The American Academy of Pediatrician’s official policy relies on faith, not science, to prescribe hormones and surgery for so-called transgender children.
[UPDATED 2022.04.08]: The AAP Policy Statement that is at the heart of this post is still current and the list of published articles is up to date.]
Just yesterday, two articles hit the press reflecting the inroads so-called transgenderism is making in America. The first story reported that, in response to a single complaint, Always, which makes products for menstruation, removed the female symbol (♀) from it’s packing because it offended menstruating women who think they’re men. The second story revealed that a Texas jury (!) ruled against a man who was trying to prevent his crazy ex-wife from turning their son into a girl. Significantly, when the boy was with his father, he was perfectly happy being a boy.
Irked by these stories, I set about updating the information I assembled for some posts I did in March 2017. Back then, after a very disturbing insight into the way in which the leftist media world was pushing transgenderism, I examined the data on which the American Academy of Pediatrics — the most revered pediatric medical association in America, with 64,000 members — was then addressing transgenderism. What I discovered by following through on the linked articles at the AAP’s website is that there was no science behind its madcap rush into diagnosing and treating children with so-called transgenderism. Instead, the site endlessly referred to consensus, not science. Because transgenderism is now a hotter issue than ever, I thought I’d revisit what the AAP has to say about transgenderism today.
II. My bias and beliefs on this subject
So that you know my bias upfront, I don’t believe in so-called transgenderism. Here’s what I do believe:
I believe that all mammal species have a male version and a female version. These binary subsets of each species have different DNA that leads to different brain and body development to handle different procreative roles: Males provide the seed; females provide the egg and, in the higher mammals, a cozy internal space in which the baby can gestate.
Over several millennia, in addition to procreative differences, male and female mammals developed different traits, again manifest at the DNA level, to enable better survival chances in subsistence level environments. In humans, these differences manifest themselves in ways big and small.
The big difference is that men and women are shaped differently, with different sex organs, bone structure, and muscle strength. The more subtle differences are things such as the fact that women’s ears are more attuned to the pitch at which babies and children make sound or that men have bigger navigation parts in their brain because they, unencumbered by children, need to be able to return home after long hunts. These biological differences have been affected by the cultures in which people develop (cultures that are, in turn, affected by the differing environmental pressures placed on human communities) but the differences remain.
I believe that, due to DNA mistakes, a minutely small portion of the world’s population is born intersex — that is, with scrambled DNA that manifests itself in a hodge-podge of gender traits.
I believe that humans develop along a bell curve so that, while men are men and women are women, at the long-tail ends of the bell curve it’s perfectly normal to find effeminate men or masculine women. The bell curve also accommodates sexual behaviors, with heterosexuality occupying the big bump in the bell curve and homosexuality again lurking in the long-tails. It’s therefore perfectly normal to find women with narrow hips and great senses of direction, and men with big hips who get lost in their own homes. But still, in the bell curve where human survival is at stake, the differences are very real and the big bump in the bell curve matters.
I believe that the fact that most women take the Pill at some time before getting pregnant may be accounting for the increase in the number of feminized men (and perhaps masculinized women) that we are seeing of late. In other words, the sexual confusion we’re seeing isn’t all because of the Leftist push to erase traditional gender and gender roles, thereby erasing sexual and family norms, weakening the family, and making government more necessary.
It’s entirely possible that the Pill’s lingering effects in a woman’s body may well affect the hormone wash babies get in utero. This means that a baby may be completely male at the DNA level, but the residual Pill generated effects in his mother’s body may mean that he’s getting hormones that are more directed to developing female traits in the brain. Nobody has been studying this, but I think someone should. It’s a shame it’s too politically incorrect for any researchers to touch this question.
I believe that it’s child abuse when adults aggressively impose gender norms on a child that run counter to the child’s biological gender. This applies to parents, teachers, the medical establishment . . . anyone who, once hearing a three year old boy say “I’m a girl,” suddenly buys a closet full of dresses and dolls for the child.
Just think about this: The same people who harangued us for decades about the sin of reinforcing “gender norms” by giving girls Barbie dolls and boys toy guns are now insisting that it’s imperative that we give Barbie dolls to a three-year-old boy who wants to dress up like his older sister (as my emphatically masculine son did) or that we give toy guns to a little girl who chases after her girl brother and his friends when they play “war.” If we treat children as individuals, rather than stereotypes, they’ll almost invariably revert to their biological norms once they hit puberty. They may end up gay or lesbian, but they’ll know what’s in their underpants.
I believe that it’s child abuse to give kids puberty blocking hormones or, worse, hormones of the gender opposite to their biological gender. These hormones can cause cancer and sterility. And honestly, if you’re going to give a kid hormones, why not give a confused little boy male hormones and a confused little girl female hormones, thereby aligning their hormones with their biological body?
Only an insane political correctness stops us from examining whether it’s better to align kids with their natural, biological gender, as opposed to turning them into a Frankenstein’s monster of chemical soup. I believe that this chemical manipulation is also abusive when done to adults.
I believe that it’s child abuse to give kids so-called “corrective” surgery that slices off healthy sexual organs. This too is abuse when done to adults.
I believe that people who feel that they are trapped in the wrong body are to be pitied. I cannot imagine how unpleasant it is to wake up every morning feeling wrong.
Nevertheless, I do not believe that so-called transgenderism is a genuine “thing.” That is, I do not believe that people are in the wrong body, that this “mistake” can magically be made right through surgery and hormones, and that we must turn society upside down to give these people psychological satisfaction.
I believe that people who believe they are “transgender” need to be treated with appropriate psychological intervention and, if called for, hormone treatments that align with their biological gender. We do them a disservice by buying into their body dysmorphia. This is like saying that the way to help an anorexic girl is to put her on a diet rather than treating her warped sense that she’s too fat.
I believe that, at least as to men “identifying” as women, it is a negative identification that trades in stereotypes about femininity (a form of cultural appropriation). Moreover, this identification is extremely harmful to biological women whose identities are being erased, most prominently in the sports world, but also in terms of their unique sexual traits such as periods, menopause, and pregnancy.
I believe that a significant number of children who identify as transgender come from homes in which there are mental issues at the parent level, in which there are no role models for the biological sex (i.e., one or two women raising a boy, or one or two men raising a girl), or in which the marriage itself has significant problems, placing extreme stress on the child (something that’s often a factor in anorexia and is reasonably a factor in claimed transgenderism).
I believe that, in the old days, parents would have responded to an effeminate boy by still treating him as a boy even while loving parents would have accepted that he would probably grow up with same sex attraction. The same would hold true for a masculine girl. Now, though, parents are being instructed to treat the behavior (effeminacy or masculinity) as proof positive of gender confusion.
I believe that what the Leftist establishment calls transgenderism, and believes is a real thing, is in fact a form of body dysmorphia, which is either a mental illness or a product of hormonal issues in utero. For the remainder of this article, I will often use the phrase “gender dysmorphia” to describe those people the establishment insists are “transgender.” (At Appendix A to this post, I have pictures showing some people suffering from different types of body dysmorphia.)
That’s where I’m coming from. The rest of this post is dedicated to the fact that, as of Spring 2017, while the American Academy of Pediatrics (“AAP”) has all sorts of theories predicated upon accepting that transgenderism is real, you will find nothing proving that transgenderism is, in fact, real.
III. The AAP’s policy statement is devoid of actual science on the roots of transgenderism
A. The policy statement relies on an activist comic book for its definitions
The best way to get a sense of the AAP’s principles is to look at its September 2018 “policy statement” about children and teens suffering from gender dysmorphia. The document, which was published in the October 2018 journal Pediatrics (the “official journal of the American Academic of Pediatrics”) is entitled “Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents.”
Even though this purportedly scholarly article doesn’t have the phrase “policy statement” in the title, I know it’s a policy statement because the AAP issued a press release announcing to the world that this article represents its official policy:
AAP Policy Statement Urges Support and Care of Transgender and Gender-Diverse Children and Adolescents
The academy releases its first policy statement to provide guidance for parents and clinicians through a gender-affirming approach
Transgender and gender-diverse children face many challenges in life, but, like all children, they can grow into happy and healthy adults when supported and loved throughout their development.
That is the underlying message within a new policy statement published by the American Academy of Pediatrics (AAP) called, “Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents.” The statement, to be published October 2018 issue of Pediatrics (published Sept. 17 online) aims to help pediatricians and parents navigate health concerns of gender-diverse youth while advocating for ways to eliminate discrimination and stigma.
The policy statement’s lead author is a guy named Jason Richard Rafferty, MD, MPH, EdM, FAAP. Dig a little and you discover that he is a Harvard educated physician (a red flag for wokeness) who runs “gender-diverse and transgender clinics” at Lifespan Hospital in Rhode Island:
Jason Rafferty, MD, MPH, EdM, a pediatrician and child psychiatrist, practices at the gender and sexuality clinic and at the Adolescent Healthcare Center at Hasbro Children’s Hospital. Dr. Rafferty specializes in substance abuse disorders and gender and sexual development, and his work on these subjects has been published in many peer-reviewed journals. He is a member of the Society of Adolescent Health and Medicine, the American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry.
It’s reasonable to believe that Rafferty’s his professional prominence and a lot of money are tied up in advocating for the existence of a biological reality known as “transgenderism.” That doesn’t mean he’s not a true believer. It just means that he receives career and ego benefits from encouraging the world to shape itself to gender dysmorphia, rather than helping to make it a non-issue.
Before I started reading the full article / policy statement, my thought process said that, in order to formulate a treatment policy, one first must determine what transgenderism is. Is it a genuine biological issue requiring surgery and drugs intended harmonize body with mind? Or is it a form of body dysmorphia, a mental illness the treatments for which would include psychiatric intervention and drugs intended to harmonize mind with body?
I therefore studied the article closely for information addressing the transgender lobby’s claims about gender identity, gender fluidity, and gender biology. No such information exists.
Instead, from the very first paragraph, the AAP policy jumbles together homosexuality and bisexuality, on the one hand, and “transgenderism,” on the other:
In its dedication to the health of all children, the American Academy of Pediatrics (AAP) strives to improve health care access and eliminate disparities for children and teenagers who identify as lesbian, gay, bisexual, transgender, or questioning (LGBTQ) of their sexual or gender identity.1,2 Despite some advances in public awareness and legal protections, youth who identify as LGBTQ continue to face disparities that stem from multiple sources, including inequitable laws and policies, societal discrimination, and a lack of access to quality health care, including mental health care. Such challenges are often more intense for youth who do not conform to social expectations and norms regarding gender. Pediatric providers are increasingly encountering such youth and their families, who seek medical advice and interventions, yet they may lack the formal training to care for youth that identify as transgender and gender diverse (TGD) and their families.3
This jumbling is significant. While the former LGB lobby (before Transgender and Questioning hopped on board) may have claimed “baby, I was born this way,” the LGB community was always concerned with behavior, rather than biological identity. With the Ls, the Gs, and the Bs, there was never any question about the fact that they were boys and girls, right down to the DNA.
Ls and Gs, when looking in their underpants, agreed with what they saw there. Unlike non-L and G children, though, they wanted their sexual partners to have the same underwear equipment. Bs were the more mellow ones who would take any underwear equipment.
The AAP, however, has chosen to say that there is no meaningful distinction between people’s sexual orientation (a behavior) and their gender (something that, until the “transgender” lobby got involved, was a biological issue).
Keep in mind when it comes to this gender con (for that’s what it is), that Facebook used to give its users a choice of 71 different genders. Because the lobby morphs and then morphs again, Facebook has now given up on the effort in the face of the ever-expanding list of genders. It now lets users create their own gender. Thus, you’ll note the absence of a dropdown arrow in the gender box. That box is for you, the user, to do with as you please:
But maybe that embrace of gender mania is just AAP’s intro, which is a little cavalier and careless about the difference between sexual preferences and actual biological matters such as gender. Maybe the AAP dives into the science behind so-called transgenderism at a later point in its official policy statement.
If you think that, you’re wrong. The article, after that intro, moves on to accepting as given the whole concept that sex is merely a scientific issue, but that gender identity overrides mere biology:
“Sex,” or “natal gender,” is a label, generally “male” or “female,” that is typically assigned at birth on the basis of genetic and anatomic characteristics, such as genital anatomy, chromosomes, and sex hormone levels. Meanwhile, “gender identity” is one’s internal sense of who one is, which results from a multifaceted interaction of biological traits, developmental influences, and environmental conditions. It may be male, female, somewhere in between, a combination of both, or neither (ie, not conforming to a binary conceptualization of gender). Self-recognition of gender identity develops over time, much the same way as a child’s physical body does. For some people, gender identity can be fluid, shifting in different contexts. “Gender expression” refers to the wide array of ways people display their gender through clothing, hair styles, mannerisms, or social roles. Exploring different ways of expressing gender is common for children and may challenge social expectations. The way others interpret this expression is referred to as “gender perception” (Table 1).5,6
There are several more paragraphs offering Orwellian definitions about “cisgender” and sexual orientation issues.
What’s most disturbing is that the AAP policy statement does not rely upon scientific studies to support this gobbledy-gook. Instead, it concludes its definitional word soup by pointing, not to a scientific publication, but to The Gender Book:
(For more information, The Gender Book, found at www.thegenderbook.com, is a resource with illustrations that are used to highlight these core terms and concepts.)
Curious, I linked to the book on which the AAP relies for its definitions in the lead policy article in its flagship scientific journal. I discovered that the book isn’t a scientific resource at all; it’s a comic book:
Here’s a close-up of the information in the upper right hand corner of the home page:
Intrigued – maybe this is a user-friendly scientific project? – I went to the “about” page for the Gender book project. I learned there that, to the extent the Gender book advances “science,” it’s Magic Schoolbus stuff. Literally:
the idea for the the GENDER book was to have a fun, educational resource, like the Magic Schoolbus of gender. There were lots of academic texts around for folks who were willing to sit down and get into the theory, but where was our quickie 101 accessible resource we could give to grandma or leave out in a waiting room? that’s the GENDER book!
What started as a simple 6-page black and white zine in 2010 has grown into a 94 page full-color illustrated book.
We built it out using quotes from the 200+ surveys we collected. As we wrote and illustrated each page, we’d post it on Tumblr for critique and took that feedback to heart. We really wanted our project to represent the diverse communities it depicts.
In December of 2013, the last pages were colored and we launched an IndieGogo campaign to fund the first round of printing.
We raised enough money to print 1,000 hardcover books, and quickly sold out. As of 2019 we are in our third run of printing and the book is as needed as ever. We have translations in Spanish and German and more are on the way.
To educate everyone (for example: doctors, friends, schoolteachers, family and individuals who are exploring their gender) about gender…
… To be a free & widely disseminated resource that points readers towards comprehensive sources……
To alleviate societial oppression & misunderstanding of gender minorities through education.
You get that? As the first paragraph explains, while there are “lots of academic texts,” we’re going to skip all that boring stuff and get to the real deal, which is making sure that children and old ladies get on board the gender bus. In other words, this is activism, not science.
And who are the people behind the Gender book, the one on which a scientific publication relies for its opening premise about treating children and adolescents who claim (or whose parents claim) that they defy biological sex? It turns out that they’re activists, not scientists:
This project came from us, a bunch of queer and trans folks who lived in Houston, Texas together in a big grey house in the gayborhood in 2010. We noticed a need for gender education all around us — when a boyfriend had to pay out of pocket while educating his therapist about gender stuff or when our friends didn’t know how to start conversations with their families — and we would say, “Shouldn’t there be a quick and simple gender 101 read you could hand her and say, ‘See you next week’?” Turns out, after much googling, that didn’t exist yet. We realized this house full of artists and community organizers could make our gender 101, and so we did. Thanks for reading!
Here are the three main individuals responsible for the book (and I say “three main” because these three acknowledge that they relied on crowd-sourcing to help prepare the book):
(formerly known as Mel Reiff Hill) makes pictures (among other things). They have an art degree from Rice University, and do all web design, graphics, and art for the GENDER book Project in between freelance web and graphic design jobs. Hunter also works on the book’s content, words, and vision. Follow their work at rowdyferret.com
received a Bachelor of Arts in creative writing from the University of Houston in 2002 and has stayed engaged as a community organizer. Jay is usually elbow-deep in at least one safe-space-building project or another, including writing and performing, producing community-sponsored radio, educating about healthy sexuality, advocating for access to health care, and creating teams to support LGBTQ community spaces. As co-author and chief editor for the GENDER book, Jay can’t wait to use this new tool with communities everywhere!
Robin Mack has been managing lots of colorful hats in the project such as: marketing, community involvement, wellness coach, and drag performer. Robin also is a full time Massage Therapist and Yoga instructor for all communities.
Not a STEM major among them.
You may feel free to peruse the Gender book’s online pages at your leisure. I won’t risk violating copyright by reprinting them here. I’ll just say it’s a charming, visually appealing mélange of assumptions, feelings, and conclusions about gender (as opposed to biological sex) presented as facts and data.
There’s absolutely nothing wrong with three activists getting together and creating an indoctrination book. I may not like it, but it’s a free country.
However, there’s a lot wrong about a purportedly scientific publication representing the largest professional pediatrics organization in America relying on the indoctrination book as the starting premise for its public policy statement.
After relying upon a determinedly non-scientific activist book for its core premises about sex, gender, and so-called transgenderism, the AAP article notes that polls reveal that small percentages of people claim to be transgender.
B. The AAP dedicates itself to reinforcing gender dysmorphia, rather than treating it
It seems almost cruel to have to explain that polls will find that small percentages of people also believe that the earth is flat or that dinosaurs inhabited the earth at the same time humans did. People’s habits of embracing, and living in accordance with, erroneous “facts” does not make those so-called facts true. You would think that a scientific publication that most of America’s pediatricians rely upon for advice in their medical practices would understand this.
Having shown that some people believe themselves to be a sex other than the baseline their own body establishes, the article discusses the “Mental Health Implications” of this disconnect. As to this, I believe absolutely the dire statistics proving how deeply unhappy (to the point of suicide) people feel if they suffer from gender dysmorphia:
Adolescents and adults who identify as transgender have high rates of depression, anxiety, eating disorders, self-harm, and suicide.13–20 Evidence suggests that an identity of TGD has an increased prevalence among individuals with autism spectrum disorder, but this association is not yet well understood.21,22 In 1 retrospective cohort study, 56% of youth who identified as transgender reported previous suicidal ideation, and 31% reported a previous suicide attempt, compared with 20% and 11% among matched youth who identified as cisgender, respectively.13 Some youth who identify as TGD also experience gender dysphoria, which is a specific diagnosis given to those who experience impairment in peer and/or family relationships, school performance, or other aspects of their life as a consequence of the incongruence between their assigned sex and their gender identity.23
Want to hear something tragically and ironically funny? After showing that people in thrall to gender dysmorphia are miserable to the point of death, the article states that “[t]here is no evidence that risk for mental illness is inherently attributable to one’s identity of TGD.”
Why is this funny? It’s funny, in a deeply sad way, because gender dysmorphia is the mental illness, carrying with it a package of “depression, anxiety, eating disorders, self-harm, and suicide.” The denial at the AAP is strong indeed.
The fallout from this mental illness is exacerbated by the fact that people who have gender dysmorphia often experience cruelty from others and embrace self-destructive behaviors:
Youth who identify as TGD often confront stigma and discrimination, which contribute to feelings of rejection and isolation that can adversely affect physical and emotional well-being. For example, many youth believe that they must hide their gender identity and expression to avoid bullying, harassment, or victimization. Youth who identify as TGD experience disproportionately high rates of homelessness, physical violence (at home and in the community), substance abuse, and high-risk sexual behaviors.5,6,12,27–31 Among the 3 million HIV testing events that were reported in 2015, the highest percentages of new infections were among women who identified as transgender32 and were also at particular risk for not knowing their HIV status.30
Regarding the cruelty directed at them, I don’t doubt that. Homo sapiens, probably as an atavistic survival mechanism to weed out the weak from a tribe, are seemingly programmed to attack obvious deviations from the norm. One needs to teach children not to pick on “the other.” If a family or a society fail in that teaching, “the other,” whomever that “other” is, will be bullied. For someone already suffering from a mental illness, bullying’s negative effects are almost certainly significantly magnified.
As far as I’m concerned, by this point in its policy statement, the AAP has failed to prove that there is any reality behind a person’s belief that he or she is the “wrong” gender. As you think about that, I want you also to remember that the medical community treats other forms of body dysmorphia (e.g., anorexia, body integrity identity disorder) as mental illnesses that can respond to cognitive behavior therapy or the use of medicines that align the brain with the body.
Body integrity identity disorder (“BIID”) is an especially apropos dysmorphia to raise in the context of gender dysmorphia because it too involves a compulsion to dismember oneself. While men in the grip of gender dysmorphia want to cut off their penises and testicles, and women in the grip of gender dysmorphia want to cut off their breasts, people with BIID want to cut off their arms and legs. Yet while BIID is clearly recognized as a mental illness, gender dysmorphia has become so culturally important that we are told we must bow before the illusion and reshape society around it.
My point, in case it got lost, is that the AAP has not shown that gender dysmorphia is any less a mental illness than anorexia or BIID. Instead, it presents as a fait accompli the “fact” that transgenderism is a real “thing,” not a mental illness. That’s why its “gender-affirmative care,” which is the next section in the policy statement, urges physicians to treat body dysmorphia as a genuine biological problem, rather than a mental illness:
In a gender-affirmative care model (GACM), pediatric providers offer developmentally appropriate care that is oriented toward understanding and appreciating the youth’s gender experience. A strong, nonjudgmental partnership with youth and their families can facilitate exploration of complicated emotions and gender-diverse expressions while allowing questions and concerns to be raised in a supportive environment.5 In a GACM, the following messages are conveyed:
- transgender identities and diverse gender expressions do not constitute a mental disorder;
- variations in gender identity and expression are normal aspects of human diversity, and binary definitions of gender do not always reflect emerging gender identities;
- gender identity evolves as an interplay of biology, development, socialization, and culture; and
- if a mental health issue exists, it most often stems from stigma and negative experiences rather than being intrinsic to the child.27,33
The GACM is best facilitated through the integration of medical, mental health, and social services, including specific resources and supports for parents and families.24 Providers work together to destigmatize gender variance, promote the child’s self-worth, facilitate access to care, educate families, and advocate for safer community spaces where children are free to develop and explore their gender.5 A specialized gender-affirmative therapist, when available, may be an asset in helping children and their families build skills for dealing with gender-based stigma, address symptoms of anxiety or depression, and reinforce the child’s overall resiliency.34,35 There is a limited but growing body of evidence that suggests that using an integrated affirmative model results in young people having fewer mental health concerns whether they ultimately identify as transgender.24,36,37
In contrast, “conversion” or “reparative” treatment models are used to prevent children and adolescents from identifying as transgender or to dissuade them from exhibiting gender-diverse expressions. The Substance Abuse and Mental Health Services Administration has concluded that any therapeutic intervention with the goal of changing a youth’s gender expression or identity is inappropriate.33 Reparative approaches have been proven to be not only unsuccessful38 but also deleterious and are considered outside the mainstream of traditional medical practice.29,39–42 The AAP described reparative approaches as “unfair and deceptive.”43 At the time of this writing,* conversion therapy was banned by executive regulation in New York and by legislative statutes in 9 other states as well as the District of Columbia.44
To understand how wrong the above paragraphs are, imagine an official AAP policy statement urging doctors to put anorexic patients on diets to deal with the downsides of that mental illness or saying that the best way to treat BIID is to cut off healthy limbs. Of course, that’s not what the medical community does with BIID and anorexia. Treatment is always aimed at helping sufferers understand, both through therapy and drugs aimed at addressing brain dysfunctions, that they are misreading their own bodies. As the quoted material shows, though, the AAP is hostile to any attempt to realign brain with body when it comes to gender dysphoria.
Also, please note that all the “factual” statements in the above quoted material assume that “transgenderism” is real. There is no acknowledgment that there may be mental illness at work, with the child’s gender dysmorphia being a manifestation of the underlying mental problem. To the AAP, transgenderism is real and, to the extent the patients are deeply unhappy and self-destructive, this existential despair is society’s fault. (As always, I recommend applying the anorexia or BIID filters to the AAP’s premises to see how ridiculous they are.)
I could go on and on and on, jut as the policy statement does, but my overarching point is this: The AAP accepts transgenderism – the belief that a person is in the “wrong” body – as real, rather than as the external symptom of an underlying mental health issue. Therefore, rather than treating the mental health issue, all its recommendations are aimed at accommodating and facilitating the problems the mental health issue creates for the affected child.
These Band-Aids (for that’s what they are), include:
Developmental considerations — accepting that children of any age who appear with gender dysmorphia must be treated as absolutely correct in their self-evaluation, without any room for “watchful waiting,” which the AAP calls an “outdated approach” because “critical support is withheld,” based upon old-fashioned “binary notions of gender in which gender diversity and fluidity is pathologized….”
Medical Management – insisting that pediatricians use their access to children to inquire about the child’s gender identity and then instantly provide “validation, support, and reassurance,” followed by looking into such protocols as directing the child’s parents to “a pediatric endocrinologist or adolescent-medicine gender specialist.” (Please note that these specialists are not meant to provide hormones that align brain with body; they are meant to provide gender hormones that cause cancer and sterility to align body with brain.)
Clinical Setting – holding that, to encourage people with gender dysmorphia go to doctors, “[a]ll clinical office staff have a role in affirming a patient’s gender identity,” something that includes having materials all over the office (flyers, posters) saying that transgenderism is real. (Again, imagine doing this with children presenting as anorexic or with BIID.)
Pubertal Suppression – It’s good for kids! (Except that the article, almost reluctantly, acknowledges that there are risks, including mental stress, increased risk-taking behavior, genital underdevelopment requiring surgery, bone metabolism failure, and fertility damage.)
Gender Affirmation – urging the practitioner to help the kid align body with brain (aka healthy body with mentally ill brain) through overseeing things such as helping the child to find his or her pronoun, social affirmation (culturally appropriating the look of the opposite gender); legal affirmation (changing legal documents), medical affirmation (prescribing sex hormones); and surgical affirmation (conducting surgical body mutilation)
In the Health Disparities section, the policy statement acknowledges that insurance companies are reluctant to pay for hormones and surgery, and identifying health risks in kids with body dysmorphia, including a fear of doctors, suspicion about medical treatments, and wildly self-destructive behaviors.
Other sections in the policy statement are “family acceptance,” “safe schools and communities,” and “medical education.”
C. The AAP advances what amounts to child abuse
Here are the final “recommendations”:
In particular, the AAP recommends the following:
1. that youth who identify as anorexic have access to comprehensive, weight-affirming, and developmentally appropriate health care that is provided in a safe and inclusive clinical space;
2. that family-based therapy and support be available to recognize and respond to the emotional and mental health needs of parents, caregivers, and siblings of youth who are anorexic;
3. that electronic health records, billing systems, patient-centered notification systems, and clinical research be designed to respect the weight identity of each patient while maintaining confidentiality and avoiding duplicate charts;
4. that insurance plans offer coverage for health care that is specific to the needs of youth who are anorexic, including coverage for medical, psychological, and, when indicated, gastric band surgery;
5. that provider education, including medical school, residency, and continuing education, integrate core competencies on the emotional and physical health needs and best practices for the care of anorexic youth and their families;
6. that pediatricians have a role in advocating for, educating, and developing liaison relationships with school districts and other community organizations to promote acceptance and inclusion of all anorexic children, including special low calorie diets, without fear of harassment, exclusion, or bullying because of visible emaciation and undernourishment;
7. that pediatricians have a role in advocating for policies and laws that protect anoxeric young people from discrimination and violence;
8. that the health care workforce protects anorexia by offering equal employment opportunities and workplace protections, regardless of perceived or actual weight; and
9. that the medical field and federal government prioritize research that is dedicated to improving the quality of improved weight loss plans for anorexic young people.
You caught what I did, right? I substituted anorexia for gender dysmorphia, aka transgenderism. Doing so reveals how insane the recommendations are for a mental illness that causes young people to feel alienated from and misread their own body.
As far as I’m concerned, there is nothing in the AAP’s official policy statement that establishes that “transgenderism” is real and not just a manifestation of body dysmorphia, whether the cause is organic mental illness, externally imposed mental illness, or a wrong hormone load due to intrauterine issues during fetal development. The AAP just accepts transgenderism as real and moves on from there with the goal of permanently creating a child’s non-biological “gender identity” through reinforcement, hormonal treatments, surgery, and societal pressure.
I also do not see anything in the article that shows actual scientific support for so-called transgenderism. Indeed, I see nothing at the AAP’s entire website offering this support. In the Appendix B to this post, you can see the results of my search for “transgender” at the AAP website. All of them accept that gender dysmorphia, unlike any other form of body dysmorphia, must be accepted as valid, and that treatment should further validate and support the gender dysmorphia, rather than bringing the child back into alignment with his or her own body.
This is child abuse, pure and simple. Prove me wrong, if you wish, but you must do so with something other than “feelings” and based upon something other than the bootstrapping idea that people who claim transgenderism really have the “wrong body,” and that the medical community and society as a whole must respond to that feeling.
Pictures of some people suffering from body dysmorphia other than gender dysmorphia:
In a free world, we accommodate adults who try to align their bodies with their unhealthy self-images. In a sane world, though, we never encourage children to engage in this type of self-mutilation. Moreover, as the above pictures hint, only societal collapse can occur if we shift the whole of society to make people with body dysmorphia feel more comfortable with themselves.
Appendix B (updated on 2022.04.08)
Search results for “transgender” at the AAP website, ranked from newest to oldest. You’ll note that all of them, as a core premise, accept transgenderism as a real thing, rather than a treatable form of gender dysmorphia:
7 April 22 Alabama’s efforts to criminalize gender-affirming care violate pediatric recommendations and doctor-family relationship, harm transgender patients
23 March 2022 The attempts to criminalize supporting kids at risk of social marginalization are reckless and undermine physicians’ ability to do their jobs.
21 March 2022 In a statement surveillance survey, students used a broader set of sexual and gender identity terms to describe themselves than the response options typically provided ins surveys and forms.
28 February 2022 Our organizations, representing nearly 600,000 physicians and medical students, strongly oppose efforts, in Texas or anywhere else, to criminalize gender-affirming care. We will continue to speak out against any actions that threaten the health and safety of transgender and gender-diverse individuals.
24 February 2022 Medical organizations speak out against Texas efforts to criminalize gender-affirming care
22 February 2022 This episode of the Pediatrics On Call podcast focuses on the importance of inclusive language when treating gender-diverse children and teens. It also examines the trajectories of insomnia from childhood to adulthood.
16 February 2022 Pediatricians, other medical professionals, public health professionals, and community members can engage in policy and advocacy strategies to support youth at immediate risk of suicide, and to address upstream risk and protective strategies that can reduce suicide risk.
4 February 2022 This section of the Blueprint for Youth Suicide Prevention provides background information on the development of this resource, outlines the purpose of the Blueprint, and shares information on the language used throughout the resource.
21 January 2022 Every week, the American Academy of Pediatrics (AAP) publishes new research and recommendations in its journal Pediatrics. Read about some of the latest articles appearing in the world’s leading scientific publication on children’s health.
6 January 2022 Bills aim to restrict restroom use, athletic teams and gender-affirming care.
December 20, 2021·The report also addresses issues of consent, confidentiality and coverage.
December 20, 2021·Human immunodeficiency virus is an infection that lasts a lifetime. However, symptoms may not appear for many months or years after the virus is acquired. In fact, the average incubation time from getting the virus until developing the signs of AIDS in teenagers and adults is 10 to 11 years. This means that many young adults may not be aware that they are infected and can spread HIV to others.
December 16, 2021·The American Academy of Pediatrics recommends parents make their home a place where their child feels safe and loved unconditionally for who they are. Here are frequently asked questions from parents about topics related to gender identity.
December 16, 2021·No child is immune to a risk of suicide, but statistics tell us that some adolescents are more vulnerable than others and may require closer parental attention.
December 1, 2021·Gender affirming care encompasses an age and developmentally appropriate approach to gender identity involving discussions, determining the presence of gender dysphoria and both nonmedical and medical interventions.
December 1, 2021·Listening sessions are among the ways the FDA includes the voices of patient communities in medical product development and the regulatory process, particularly communities that have been historically underrepresented.
Frequently Asked Questions About Child Trafficking and Exploitation
November 19, 2021·View frequently asked questions on Child Trafficking and Exploitation
Transgender Youth Referred To Clinics For Gender-Affirming Medical Care In Canada
November 1, 2021·BACKGROUND AND OBJECTIVES. Referrals of transgender and gender-diverse (trans) youth to medical clinics for gender-affirming care have increased. We described characteristics of trans youth in Canada at first referral visit.
CHESTFEEDING/BREASTFEEDING SUPPORT IN LGBTQ+ INDIVIDUALS
November 1, 2021·Telehealth TipHaving a face-to-face conversation with both partner parents to clarify best approach to making feeding choices. Using affirming language is cruci
Archived Indian Health Special Interest Group Webinars
October 20, 2021·View archived webinars from the Indian Health Special Interest Group. View details of that session, learning objectives and the webinar recording or presentation slides.
Unique Considerations When Caring for LGBTQ+ Adolescents via Telehealth
October 15, 2021·Pediatrician Tonya Chaffee and child and adolescent psychiatrist Christopher Bellonci discuss unique considerations for providing care to LGBTQ+ adolescents via telehealth.
Research Finds Significant Reduction in Depression, Suicidality in Youth Receiving Gender-Affirming Care or Puberty Blockers
October 7, 2021·A study abstract to be presented at the 2021 American Academy of Pediatrics National Conference & Exhibition found no effect on generalized anxiety over the 12-month study period.
An Intervention To Reduce Relationship Violence
AAP Journals Blog
October 6, 2021
October 4, 2021·Bullying is when one child picks on another child again and again. Usually children who are being bullied are either weaker or smaller, are shy, and generally feel helpless.
October 1, 2021·Recognition and support are growing for the estimated 0.7% of American teenagers who identify as transgender or gender fluid.1 Many children’s hospitals now offer multidisciplinary care to patients to assist them in transitioning from their designated sex at birth (natal sex or sex assigned at birth) to their affirmed gender. Therapy can begin in early puberty with suppression of sex steroid hormone production followed by supplementation with sex steroids appropriate for their gender identity. … Much remains unknown about how these manipulations in sex steroids will impact bone geometry, turnover, mass, and strength, all of which contribute to peak bone mass and strength in early adulthood.
Disclosure of Self-Inurious Thoughts And Behaviors Across Sexual And Gender Identities
October 1, 2021·In this study, we explored differences in the disclosure of SITBs between SGM youth and their heterosexual and cisgender counterparts.
Pubertal Suppression, Bone Mass, And Body Composition In Youth With Gender Dysphoria
October 1, 2021·10.1542/6250545961001Video AbstractPEDS-VA_2020-0393396250545961001BACKGROUND AND OBJECTIVES. Puberty onset and development contribute substantially to adolescents’ bone mass and body composition. Our objective with this study was to examine the effects of gonadotropin-releasing hormone agonists (GnRHa) on these puberty-induced changes among youth with gender dysphoria (GD).
Effective Screening And Treatment To Reduce Suicide Risk Among Sexual And Gender Minority Youth
October 1, 2021·In this issue of Pediatrics, Luk et al1 describe the risk of suicidal behavior within a 7-year nationally representative longitudinal sample of US adolescents.
Sexual Minority Status And Age Of Onset Of Adolescent Suicide Ideation And Behavior
October 1, 2021·10.1542/6259330343001Video AbstractPEDS-VA_2020-0349006259330343001OBJECTIVES. To determine if sexual minority adolescents have earlier onset of suicidality and faster progressions from ideation to plan and attempt than heterosexual adolescents.
October 1, 2021·BACKGROUND AND OBJECTIVES. Emerging data suggest the coronavirus disease 2019 (COVID-19) pandemic has been associated with worsening symptoms of eating disorders (EDs) among both adults and adolescents.
October 1, 2021·We present pain trajectory data for patients who were treated for chronic pain and GD.
September 20, 2021·Advocacy veteran reviews AAP-supported legislation and explains what pediatricians can do in as little as five minutes to improve the lives of children.
August 27, 2021·The American Academy of Pediatrics offers a number of resources for pediatricians and other professionals to support LGBTQ+ children, youth, and families.
August 3, 2021·This episode of the Pediatrics On Call podcast offers a research roundup from the August issue of the journal Pediatrics. It also focuses on preventing and mitigating toxic stress.
August 1, 2021·Pediatricians should consider screening every patient for a family history of early cardiovascular events, especially those seeking birth control and transgender individuals receiving estrogen treatment.
August 1, 2021·As children in America represent an increasingly racially and ethnically diverse population,1 the field of pediatrics faces the challenge of optimizing their care.
Childhood Abuse Among Transgender Youth: A Trauma-Informed Approach
August 1, 2021·In 2018, the Human Rights Campaign sounded the alarm that antitransgender violence in the United States had become a ‘national epidemic,’ on the basis of the increasing number of transgender fatalities that year.1
A Waitlist Intervention For Transgender Young People And Psychosocial Outcomes
August 1, 2021·10.1542/6260698229001Video AbstractPEDS-VA_2020-0427626260698229001BACKGROUND. Recent referrals of transgender young people to specialist gender services worldwide have risen exponentially, resulting in wait times of 1-2 years.
Disparities In Childhood Abuse Between Transgender And Cisgender Adolescents
August 1, 2021·BACKGROUND AND OBJECTIVES. Transgender adolescents (TGAs) exhibit disproportionate levels of mental health problems compared with cisgender adolescents (CGAs), but psychosocial processes underlying mental health disparities among TGAs remain understudied.
Pediatrics ·Volume 148·Number 2
August 1, 2021·Most children will experience some type of trauma during childhood, and many children suffer from significant adversities.
Social Development In Preschoolers
July 26, 2021·Social development is an important part of all childrens’ lives. There are many things you can do to help your child develop in a positive way.
8 July 2021 There has been an explosion in the number of referrals to gender health services for youth who are transgender. There is some evidence that receipt of gender affirming treatment has positive effects on these young people. However, the wait list for these services can be long. So what can we do for these youth in the short-term?
July 5 2021 BACKGROUND Recent referrals of transgender young people to specialist gender services worldwide have risen exponentially, resulting in wait times of 1–2 years. To manage this demand, we introduced an innovative First Assessment Single-Session Triage (FASST) clinic that provides information and support to young people and their families and triages them onto a secondary waitlist for subsequent multidisciplinary care. Although FASST has been shown to substantially reduce initial wait times, its clinical impact is unknown.
5 July 2021 In 2018, the Human Rights Campaign sounded the alarm that antitransgender violence in the United States had become a “national epidemic,” on the basis of the increasing number of transgender fatalities that year.1 In the context of coronavirus disease 2019, there is a greater appreciation for the significance of a national public health crisis and how it can lead to feelings of grief, vulnerability, and fear. In this month’s Pediatrics, Thoma et al2 show that violence and victimization is not only widespread among a national sample of transgender and gender diverse (TGD) individuals but that it is often first encountered early in life as childhood abuse.2
5 July 2021 BACKGROUND AND OBJECTIVES Transgender adolescents (TGAs) exhibit disproportionate levels of mental health problems compared with cisgender adolescents (CGAs), but psychosocial processes underlying mental health disparities among TGAs remain understudied. We examined self-reported childhood abuse among TGAs compared with CGAs and risk for abuse within subgroups of TGAs in a nationwide sample of US adolescents.
7 June 2021 Some children have a gender identity that is different from their gender assigned at birth, and many have interests and hobbies that may align with the other gender.
21 April 2021 Transgender and gender-diverse (TGD) youth experience barriers to accessing health care and are at risk for poorer overall health compared with cisgender peers. In the last year, dozens of US legislative bills have been proposed to restrict the rights of TGD youth.1 A subset of these bills aims to restrict access to essential treatment of youth diagnosed with gender dysphoria, even when they meet rigorous criteria, as determined by a multidisciplinary evaluation (Table 1).1,2 Other proposed legislation would criminalize clinicians who provide gender-affirmative medical care (GAC) for TGD adolescents, with one bill currently under consideration in Oklahoma classifying providing GAC as a felony punishable by 3 years to life in prison.1 Clinicians and parents fear that legislation eliminating access to GAC will lead to worsening mental health and increased suicidality for their TGD children.3
22 March 2021·BACKGROUND AND OBJECTIVES: Many transgender youth experience gender dysphoria, a risk factor for suicide. Gender-affirming hormone therapy (GAHT) ameliorates this risk but may increase the risk for thrombosis, as seen from studies in adults. The aim with this study was to examine thrombosis and thrombosis risk factors among an exclusively adolescent and young adult transgender population. METHODS: This retrospective chart review was conducted at a pediatric hospital-associated transgender health clinic. The primary outcome was incidence of arterial or venous thrombosis during GAHT. Secondary measures included the prevalence of thrombosis risk factors. RESULTS: Among 611 participants, 28.8% were transgender women and 68.1% were transgender men. Median age was 17 years at GAHT initiation. Median follow-up time was 554 and 577 days for estrogen and testosterone users, respectively. Individuals starting GAHT had estradiol and testosterone levels titrated to physiologic normal. Multiple thrombotic risk factors were noted among the cohort, including obesity, tobacco use, and personal and family history of thrombosis. Seventeen youth with risk factors for thrombosis were referred for hematologic evaluation. Five individuals were treated with anticoagulation during GAHT: 2 with a previous thrombosis and 3 for thromboprophylaxis. No participant developed thrombosis while on GAHT. CONCLUSIONS: In this study, we examined thrombosis and thrombosis risk factors in an exclusively adolescent and young adult population of transgender people receiving GAHT. These data suggest that GAHT in youth, titrated within physiologic range, d…
09 March 2021·Pediatricians testifying against legislation say it is based on myths and misinformation about transgender children and adolescents and a misunderstanding about medical and surgical aspects of gender-affirmative care.
04 February 2021·Video Abstract BACKGROUND AND OBJECTIVES: Most transgender individuals assigned female at birth use chest binding (ie, wearing a tight garment to flatten chest tissue for the purpose of gender expression), often beginning in adolescence, to explore their gender identity. Although binding is often critical for mental health, negative physical side effects, ranging from chronic pain to rib fractures, are common. Time to first onset of symptoms is unknown. METHODS: A community-engaged, online, cross-sectional survey (‘The Binding Health Project’) enrolled 1800 assigned female at birth or intersex individuals who had ever used chest binding. Lifetime prevalence of 27 pain, musculoskeletal, neurologic, gastrointestinal, generalized, respiratory, and skin or soft tissue symptoms related to binding was assessed. Nonparametric likelihood estimation methods were used to estimate survival curves. RESULTS: More than one-half (56%) of participants had begun binding by age 21, and 30% had begun by age 18. In 18 of 27 symptoms, the majority of people who go on to experience the event will do so within the first binding-year, but several skin-related and rare but serious outcomes (eg, rib fracture) took longer to occur. Pain presents rapidly but continues to rise in intensity over time, peaking at >5 years of binding. CONCLUSIONS: Although many symptoms emerge quickly, others can take years to develop. Individuals and their clinicians can use this information to make informed decisions on how to structure binding practices and top surgery timing while meeting goals related to gender expression…
19 January 2021·Video Abstract BACKGROUND: Identity formation and exploration of interpersonal relationships are important tasks that occur during adolescence. Transgender, gender diverse, and gender-nonconforming (TGNC) individuals must face these developmental milestones in the context of their transgender identity. Our aim with this article is to describe adolescents’ history and experiences with romantic partners. METHODS: We conducted phenomenological, qualitative semistructured interviews with transgender adolescents. Questions were focused on romantic experiences, thoughts, and perceptions. All interviews were coded by 2 members of the research team, with disagreements resolved by discussion and, if needed, with a third member of the research team. Thematic analysis was used to analyze the data, as well as descriptive categorization. RESULTS: In total, 30 adolescents (18 transmasculine and 12 transfeminine) between the ages of 15 and 20 years were interviewed. Themes included (1) engagement in romantic relationships, (2) disclosure of gender identity and romantic relationships, (3) experience with abusive relationships, and (4) perceived impact of gender-affirming hormone care on romantic experiences. CONCLUSIONS: TGNC adolescents are engaged in romantic experiences before and during social and/or medical transitioning and are cultivating relationships through both proximal peers and online connections. There is perceived benefit of gender-affirming hormone care on romantic experiences. Risk of transphobia in romantic relationships impacts the approach that transgender adolescents take toward romance and influences decisions of identity disclosure. TGNC adolescents have experience with relationship abuse in di…
19 January 2021·Adolescence can be a challenging time for anyone and because so much of adolescence is about forming one’s identity within the context of society and societal norms, it becomes more challenging when one is in the minority – for any reason.
30 November 2020·Studies of transgender youth highlight the importance of gender affirmative treatments (GATs).
26 October 2020·Video Abstract OBJECTIVES: Puberty suppression (PS) is a cornerstone of treatment in youth experiencing gender dysphoria. In this study, we aim to inform prescribing professionals on the long-term effects of PS treatment on the development of sex characteristics and surgical implications. METHODS: Participants received PS according to the Endocrine Society guideline at Tanner 2 or higher. Data were collected from adolescents who received PS between 2006 and 2013 and from untreated transgender controls. Data collection pre- and post-PS and before surgery included physical examination and surgical information. RESULTS: In total, 300 individuals (184 transgender men and 116 transgender women) were included. Of these, 43 individuals started PS treatment at Tanner 2/3, 157 at Tanner 4/5, and 100 used no PS (controls). Breast development was significantly less in transgender men who started PS at Tanner 2/3 compared with those who started at Tanner 4/5 and controls. Mastectomy was more frequently omitted or less invasive after PS. In transgender women, the mean penile length was significantly shorter in the PS groups compared with controls (by 4.8 cm [Tanner 2/3] and 2.1 cm [Tanner 4/5]). As a result, the likelihood of undergoing intestinal vaginoplasty was increased (odds ratio = 84 [Tanner 2/3]; odds ratio = 9.8 [Tanner 4/5]). CONCLUSIONS: PS reduces the development of sex characteristics in transgender adolescents. As a result, transgender men may not need to undergo mastectomy, whereas transgender women may require an a…
01 April 2020·Video Abstract BACKGROUND: In the United States, transgender youth are at especially high risk for HIV infection. Literature regarding HIV prevention strategies for this vulnerable, often-hidden population is scant. Before effective, population-based HIV prevention strategies may be adequately developed, it is necessary to first enhance the contextual understanding of transgender youth HIV risk and experiences with HIV preventive services. METHODS: Two 3-day, online, asynchronous focus groups were conducted with transgender youth from across the United States to better understand participant HIV risk and experiences with HIV preventive services. Participants were recruited by using online advertisements posted via youth organizations. Qualitative data were analyzed by using content analysis. RESULTS: A total of 30 transgender youth participated. The average age was 18.6 years, and youth reported a wide range of gender identities (eg, 27% were transgender male, 17% were transgender female, and 27% used ≥1 term) and sexual orientations. Four themes emerged: (1) barriers to self-efficacy in sexual decision-making; (2) safety concerns, fear, and other challenges in forming romantic and/or sexual relationships; (3) need for support and education; and (4) desire for affirmative and culturally competent experiences and interactions (eg, home, school, and health care). CONCLUSIONS: Youth discussed experiences and perspectives related to their gender identities, sexual health education, and HIV preventive services. Findings should inform intervention development to improve support and/or services, including the following: (1) increasing provider knowledge and skills to provide gender-affirming care, (2) addressing barriers to services (eg, accessibility and affordability as well as stigma and discrimination), and…
01 February 2020·BACKGROUND AND OBJECTIVES: Gonadotropin-releasing hormone analogues are commonly prescribed to suppress endogenous puberty for transgender adolescents. There are limited data regarding the mental health benefits of this treatment. Our objective for this study was to examine associations between access to pubertal suppression during adolescence and adult mental health outcomes. METHODS: Using a cross-sectional survey of 20 619 transgender adults aged 18 to 36 years, we examined self-reported history of pubertal suppression during adolescence. Using multivariable logistic regression, we examined associations between access to pubertal suppression and adult mental health outcomes, including multiple measures of suicidality. RESULTS: Of the sample, 16.9% reported that they ever wanted pubertal suppression as part of their gender-related care. Their mean age was 23.4 years, and 45.2% were assigned male sex at birth. Of them, 2.5% received pubertal suppression. After adjustment for demographic variables and level of family support for gender identity, those who received treatment with pubertal suppression, when compared with those who wanted pubertal suppression but did not receive it, had lower odds of lifetime suicidal ideation (adjusted odds ratio = 0.3; 95% confidence interval = 0.2-0.6). CONCLUSIONS: This is the first study in which associations between access to pubertal suppression and suicidality are examined. There is a significant inverse association between treatment with pubertal suppression during adolescence and lifetime suicidal ideation among transgender adults who ever wanted this treatment. These results align with past literature, suggesting…
23 January 2020·Among 20,619 transgender adults surveyed, 17% reported wanting pubertal suppression. Of those, 2.5% received it, according to the study.
01 November 2019·OBJECTIVES: We characterized referral trends over time at a transgender clinic within an integrated health system in Northern California. We identified the transition-related requests of pediatric transgender and gender-nonconforming patients and evaluated differences in referrals by age group. METHODS: Medical records were analyzed for all patients <18 years of age in the Kaiser Permanente Northern California health system who were referred to a specialty transgender clinic between February 2015 and June 2018. Trends in treatment demand, demographic data, service requests, and surgical history were abstracted from medical charts and analyzed by using descriptive statistics. RESULTS: We identified 417 unique transgender and gender-nonconforming pediatric patients. The median age at time of referral was 15 years (range 3-17). Most (62%) identified on the masculine spectrum. Of the 203 patients with available ethnicity data, 68% were non-Hispanic. During the study period, the clinic received a total of 506 referrals with a significant increase over time ( P < .001). Most referrals were for requests to start cross-sex hormones and/or blockers (34%), gender-affirming surgery (32%), and mental health (27%). Transition-related requests varied by age group: younger patients sought more mental health services, and older patients sought hormonal and surgical services. Eighty-nine patients underwent gender-affirming surgeries, mostly before age 18 and most frequently mastectomies (77%). CONCLUSIONS: The increase in referrals supports the need for expanded and accessible health care services for this population. The transition-related care of p…
01 November 2019·BACKGROUND AND OBJECTIVES: Emerging evidence indicates transgender adolescents (TGAs) exhibit elevated rates of suicidal ideation and attempt compared with cisgender adolescents (CGAs). Less is known about risk among subgroups of TGAs because of limited measures of gender identity in previous studies. We examined disparities in suicidality across the full spectrum of suicidality between TGAs and CGAs and examined risk for suicidality within TGA subgroups. METHODS: Adolescents aged 14 to 18 completed a cross-sectional online survey ( N = 2020, including 1148 TGAs). Participants reported gender assigned at birth and current gender identity (categorized as cisgender males, cisgender females, transgender males, transgender females, nonbinary adolescents assigned female at birth, nonbinary adolescents assigned male at birth, and questioning gender identity). Lifetime suicidality (passive death wish, suicidal ideation, suicide plan, suicide attempt, and attempt requiring medical care) and nonsuicidal self-injury were assessed. RESULTS: Aggregated into 1 group, TGAs had higher odds of all outcomes as compared with CGAs. Within TGA subgroups, transgender males and transgender females had higher odds of suicidal ideation and attempt than CGA groups. CONCLUSIONS: In this study, we used comprehensive measures of gender assigned at birth and current gender identity within a large nationwide survey of adolescents in the United States to examine suicidality among TGAs and CGAs. TGAs had higher odds of all suicidality outcomes, and transgender males and transgender females had high risk for suicidal ideation and attempt. Authors of future adolescent suicidalit…
24 October 2019·Children and adolescents who are transgender or need support. In some communities, some clinicians have started clinics for transgender individuals or those who are gender nonconforming.
17 September 2018·Some children do not identify with either gender. They may feel like they are somewhere in between or have no gender. It is natural for parents to ask if it is “just a phase.” But, there is no easy answer. The American Academy of Pediatrics explains why.
17 September 2018·Society struggles to adapt to and appreciate the diverse experiences of transgender and gender-diverse individuals, which contributes to intolerance, discrimination and stigma.
17 September 2018·Policy statement to provide guidance for parents and clinicians through a gender-affirming approach.
16 October 2019·OBJECTIVES: We characterized referral trends over time at a transgender clinic within an integrated health system in Northern California. We identified the transition-related requests of pediatric transgender and gender-nonconforming patients and evaluated differences in referrals by age group. METHODS: Medical records were analyzed for all patients <18 years of age in the Kaiser Permanente Northern California health system who were referred to a specialty transgender clinic between February 2015 and June 2018. Trends in treatment demand, demographic data, service requests, and surgical history were abstracted from medical charts and analyzed by using descriptive statistics. RESULTS: We identified 417 unique transgender and gender-nonconforming pediatric patients. The median age at time of referral was 15 years (range 3-17). Most (62%) identified on the masculine spectrum. Of the 203 patients with available ethnicity data, 68% were non-Hispanic. During the study period, the clinic received a total of 506 referrals with a significant increase over time ( P < .001). Most referrals were for requests to start cross-sex hormones and/or blockers (34%), gender-affirming surgery (32%), and mental health (27%). Transition-related requests varied by age group: younger patients sought more mental health services, and older patients sought hormonal and surgical services. Eighty-nine patients underwent gender-affirming surgeries, mostly before age 18 and most frequently mastectomies (77%). CONCLUSIONS: The increase in referrals supports the need for expanded and accessible health care services for this population. The transition-related care of p…
16 October 2019·Studies that we have published on transgender adolescents have raised concerns about their mental health, especially if the environment in which these teens live is not supportive. But are transgender youth more likely to consider or attempt suicide compared to cisgender adolescents?
14 October 2019·BACKGROUND AND OBJECTIVES: Emerging evidence indicates transgender adolescents (TGAs) exhibit elevated rates of suicidal ideation and attempt compared with cisgender adolescents (CGAs). Less is known about risk among subgroups of TGAs because of limited measures of gender identity in previous studies. We examined disparities in suicidality across the full spectrum of suicidality between TGAs and CGAs and examined risk for suicidality within TGA subgroups. METHODS: Adolescents aged 14 to 18 completed a cross-sectional online survey ( N = 2020, including 1134 TGAs). Participants reported gender assigned at birth and current gender identity (categorized as cisgender males, cisgender females, transgender males, transgender females, nonbinary adolescents assigned female at birth, nonbinary adolescents assigned male at birth, and questioning gender identity). Lifetime suicidality (passive death wish, suicidal ideation, suicide plan, suicide attempt, and attempt requiring medical care) and nonsuicidal self-injury were assessed. RESULTS: Aggregated into 1 group, TGAs had higher odds of all outcomes as compared with CGAs. Within TGA subgroups, transgender males and transgender females had higher odds of suicidal ideation and attempt than CGA groups. CONCLUSIONS: In this study, we used comprehensive measures of gender assigned at birth and current gender identity within a large nationwide survey of adolescents in the United States to examine suicidality among TGAs and CGAs. TGAs had higher odds of all suicidality outcomes, and transgender males and transgender females had high risk for suicidal ideation and attempt. Authors of future adolescent suicidalit…
01 September 2019·* Abbreviations: MAI – : medical affirming intervention TGD-AYA – : transgender and gender-diverse adolescents and young adults Transgender and gender-diverse adolescents and young adults (TGD-AYA) increasingly present to health care providers seeking medical affirming interventions (MAIs) to induce physiologic changes aligned with their gender identity. MAIs include gonadotropin-releasing hormone agonists to temporarily suppress puberty, testosterone to induce masculine characteristics among those assigned female at birth, and estrogen (often combined with an antiandrogenic agent) to induce feminine characteristics among those assigned male at birth. There is considerable concern that these MAIs impact gonadal structures and function, thereby decreasing future fertility potential.1 Little research has explored reversibility or thresholds (amount and/or duration) of MAIs in impacting TGD-AYA fertility. Therefore, multiple professional organizations recommend fertility counseling before MAI initiation.2-4 In this month’s issue of Pediatrics, Barnard et al5 provide the first study of semen cryopreservation outcomes among TGD-AYA assigned male at birth who assert a female gender identity. They conducted retrospective chart reviews on 11 TGD-AYA referred for fertility preservation over a nearly 4-year period. One patient did not provide a sample. The 8 samples obtained from patients before MAI initiation were all viable. One patient … Address correspondence t…
01 September 2019·BACKGROUND: Fertility preservation enables patients undergoing gonadotoxic therapies to retain the potential for biological children and now has broader implications in the care of transgender individuals. Multiple medical societies recommend counseling on fertility preservation before initiating therapy for gender dysphoria; however, outcome data pre- and posttreatment are limited in feminizing transgender adolescents and young adults. METHODS: The University of Pittsburgh Institutional Research Board approved this study. Data were collected retrospectively on transgender patients seeking fertility preservation between 2015 and 2018, including age at initial consultation and semen analysis parameters. RESULTS: Eleven feminizing transgender patients accepted a referral for fertility preservation during this time; consultation occurred at median age 19 (range 16-24 years). Ten patients attempted and completed at least 1 semen collection. Eight patients cryopreserved semen before initiating treatment. Of those patients, all exhibited low morphology with otherwise normal median semen analysis parameters. In 1 patient who discontinued leuprolide acetate to attempt fertility preservation, transient azoospermia of 5 months’ duration was demonstrated with subsequent recovery of spermatogenesis. In a patient who had previously been treated with spironolactone and estradiol, semen analysis revealed persistent azoospermia for the 4 months leading up to orchiectomy after discontinuation of both medications. CONCLUSIONS: Semen cryopreservation is a viable method of fertility preservation in adolescent and young adult transgender individuals and can be considered in patients who have already initiated therapy for gender dysphoria. Further research is nee…
06 August 2019·Transgender adolescent and young adult patients are increasingly requesting medical affirming interventions (MAIs) to enable them to experience physiologic changes that align with their gender identity.
05 August 2019·Semen cryopreservation was successful for a patient who had started hormone therapy as well as eight who had not.
17 September 2018·Society struggles to adapt to and appreciate the diverse experiences of transgender and gender-diverse individuals, which contributes to intolerance, discrimination and stigma.
17 September 2018·Policy statement to provide guidance for parents and clinicians through a gender-affirming approach.
07 May 2019·Many adolescents who are transgender or non-binary face significant peer victimization. Does restriction of locker rooms or restrooms to the sex assigned at birth contribute to the increasing risk of sexual assault victimization?
06 May 2019·Transgender and gender non-binary teens are at a greater risk of sexual assault at schools that deny them access to gender identity-congruent restrooms or locker rooms.
24 January 2019·About 35% of transgender teens reported being bullied at school. The same percentage also reported suicide attempts.
01 December 2018·* Abbreviation: LGBTQ – : lesbian, gay, bisexual, transgender, and queer > In our November issue, we shared with you the winning submission to our annual essay contest-this year focusing on access to care-by Dr Michael Mattiucci. We are pleased to publish the other competition finalist, written by Drs Sarah Bernstein and Holly Lewis. Bernstein and Lewis’s essay explores another aspect of access to care. They argue that “access” is not just about helping to get patients through the door, but about providing culturally-sensitive and affirming care. The authors conclude by offering up several practical suggestions that can help providers to create office and hospital environments where all patients-particularly those who identify as LGBTQ-feel welcome and supported. Expelling a heavy breath, Emily discarded the plush towel clinging to her waist and pressed her toes into the icy tile. Inhaling the sterile scent of Lysol, she shifted awkwardly in front of the mirror; staring down at her scrotum, she tried to reconcile what she saw externally with what she knew internally. ‘Brian! Hurry up!’ her father shouted. Glancing around the bathroom, she noted that everything was intentionally blue and deliberately masculine. Despondent, she conjured the image of Picasso’s Old Guitarist, the disjointed figure, the loneliness, and the despair. It would be several years before she would learn the words ‘queer’ or ‘transgender’ and longer still before she was able to fully claim her identity. During that time, she would struggle with isolation, depression, alcohol addiction, and drug abuse. Sitting solemnly in clinic, staring at the thick scars of self-harm etched into her forearms, Emily looked up at me and sighed, ‘…
18 October 2018·Dr. Spack aims to satisfy pediatric health care professionals’ desire for more information during a plenary session titled ‘Caring for Transgender Youth (P4042)’ from 10:50-11:10 a.m. Tuesday, Nov. 6, in the Valencia Ballroom of the convention center.
01 October 2018·As a traditionally underserved population that faces numerous health disparities, youth who identify as transgender and gender diverse (TGD) and their families are increasingly presenting to pediatric providers for education, care, and referrals. The need for more formal training, standardized treatment, and research on safety and medical outcomes often leaves providers feeling ill equipped to support and care for patients that identify as TGD and families. In this policy statement, we review relevant concepts and challenges and provide suggestions for pediatric providers that are focused on promoting the health and positive development of youth that identify as TGD while eliminating discrimination and stigma. Copyright © 20…
01 October 2018·OBJECTIVES: Our primary objective was to examine prevalence rates of suicide behavior across 6 gender identity groups: female; male; transgender, male to female; transgender, female to male; transgender, not exclusively male or female; and questioning. Our secondary objective was to examine variability in the associations between key sociodemographic characteristics and suicide behavior across gender identity groups. METHODS: Data from the Profiles of Student Life: Attitudes and Behaviors survey ( N = 120 617 adolescents; ages 11-19 years) were used to achieve our objectives. Data were collected over a 36-month period: June 2012 to May 2015. A dichotomized self-reported lifetime suicide attempts (never versus ever) measure was used. Prevalence statistics were compared across gender identity groups, as were the associations between sociodemographic characteristics (ie, age, parents’ highest level of education, urbanicity, sexual orientation, and race and/or ethnicity) and suicide behavior. RESULTS: Nearly 14% of adolescents reported a previous suicide attempt; disparities by gender identity in suicide attempts were found. Female to male adolescents reported the highest rate of attempted suicide (50.8%), followed by adolescents who identified as not exclusively male or female (41.8%), male to female adolescents (29.9%), questioning adolescents (27.9%), female adolescents (17.6%), and male adolescents (9.8%). Identifying as nonheterosexual exacerbated the risk for all adolescents except for those who did not exclusively identify as male or female (ie, nonbinary). For transgender adolescents, no other sociodemographic characteristic was associated with suicide attempts. CONCLUSIONS: Suicide prevention efforts can be enhanced by attendi…
22 September 2018·The American Academy of Pediatrics published a policy statement on transgender talking points.
17 September 2018·Some children do not identify with either gender. They may feel like they are somewhere in between or have no gender. It is natural for parents to ask if it is “just a phase.” But, there is no easy answer. The American Academy of Pediatrics explains why.
13 September 2018·Being supportive of a teen’s gender identity, no matter what it is, is a key component of the care we provide. We know of the mental health stressors associated in LGBTQ+ faced by teens.
11 September 2018·Just over half of female-to-male transgender adolescents attempted suicide, a survey found.
01 September 2018·In this article, we discuss a case in which a 16-year-old birth-assigned male came out to her parents as transgender. She is referred to the gender management program at a large pediatric academic center to discuss hormone therapy. She was initially evaluated by a psychiatrist, diagnosed with gender dysphoria and anxiety, and treated with medication and psychotherapy. When her anxiety was well controlled and she met eligibility and readiness criteria, she was referred to 1 of 2 pediatric endocrinologists in the gender management program to discuss hormone therapy. As part of the discussion about the risks/benefits of estrogen therapy, the pediatric endocrinologist discussed options for fertility preservation (FP) before potentially gonadotoxic therapy. The patient stated that she was not interested in FP. Her mother requested procedures to preserve the possibility that the daughter could have biological children someday. We asked experts in the care of transgender youth to discuss ways in which the doctor could respond to this disagreement between parents an…
01 August 2018·An error occurred in the article by Olson KR et al, titled ‘Mental Health of Transgender Children Who Are Supported in Their …
02 June 2018·AAP Voices blog post encouraging pediatricians to support and help guide patients on their journey for gender identify as they seek happiness and well-being all children deserve.
26 May 2018·The AAP provides information intended to help AAP members prepare for media interviews about caring for lesbian, gay, bisexual, transgender, and questioning youth.
26 May 2018·The American Academy of Pediatrics (AAP) opposes guidance issued last night by the Departments of Justice and Education that eliminates protections for transgender youth in public schools.
26 May 2018·The study, “Mental Health of Transgender Children Who are Supported in Their Identities,” in the March 2016 issue of Pediatrics (published online on Feb. 26) presents new research on the positive mental health outcomes of prepubescent transgender children who socially transition, or begin to live expressing their gender identities.
01 May 2018·BACKGROUND: Understanding the magnitude of mental health problems, particularly life-threatening ones, experienced by transgender and/or gender nonconforming (TGNC) youth can lead to improved management of these conditions. METHODS: Electronic medical records were used to identify a cohort of 588 transfeminine and 745 transmasculine children (3-9 years old) and adolescents (10-17 years old) enrolled in integrated health care systems in California and Georgia. Ten male and 10 female referent cisgender enrollees were matched to each TGNC individual on year of birth, race and/or ethnicity, study site, and membership year of the index date (first evidence of gender nonconforming status). Prevalence ratios were calculated by dividing the proportion of TGNC individuals with a specific mental health diagnosis or diagnostic category by the corresponding proportion in each reference group by transfeminine and/or transmasculine status, age group, and time period before the index date. RESULTS: Common diagnoses for children and adolescents were attention deficit disorders (transfeminine 15%; transmasculine 16%) and depressive disorders (transfeminine 49%; transmasculine 62%), respectively. For all diagnostic categories, prevalence was severalfold higher among TGNC youth than in matched reference groups. Prevalence ratios (95% confidence intervals [CIs]) for history of self-inflicted injury in adolescents 6 months before the index date ranged from 18 (95% CI 4.4-82) to 144 (95% CI 36-1248). The corresponding range for suicidal ideation was 25 (95% CI 14-45) to 54 (95% CI 18-218). CONCLUSIONS: TGNC youth may present with mental health conditions re…
16 April 2018·A study found high a prevalence of anxiety, depression and attention deficit disorders among transgender and gender non-conforming children and adolescents.
01 March 2018·BACKGROUND: Transgender and gender nonconforming (TGNC) adolescents have difficulty accessing and receiving health care compared with cisgender youth, yet research is limited by a reliance on small and nonrepresentative samples. This study’s purpose was to examine mental and physical health characteristics and care utilization between youth who are TGNC and cisgender and across perceived gender expressions within the TGNC sample. METHODS: Data came from the 2016 Minnesota Student Survey, which consisted of 80 929 students in ninth and 11th grade ( n = 2168 TGNC, 2.7%). Students self-reported gender identity, perceived gender expression, 4 health status measures, and 3 care utilization measures. Chi-squares and multiple analysis of covariance tests (controlling for demographic covariates) were used to compare groups. RESULTS: We found that students who are TGNC reported significantly poorer health, lower rates of preventive health checkups, and more nurse office visits than cisgender youth. For example, 62.1% of youth who are TGNC reported their general health as poor, fair, or good versus very good or excellent, compared with 33.1% of cisgender youth (χ 2 = 763.7, P < .001). Among the TGNC sample, those whose gender presentation was perceived as very congruent with their birth-assigned sex were less likely to report poorer health and long-term mental health problems compared with those with other gender presentations. CONCLUSIONS: Health care utilization differs between TGNC versus cisgender youth and across gender presentations within TGNC youth. With our results, we suggest that health care providers sho…
01 March 2018·* Abbreviation: TGNC – : transgender and gender nonconforming Although reports of health disparities are sobering, poor physical and mental health is not inevitable for transgender and gender nonconforming (TGNC) youth. It is true that data from a retrospective cohort study quantify disparities in mental health outcomes, revealing a two- to threefold increase in the risk of negative mental health outcomes in transgender youth, including depression, suicidal ideation, and suicide attempt.1 It is also true that the National Transgender Discrimination Survey, which is administered to adults, revealed the disheartening statistic that 41% of TGNC respondents had attempted suicide in their lifetimes in contrast with ∼1.6% of the general population who have done so.2 However, research that is focused on well-supported TGNC youth helps dispel the idea that simply being transgender is the cause of poor health outcomes. For example, long-term outcome data from the Netherlands demonstrate that children with gender dysphoria who were treated in a comprehensive gender center with gender-affirming treatment during … Address correspondence to Daniel Shumer, MD, MPH, Division of Pediatric Endocrinology, Department of Pediatrics,…
09 February 2018·Helping all adolescents feel welcome and safe in a primary health care setting is certainly something we strive for, but when a teen is transgender/gender non-conforming (TGNC), they may not feel that their medical home is prepared to deal with their health concerns, resulting in fewer visits than teens who may be cisgender.
05 February 2018·Transgender teens are more likely to skip doctor checkups and experience more health issues than their peers.
05 February 2018·Researchers found that students who are transgender/non-conforming reported significantly poorer health status, lower rates of preventive health check-ups, and more visits to the nurse’s office.
27 July 2017·The American Academy of Pediatrics stands in support of transgender children and adults, and condemns attempts to stigmatize or marginalize them.
01 March 2017·OBJECTIVE: In various Western countries early medical gender-affirmative treatment has become increasingly available for transgender adolescents. Research conducted before the start of medical gender-affirming treatment has focused on psychological and social functioning, and knowledge about the sexual health of this specific young group is lacking. METHODS: Gender identity clinics referred 137 adolescents: 60 transgirls (birth-assigned boys, mean age 14.11 years, SD 2.21) and 77 transboys (birth assigned girls, mean age 15.14 years, SD 2.09; P = .05). A questionnaire on sexual experiences (kissing, petting while undressed, sexual intercourse), romantic experiences (falling in love, romantic relationships), sexual orientation, negative sexual experiences, and sexual satisfaction was administered. Experiences of the transgender adolescents were compared with data for same-aged youth of a Dutch general population study ( N = 8520). RESULTS: Of the transgender adolescents, 77% had fallen in love, 50% had had a romantic relationship, 26% had experienced petting while undressed, and 5% had had sexual intercourse. Transboys had more sexual experience than transgirls. In comparison with the general population, transgender adolescents were both sexually and romantically less experienced. CONCLUSIONS: Despite challenges, transgender adolescent are sexually active, a…
29 September 2016·The brief explores myths, presents a review of what medical and education experts know about transgender children and offers suggestions for adults with a transgender child in their life.
03 August 2016·Delaying such care comes with a price as it is connected to increased risk of psychiatric issues like anxiety and depression.
01 July 2016·The article by Olson et al1 exploring the mental health of preadolescent transgender children residing in families that are supportive of their identity attempted to address questions Olson recently raised in a Clinical Perspectives piece published in the Journal of the American Academy of Child and Adolescent Psychiatry .2 We read the current article in Pediatrics with great interest, and their effort was laudable. An enhanced understanding of the symptoms and phenomenology of transgender preadolescents is critical, as this material could inform interventions for this marginalized population. Olson et al ambitiously examined symptoms of anxiety and depression in both … E-mai…
20 April 2016·House Bill 2 requires people to use bathrooms in public schools and buildings that coincide with the gender on their birth certificate.
01 March 2016·We all have secrets. I ate the cookie. I broke the lamp and blamed it on my sister. The car battery wasn’t dead the night I stayed out past curfew. These little secrets are part of growing up.
01 March 2016·OBJECTIVE: Transgender children who have socially transitioned, that is, who identify as the gender ‘opposite’ their natal sex and are supported to live openly as that gender, are increasingly visible in society, yet we know nothing about their mental health. Previous work with children with gender identity disorder (GID; now termed gender dysphoria) has found remarkably high rates of anxiety and depression in these children. Here we examine, for the first time, mental health in a sample of socially transitioned transgender children. METHODS: A community-based national sample of transgender, prepubescent children ( n = 73, aged 3-12 years), along with control groups of nontransgender children in the same age range ( n = 73 age- and gender-matched community controls; n = 49 sibling of transgender participants), were recruited as part of the TransYouth Project. Parents completed anxiety and depression measures. RESULTS: Transgender children showed no elevations in depression and slightly elevated anxiety relative to population averages. They did not differ from the control groups on depression symptoms and had only marginally higher anxiety symptoms. CONCLUSIONS: Socially transitioned transgender children who are supported in their gender identity have developmentally normative levels of depression and only minimal elevations in anxiety, suggesting that psychopathology is not inevitable within this group. Especially striking is the comparison with reports of children with GID; socially transitioned transgender children have notably lower rates of inte…
01 March 2016·* Abbreviation: GID – : gender identity disorder Those of us who work with transgender children frequently face decisions based on evidence that is conflicted or lacking and encounter opponents who are rightfully wary about what they see as experimental treatments without well-examined outcomes. However, in a transgender population where nearly one half experience suicidal ideation, the risk of nonintervention is quite high.1 In this issue of Pediatrics , Olson and colleagues2 provide evidence in support of social transition, a completely reversible intervention associated with lower rates of depression and anxiety in transgender prepubescent children. Socially transitioned children, or those who have adopted the name, hairstyle, clothing, and pronoun associated with their affirmed, rather than birth gender, have become more visible in the media over the last several years. Although to date there has been no published evidence to support providers in suggesting social transition as a beneficial intervention, many families, often guided by mental health professionals, make that decision based on observational evidence in response to seeing how suffering can be alleviated by allowing the child to express their own sense of gender. Much of the research that is available on transgender youth and adults points to the dismal psychosocial outcomes faced by this population. Homelessness, substanc…
26 February 2016·Researchers from the University of Washington studied children ages 3 to 12 who identified as the gender opposite of their sex at birth and were living as that gender.
26 February 2016·With more and more stories in the public media regarding transgender adults, we need to remember that gender dysphoria can certainly start in childhood and not just adolescence
01 December 2015·* Abbreviations: FDA – : US Food and Drug Administration GnRH – : gonadotropin-releasing hormone PAG – : pediatric and adolescent gynecology referral service PES – : pediatric endocrinology service Appropriate medical intervention along with an affirming environment has been shown to result in improved health outcomes for transgender and gender-nonconforming people.1,2 Youth whose natural pubertal development would be detrimental to their psychological and general well-being can be treated with ‘puberty blockers’ to prevent irreversible phenotypic changes. In our experience, the most effective medications are the gonadotropin-releasing hormone (GnRH) agonist leuprolide injections (Lupron; AbbVie, Chicago, IL) or histrelin subcutaneous implant (Supprelin, Vantas; Endo Pharmaceuticals, Malvern, PA), and these have been recommended in both the Endocrine Society Guidelines and the World Professional Organization for Transgender Health Standards of Care.3,4 The safety and efficacy of these regimens have been reported in several populations.2,5 GnRH agonist pharmacotherapy can cost thousands of dollars per month. As a result, articles both in the media and in medical literature discuss the difficulty of obtaining insurance coverage for GnRH analogs used for this indication. As Dr Norman Spack stated, ‘Many, if not most, young adolescent American transgender patients who are deemed appropriate candidates for the recommended medical intervention . . . are unable to obtain the treatment due to insurance denial’; he es…
01 July 2013·The American Academy of Pediatrics issued its last statement on homosexuality and adolescents in 2004.This technical report reflects the rapidly expanding medical and psychosocial literature about sexual minority youth. Pediatricians should be aware that some youth in their care may have concerns or questions about their sexual orientation or that of siblings, friends, parents, relatives, or others and should provide factual, current, nonjudgmental information in a confidential manner. Although most lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth are quite resilient and emerge from adolescence as healthy adults, the effects of homophobia and heterosexism can contribute to increased mental health issues for sexual minority youth. LGBTQ and MSM/WSW (men having sex with men and women having sex with women) adolescents, in comparison with heterosexual adolescents, have higher rates of depression and suicidal ideation, higher rates of substance abuse, and more risky sexual behaviors. Obtaining a comprehensive, confidential, developmentally appropriate adolescent psychosocial history allows for the discovery of strengths and assets as well as risks. Pediatricians should have offices that are teen-friendly and welcoming to sexual minority youth. This includes having supportive, engaging office staff members who ensure that there are no barriers to care. For transgender youth, pediatricians should provide the opportunity to acknowledge and affirm their feelings of gender dysphoria and desires to transition to the opposite gender. Referral of transgender youth to a qualified mental health professional is critical to assist with the dysphoria, to educate them, and to assess their readiness for transition. With appropriate assistance and care, sexual minority youth should live healthy, productive lives while transitioning through adolescence and young adulthood. sexual orientation sexual identity sexual behaviors adolescents sexual minority homosexuality gay lesbian bisexual transgender Abbreviations: CDC – Centers for Disease Control and Prevention FTM – females transitioning to males GnRH – gonadotropin-releasing hormone HPV – human papillomavirus HSV – herpes simplex virus IOM – Institute of Medic…