AMAC Exclusive – By Katie Sullivan
News last month that the American Academy of Pediatrics (AAP) would be conducting a “systematic review” of the evidence supporting so-called “gender-affirming care” for minors left many conservatives hopeful that the U.S. medical establishment might finally reverse its enthusiastic support for life-altering drug regimens and surgical procedures for young people. But recent comments from AAP leadership have made clear that, far from rethinking their stance, the AAP is doubling down.
On August 9, the AAP board, which represents some 67,000 pediatricians and clinicians, voted unanimously to reaffirm its position from 2018 on gender-related care for minors, which included support for gender-affirming counseling, cross-sex hormones, and even surgeries like double mastectomies. The 2018 guidelines have been blasted by conservatives as thoroughly unscientific and rooted in left-wing ideology rather than any objective analysis of scientific evidence.
At the same time, AAP also authorized the development of an “expanded set of guidance for pediatricians based on a systematic review of the evidence” – wording that seemed to indicate the group was open to reconsidering its support for practices that even some who work in child gender clinics have questioned.
K R Stevens, writing for the National Institutes of Health’s online Library of Medicine, explains that systematic reviews “are carefully synthesized research evidence designed to answer focused clinical questions.” Furthermore, she writes, “Systematic reviews implement recently developed scientific methods to summarize results from multiple research studies.”
Such reviews have already led several of the most traditionally “progressive” countries in Europe to reverse course on prescribing “gender reassignment” surgeries and certain drugs for those under 18.
In Sweden, the National Board of Health and Welfare concluded “that the risks of puberty-inhibiting and gender-affirming hormone treatment for those under 18 currently outweigh the possible benefits for the group as a whole” after requesting a review of the research on the safety of hormone treatments last February. Some of the risks they cite include the possibility of detransition and the general lack of knowledge about “the treatment’s impact on gender dysphoria as well as the mental health and quality of life of minors.”
Notably, Sweden was the first country to introduce legal gender reassignment. Now, puberty blockers and sex change surgeries for minors have been almost entirely halted.
In 2020, the Finnish Health Authority also launched a systematic review which found evidence supporting the benefits of transgender-related treatments for minors to be “inconclusive.” Hormone therapies and surgeries for Finnish youth are now banned in almost all cases.
In June, England’s National Health Service moved to limit the use of “puberty suppressing hormones” to clinical research and no longer allow them to be “routinely commissioned for children and adolescents who have gender incongruence/dysphoria.”
With the American left historically following the latest trends in Europe, AAP’s announcement of its own “systematic review” created some hope that U.S. medical associations might also acknowledge the alarming lack of evidence supporting child gender transitions and advise a more cautious approach.
But subsequent comments from AAP leadership indicates that this is far from the case here. Stat News reported late last month that “AAP and other experts say the systematic review only indicates their confidence in the current standards of care.” In other words, the “systematic review” isn’t a review at all – it’s just a way for AAP to re-affirm their current stance on the matter.
AAP chief executive Mark Del Monte confirmed as much when he told the New York Times that the AAP board “has confidence that the existing evidence is such that the current policy is appropriate.” Neither Del Monte nor anyone else on the AAP board has shown even the slightest indication that they’re willing to reconsider their position.
The AAP has also vigorously opposed state laws which prohibit hormone therapy and sex-change operations for minors. Given how overtly political AAP has become, it seems more likely that the group will use their “systematic review” as just another tool to pressure policymakers to allow more expansive access to hormone therapies and surgeries.
Wherever an honest review of the evidence supporting child gender transitions has been conducted, the results have invariably pointed to the risks outweighing the potential benefits. But Americans shouldn’t hold their breath for any such outcome here.
Katharine “Katie” Sullivan was an Acting Assistant Attorney General and a senior advisor to the White House Domestic Policy Council under President Trump. She previously served 11 years as a state trial court judge in Colorado.