Leading U.S. pediatricians’ group reaffirms support for gender-related care for minors

A leading U.S. pediatric organization has reaffirmed its support for gender-related treatments in minors, but also plans a systematic review of the medical research.

The move by the American Academy of Pediatrics (AAP) to examine research on the treatments is similar to recent moves in England and Sweden. Both limited access to the treatments after their reviews found uncertain evidence for their effectiveness in adolescents, the New York Times reported.

“The board has confidence that the existing evidence is such that the current policy is appropriate,” said Mark Del Monte, chief executive of the AAP, which represents 67,000 pediatricians. “At the same time, the board recognized that additional detail would be helpful here.”

Asked about the policy changes in European countries, Del Monte said, “they engaged in their process, we’re engaging in our process.”

A systematic review of the evidence is considered the gold standard.

The AAP issued a statement on gender-related treatments in 2018, and it’s customary for the group to reevaluate position statements after five years, the Times reported.

The 2018 statement said the treatments were essential and should be covered by health insurers. The group’s 16-member board reaffirmed the guidelines Thursday.

After the new review is complete, the organization plans to issue additional clinical guidance for doctors. It is also likely to update its recommendations at that time.

As in Europe, gender-affirming care for minors is at the center of political debate in the United States. Opponents consider it experimental. Republican lawmakers have banned it in 19 states.

This care can include psychotherapy, puberty-blocking drugs, hormones and, rarely, surgeries. Early evidence suggested that gender-affirming care could improve the mental health of transgender adolescents.

The AAP says legislative bans intrude on decisions by doctors and their patients. The academy has filed friend-of-the-court briefs in support of court challenges to these bans, the Times reported.

Dr. Julia Mason, an Oregon pediatrician who co-founded a group called the Society for Evidence-Based Gender Medicine, told the Times she was glad to see that a review is planned.

“We are making strong recommendations based on weak evidence,” she said.

Dr. Marci Bowers, a gynecologic and reconstructive surgeon and the president of the World Professional Association for Transgender Health, said gender-related care profoundly improves many children’s lives.

“They know this population,” said Bowers, who is a transgender woman. “They know the stories. Anecdotally, it’s overwhelmingly positive.”

Referring to policies abroad, she noted that Europe has not banned gender-related care entirely.

“What they’re saying is this population needs to be studied,” she said. “And I agree with that.”

The European changes include a decision in June by England’s National Health Service to restrict the use of puberty blockers to clinical trials. The NHS said “there is not enough evidence to support their safety or clinical effectiveness as a routinely available treatment.”

Last year, Sweden’s health care governing body decided the risks of puberty-inhibiting and gender-affirming hormone treatments outweigh the benefits for those under 18.

More information:
The Association of American Medical Colleges has more on gender-affirming care.

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