Children who struggle to match their gender identity with their biological sex should not be pushed into transgender therapies, but given treatments that help treat the underlying cause of the dysphoria, said doctors in the field.
From a medical standpoint, deciding not to offer hormonal therapy to children who experience gender dysphoria is “not a judgment” on the child, but a matter of the best medical healthcare, said Dr. Paul Hruz, associate professor of Pediatrics, Endocrinology, Cell Biology and Physiology at the Washington University of Medicine. “It’s the best outcome, because they’re not exposed to all these harms that we know they will experience if they move forward” with the hormone treatments, he said.
Dr. Hruz also voiced serious concerns about treating young people with intense and potentially dangerous off-label hormone therapy, without subjecting the regimen to rigorous scientific testing. This falls short of the scientific standards used to evaluate other treatments, he said. “We search for the truth by testing it with experimental evidence.”
Hruz spoke at an Oct. 11 panel on Gender Dysphoria in Children at the Heritage Foundation in Washington, D.C. Also speaking at the event were Dr. Michelle Cretella, president of the American College of Pediatricians, and Dr. Allan Josephson, professor and division chief of Child and Adolescent Psychiatry at the University of Louisville in Kentucky.
Gender dysphoria is a psychological condition in which a person’s experience of the psychological and cultural associations of their gender differ greatly from their biological sex. It is unclear how many children in the United States experience gender dysphoria, but the condition is relatively uncommon.
Cretella explained the health risks of putting children on puberty blockers and hormones associated with the opposite sex. The use of these drugs, she said, “is treating puberty like a disease, arresting a normal process which is critical to normal development for kids.” She pointed out that there had never been long-term studies on hormone repression drugs, and their impact — particularly on children — is unknown.
What is known, however, is the risk of cancer and cardiovascular disease, and growth disruption associated with hormone therapies used for cross-sex treatment. She also pushed back against the claims that affirming a patient's perceived gender leads to improved outcomes to children, saying that “those studies are extremely short term” with small study groups and poorly designed controls.
Cretella pointed to former patients who change their minds “at age 28 or so and saying, ‘Oh my gosh, what was done to me?’” Emphasizing the importance of rooting medical practices in science rather than ideology, Hruz noted that no randomized controlled trial or consistent findings have shown that puberty blockers and cross-sex hormones are the best treatments for children with gender dysphoria. “The reality is there is no science to back this drastic change.”
He also noted that as many as 90 percent of youth outgrow gender dysphoria by the end of adolescence and realign their identity with their biological sex. Josephson focused on the psychological element of childhood gender dysphoria, noting that at its root, the disorder is a social and psychological phenomenon.
He contested that relying on hormonal therapies leaves aside a full investigation of the root psychological causes underlying the dysphoria, which therefore halts the most effective treatment before it starts. Josephson pointed to the treatment of one patient who came in for counseling on gender dysphoria and ended up uncovering deep wounds of childhood abuse underlying their discomfort.
“When doctors see pain or distress we try to find the cause of it and map out a treatment. We don’t try to ignore it,” he urged. And treatment does not mean avoiding all forms of stress or trial, Josephson said. “In the process of development we’re always subjected to some kind of stress or developmental crisis.” T
he key is to adequately diagnose and treat the underlying causes of gender dysphoria, he said. “If we ignore pain, the bottom line is that we might miss a diagnosis and chance for developmental progress.” Most of all, Josephson said, children going through gender dysphoria need to be affirmed and loved. “Of course you affirm a child and love a child,” he said. “But you don’t affirm a bad idea.”