly blocked at Tanner stage 2 has never experienced orgasm.” Tanner stage 2 is one of four developmental stages in puberty, usually occurring between ages nine and eleven.

Republican lawmakers have sought to restrict or ban so-called gender-affirming treatments for minors. Such efforts were branded as “anti-LGBTQ” and “transphobic.” The Biden administration described the “dangerous anti-transgender legislative attacks” as “government overreach at its worst, they are un-American, and they must stop.”