On Monday, the American Academy of Pediatrics released guidelines to physicians and parents to accept the preferred gender identity of their children. Titled “Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents,” the AAP statement calls on healthcare providers to be “gender-affirming” when children do not recognize the sex they were born with. The guidelines contend that some cases may merit “surgical intervention” and gonadotrophin-releasing hormones to delay puberty onto the age of 16 years so as to prevent adolescents from developing sexual characteristics such as breasts and a deeper voice.
The AAP wants to eliminate discrimination and stigma associated with “youth who do not conform to social expectations and norms regarding gender.” The group also called for family members of minors experiencing gender dysphoria to receive counseling. “As pediatricians and parents, we also appreciate how challenging, and at times confusing, it can be for family members to realize their child’s experience and feelings,” said Cora Breuner MD. She is the chair of the AAP Committee on Adolescence. “What is most important is for a parent to listen, respect and support their child’s self-expressed identity,” said Jason Rafferty MD. “This encourages open conversations that may be difficult but key to the child’s mental health and the family’s resilience and wellbeing.”
The statement claims that persons exhibiting gender dysphoria may suffer from anxiety, eating disorders, and depression, while they are also likely to self-harm or commit suicide. Blaming social stigma and inadequate healthcare, it claims that “transgender identities and diverse gender expressions do not constitute a mental disorder.” The authors say that these are “normal aspects of human diversity.” They claim that “conversion therapies” are “unfair and deceptive” and “have been proven to be not only unsuccessful but also deleterious and are considered outside the mainstream of traditional medical practice.”
The report provided the following recommendations:
- Providing youth with access to comprehensive gender-affirming and developmentally appropriate health care.
- Providing family-based therapy and support be available to meet the needs of parents, caregivers and siblings of youth who identify as transgender.
- Making sure that electronic health records, billing systems, patient-centered notification systems and clinical research are designed to respect the asserted gender identity of each patient while maintaining confidentiality.
- Supporting insurance plans that offer coverage specific to the needs of youth who identify as transgender, including coverage for medical, psychological and, when appropriate, surgical interventions.
Advocacy by pediatricians within their communities, for policies and laws that seek to promote acceptance of all children without fear of harassment, exclusion or bullying because of gender expression.
Debate within the medical community over gender dysphoria has raged over the appropriate treatment. Some who have expressed doubt about progressive approaches to the phenomenon have been ostracized by the community. For example, Dr. Kenneth Zucker was fired in 2017 over more than 30 years at the renowned Child Youth and Family Gender Identity Clinic beause of his conservative approach to gender-dysphoric children. Also, the Southern Poverty Law Center labeled the American College of Pediatricians as a hate group when the ACP urged caution against hasty encouragement to teenagers who seek to identify as a gender other than the sex determined at their birth. “Adolescence is a time of upheaval and impermanence,” the ACP wrote in a 2010 letter to school superintendents. “Adolescents experience confusion about many things, including sexual orientation and gender identity, and they are particularly vulnerable to environmental influences.”