Instead of fostering serious, objective scientific inquiry and heeding concerns from within their own ranks, the establishment continues to rely on WPATH’s guidelines for dealing with gender dysphoria. And contrary to sound inquiry, WPATH cherry-picked studies instead of conducting a systematic review of the best available evidence. As one member of the Endocrine Society recently wrote about its guidelines, “the society’s full-throated endorsement of gender-affirming care implied condemnation of anyone who holds differing views.” This cows doctors into silence and coerces them into providing dangerous interventions to children.
This week, the American Academy of Pediatrics (AAP) is holding its annual leadership conference at its headquarters in Itasca, Illinois. One issue that won’t be on the formal agenda but will be on the minds of many members is how to treat gender dysphoria in children. AAP, along with most of America’s medical establishment, endorses the approach of the World Professional Association of Transgender Health (WPATH). This transgender advocacy group recommends that doctors irreversibly alter a child’s physical appearance to appear as a different gender through hormones and surgeries. But two transgender-identifying doctors in WPATH caution that teenage patients are receiving “sloppy care.” And there is dissent in AAP’s own ranks as to the legitimacy of this practice.
As many countries around the world turn to safer, non-invasive “watchful waiting” and psychotherapy to treat gender-confused kids instead of defaulting to hormones and surgeries, America is rapidly becoming an outlier. Now former patients (known as “detransitioners”), with the support of whistleblowers, are filing medical malpractice lawsuits and testifying in support of legislative limits on administering these experimental procedures to children. The architects of pediatric gender transition have built their arguments on flimsy evidence and the reputations of prestigious groups instead of objective, sound science. Their house of cards is starting to collapse.
Politicized Standards of Care
Gender dysphoria is a mental disorder that creates incongruence between one’s internal sense of gender and the reality of the sexed body. But unlike with anorexia, AAP’s recommended treatment does not focus on resolving the mind-body incongruence through counseling. Instead, doctors at “gender clinics” try to make a person’s body resemble their self-perception, disordered though it may be. Recently, 21 doctors from nine countries raised concerns that the American medical establishment has adopted “politicized” standards of care.
This isn’t the first time this has happened. Back in the twentieth century, another radical ideology captured the scientific and medical establishment. Eugenicists persuaded doctors to sterilize 70,000 Americans, who were disproportionately women and minorities. Medical schools taught eugenics. Wealthy tycoons funded the practice. And three presidents (Theodore Roosevelt, Franklin Delano Roosevelt, and Woodrow Wilson) lent their political support. The support for eugenics also existed on a systemic level: The American Neurological Association endorsed forced sterilization of people with schizophrenia, manic depression, epilepsy, and Down syndrome, and the American Medical Association relied on the research of a wealthy eugenics advocate for its contraceptive testing. Eventually, the premise of eugenics, genetic inheritance, was debunked and discredited by scientific evidence. But for three decades, doctors participated in one of the greatest ethical scandals of the last century.
Legal Endorsement of Eugenics and Growing Skepticism
Sadly, courts also enabled doctors to use their licenses, credentials, and skills to carry out experiments in eugenics on their patients. In the 1927 case Buck v. Bell, the U.S. Supreme Court upheld a Virginia law that allowed an 18-year-old woman, Carrie Buck, to be sterilized against her will. After Buck reported that she became pregnant through rape, her foster parents committed her to an institution for the “feebleminded.” Doctors sought to sterilize Buck on the grounds that it would eliminate an unfavorable trait from the population. In an infamously cruel endorsement of eugenics, Justice Oliver Wendell Holmes, Jr., declared, “Three generations of imbeciles is enough.”
The legal battle against eugenics reached a turning point when the U.S. Supreme Court recognized a prisoner’s human right to have children. In the 1942 case Skinner v. Oklahoma, the court rejected efforts to forcibly sterilize an inmate on the grounds that it violated the Constitution’s equal protection clause. Advocates for the disabled finally brought an end to eugenics in America by persuading state legislatures to pass “white cane laws” to protect the disabled from discrimination. The wave that began in state legislatures culminated in Congress’s passing the Americans with Disabilities Act in 1990. These laws made involuntary sterilization effectively unlawful and culturally unthinkable.
But, in a tragic echo of this dark moment from America’s past, some U.S. courts are now greenlighting a course of irreversible treatment for confused, vulnerable youth that would potentially render them sterile, often with a raft of lifelong medical complications and mental health challenges.
Fortunately, a contingent of courageous doctors is working to stop history from repeating itself. These doctors have repeatedly tried to introduce resolutions in the AAP calling for systematic evidence reviews, the gold standard in medicine.