Montana parents deserve better information
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Dr. Lauren Wilson, president of the Montana chapter of the American Academy of Pediatrics (AAP), has written to express her opposition to SB 99, the bill signed into law by Gov. Greg Gianforte that restricts sex change drugs and surgeries to adults only.
Wilson disagrees with Gianforte’s claim that the science of “gender-affirming care” is “unsettled.” Thirty American medical organizations, she says, agree that there is “strong, cohesive evidence that appropriate gender-affirming care improves health and well-being,” and that it can even be “life-saving.”
Wilson’s assertions are dangerously misleading, and Montanan parents should know why.
A growing number of countries, including LGBT-friendly Sweden, Finland, and the U.K., now agree with Gianforte that the science is in fact unsettled. They view the use of powerful drugs and irreversible surgeries to “treat” kids in distress seemingly over having been “assigned” the wrong sex at birth as an ongoing medical experiment the results of which we won’t know for many years.
Thus, the real question is not whether there is a consensus among major U.S. medical groups, but why these groups are at odds with the findings and policies of health authorities in Europe.
Unlike Wilson’s AAP, European countries have conducted systematic reviews of evidence. In evidence-based medicine, systematic reviews constitute the highest level of evidence evaluation. The lowest level is the expert opinion of doctors based on their clinical experience. This is because expert opinion is likely to be infected with confirmation bias, while the methodology of a systematic review is designed to detect and evaluate bias in research.
Systematic reviews in the U.K. and Scandinavia and by experts in EBM at McMaster University have all found that studies cited in support of “gender-affirming care” suffer from significant methodological weaknesses, which make any findings of mental health benefits unreliable. Sweden’s National Board of Health and Welfare has concluded that the risks of these interventions “currently outweigh the possible benefits.”
Sweden, Finland, and the U.K. have already reversed course, placing severe restrictions on minor access to puberty-blocking drugs and cross-sex hormones (unlike in the U.S., where they have proliferated in recent years, surgeries are extremely rare in Europe). Minors in these countries may now receive hormonal interventions only after careful screening and within tightly regulated research settings.
France, Australia, Norway, and New Zealand have also issued warnings about medicalizing gender non-conformity in youth.
Health authorities in these countries now say that “the first-line of treatment” for gender dysphoria should be “psychosocial support” and psychotherapy (as needed), not drugs that disrupt the pituitary gland. Unfortunately, the AAP considers any therapeutic approach that does not instantly and uncritically “affirm” (i.e., agree with) a minor’s self-diagnosis of being trans and needing transition “conversion therapy.” It does so despite overwhelming evidence to the contrary. There are U.S. states in which parents struggle to find a therapist who will actually explore potential causes of their child’s sudden trans identification and desire for hormones.
After allowing “gender-affirming care” to exist for about a decade in their clinics, the Europeans have sobered up to the reality that the evidence is just too weak to justify business-as-usual. In the United States, business is not only proceeding as usual; it’s booming.
Alongside soaring rates of transgender identification among youth—at least 2.1 percent of Generation Z, according to Gallup, and up to 9.2 percent in Pittsburgh high schools, according to one study—is a documented and dramatic rise of gender dysphoria diagnoses and medicalization. Gender dysphoria diagnoses in kids ages 6-17 rose by 70% between 2020-2021 alone. Teen double-mastectomies increased 13-fold between 2013 and 2020, and by 500% between 2016 and 2019 alone. The director of the gender clinic at Boston Children’s Hospital admitted that they were giving out puberty blockers “like candy.”
A Reuters investigation from last year found that none of the providers at 18 pediatric gender clinics said they were doing comprehensive mental health assessments; 7 clinics reported writing prescriptions upon a patient’s first visit. In 2021, the founder of the first pediatric gender clinic in the U.S. and a transgender psychologist wrote in the Washington Post that kids were being inappropriately rushed into medical transition.
More recently, the testimony of Jamie Reed, a whistleblower who spent over four years at the Washington University Transgender Center, painted a grim picture in which kids with severe psychological problems were put on a conveyor belt to transition. According to Reed’s sworn affidavit, the clinic’s doctors had ignored clear and obvious red flags and were indifferent to the serious injuries their “treatments” inflicted. This is not “safe” medical care based on “settled science.” It’s an ideologically-driven experiment that has gotten out of control.
Meanwhile, more and more young adults are speaking out as “detransitioners” who were not given the proper psychological treatment. Their professions of being “trans” were taken at face value, their natural puberty blocked, their bodies flooded with synthetic hormones, and their healthy breasts amputated. Proponents of “gender-affirming care” argue that these cases are extremely rare, but the studies they cite in support of that claim were done almost exclusively on adults who transitioned as adults, not as impressionable teenagers under an “affirming” protocol.
Moreover, detransitioners face enormous pressures—especially from transgender activists who recognize the danger to the “safe and effective” narrative—to hide their regret and suffer in silence. But they won’t.
The AAP has led the public to believe that a consensus among professional associations equates to “settled science.” It doesn’t. An investigative report published last February in the prestigious British Medical Journal clarified that while American-style gender medicine is “consensus-based,” it is not “evidence-based.”
Dr. Wilson invokes the idea that kids will kill themselves if their demands for medical transition aren’t given into.
This contradicts the findings of the systematic reviews of evidence and peer-reviewed research.
Last January, Dr. Riittakerttu Kaltiala, chief psychiatrist at one of Finland’s two gender clinics and the country’s top expert on pediatric gender medicine, told the Finnish press that the suicide narrative is “purposeful disinformation” and that spreading it is “irresponsible.” Given the risk of suicide warnings like the one made by Dr. Wilson becoming self-fulfilling prophecies, a 2017 guide authored by suicide prevention groups and cosponsored by major U.S. LGBT organizations explicitly states: “Don’t… say that a specific anti-LGBT law or policy will ‘cause’ suicide.”
For good reason, liberal Americans have long supported government regulation of powerful entities that fail or refuse to regulate themselves. The best argument for laws like SB 99 is not that Europe is too permissive or that we know with confidence that no child would ever benefit from hormones and surgeries. It’s that we cannot trust the medical professionals who dictate medical policy to regulate themselves in the interest of patient welfare.
I’m sorry to say that Dr. Wilson’s letter is yet more evidence that this distrust is well-deserved.
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