A number of pediatricians and other medical professionals are urging the nation's medical organizations to halt hormonal and surgical interventions on children with gender dysphoria -- a feeling of distress at perceived mismatch between one's biological sex and gender identity -- and to not double down on these practices amid mounting evidence of their harm.
The American College of Pediatricians recently issued the Doctors Protecting Children Declaration, calling on the American Academy of Pediatrics, the Endocrine Society, the Pediatric Endocrine Society, the American Medical Association, the American Psychological Association, and the American Academy of Child and Adolescent Psychiatry to "immediately stop" promoting "social affirmation, puberty blockers, cross-sex hormones and surgeries for children and adolescents who experience distress over their biological sex."
The ACP's declaration -- first unveiled at a June 6 press conference in Washington -- urged its colleagues to both "follow the science and their European professional colleagues" who have increasingly halted such interventions based on substantial long-term research. The ACP called on medical professionals to treat gender dysphoria with "comprehensive evaluations and therapies" that address the "underlying psychological co-morbidities and neurodiversity" that can accompany the condition or predispose a person to it.
"These doctors are saying, 'We want what's best for children. We want children and adolescents to thrive and to be healthy and to have a fulfilled life,'" Dr. Jane E. Anderson, ACP's vice president, told OSV News. "And it is not going to happen when they are directed and almost forced into gender-affirming care that harms them, mutilates them and makes them patients for the rest of their lives."
So far, 18 organizations -- including the Catholic Medical Association -- representing more than over 75,000 physicians and health care professionals have signed the declaration, as have dozens of professionals from over 50 countries.
Anderson, a retired clinical professor of pediatrics from the University of California, San Francisco, said that "despite the great research studies that have come out of Europe recently ... the professional medical organizations in America are not 'following the science'" of the impact that puberty blockers, cross-sex hormones and genital surgeries have on developing children.
The ACP declaration notes that "gender-affirming" clinics in the U.S. follow "standards of care" developed by the World Professional Association for Transgender Health, which has come under scrutiny following the March leak of hundreds of messages and recordings indicating members knew of links between cancer and hormone therapy, while admitting adolescent patients were sometimes too young to fully grasp the life-changing impact of interventions on their fertility.
"The foundation of WPATH guidelines is demonstrably flawed and pediatric patients can be harmed when subjected to those protocols," said the ACP's declaration.
Anderson also pointed to the Cass Review, a final report issued in April by Dr. Hilary Cass, a former president of the Royal College of Pediatrics and Child Health, whom National Health Service England appointed in 2020 to conduct an independent analysis of its gender identity services.
Cited extensively in the ACP declaration, the Cass Review -- which prompted NHS England to cease automatically prescribing puberty suppressing hormones to child patients at its gender identity clinics -- found in its final 338-page report that evidence supporting gender interventions for children and teens was both insufficient and fraught.
A growing list of countries that includes Denmark, Finland, France, Norway and Sweden have also limited such usage.
Anderson told OSV News that the issue of gender dysphoria in the U.S. medical community has "become a legal battle.
"Whereas in reality it is a medical, scientific conflict over what's real, what's true research and what's best for children," she said.
"The sad thing is that much of this (gender affirming) care is being promulgated as saying -- and promoted as saying -- this is going to help children and adolescents feel better and improve their mental health," she said. "It does not do that."
Anderson pointed to a 30-year study from Sweden following persons who had undergone sex reassignment surgery that showed the cohort had -- in the words of the study authors -- "considerably higher risks for mortality, suicidal behavior and psychiatric morbidity."
"We would really advocate that these children and adolescents ... need to be treated for their mental health concerns before ever looking at something like gender-affirming care, which is not helpful," said Anderson. She claimed a plurarity of these youth experience underlying mental health concerns, which can include depression or anxiety, autism, or even prior emotional trauma or sexual abuse.
"We are dealing with adolescents, children and adolescents whose brains are immature," she said, adding they are not in a position at that age to make drastic decisions regarding their bodies.
The ACP declaration, Anderson said, will continue to add signatures as people learn about it.
The "bottom line," said Anderson, is that "we don't want to harm children; we want to help them. So we need to go back to helping them with their mental health, and making that a priority."
What does the Cass Review say?
The Cass Review concluded that there was "no clear evidence" that social transition protocols, which resulted in a greater likelihood of pursuing a medical pathway for those who did so at an earlier age and/or prior to clinical evaluation, have "any positive or negative mental health outcomes, and relatively weak evidence for any effect in adolescence."
Puberty blockers worked to compromise bone density, but demonstrated "no changes in gender dysphoria or body satisfaction."
Crucially, the Cass Review said that there was "no evidence" that puberty blockers "buy time to think" about resolving gender dysphoria, but there was "some concern that they may change the trajectory of psychosexual and gender identity development."
Regarding cross-sex hormones, there was "a lack of high-quality research assessing the outcomes of hormone interventions in adolescents with gender dysphoria/incongruence, and few studies that undertake long-term follow-up," the Cass Review stated, quoting a systematic review conducted by the University of York.
The university also said that "no conclusions can be drawn about the effect on gender dysphoria, body satisfaction, psychosocial health, cognitive development, or fertility." It added, "Uncertainty remains about the outcomes for height/growth, cardio-metabolic and bone health."
The Cass Review said that while "a formal diagnosis of gender dysphoria is frequently cited as a prerequisite for accessing hormone treatment ... it is not reliably predictive of whether that young person will have longstanding gender incongruence in the future, or whether medical intervention will be the best option for them."
