WASHINGTON — Physicians, researchers, the mother of a transgender child, and a former transgender book author warned of the potential harms of hormonal treatments and surgery on gender dysphoric children, during a briefing at the conservative Heritage Foundation on Thursday afternoon.
“Transition affirmative therapies are virtually untested and inflict lasting harms,” said Ryan Anderson, PhD, a senior research fellow at the conservative think tank and the briefing’s host.
Affirmative care is a new approach to treating transgender and gender nonconforming children (TGNC), which involves supporting a child’s “self-expressed identity,” according to the American Academy of Pediatrics.
As this model of care gained momentum, in the now 45 pediatric gender clinics across the country, “parents are told that puberty blocking drugs and cross-sex hormones may be the only way to prevent their children from committing suicide,” Anderson said.
(A meta-analysis of sexual minorities risk of suicide published in JAMA Pediatrics last year, found that transgender teens have the highest risk of suicide compared with other subpopulations including heterosexual teens; however, this finding was based on only one study.)
On the other hand, Anderson said that those who have sex-reassignment surgeries have a 19-fold risk of completing suicide.
He also said studies have shown that 80-95% of those who express a gender identity different from their “bodily sex” will ultimately identify with the latter as long as their natural development isn’t interrupted.
Michael Laidlaw, MD, an endocrinologist practicing in Rocklin, California, echoed Anderson’s argument that children will grow out of their gender dysphoria in time by “watching and waiting” or with “help from a therapist or psychologist.”
If a child had cancer, he suggested, wouldn’t most parents want evidence of the disease before starting chemotherapy? Yet “we’re giving very harmful therapies on the basis of no objective diagnosis.” (The American Psychiatric Association’s definition is based on children’s self-described gender identification and preferences for clothes, toys, and playtime roles, along with “distress or impairment in function, lasting at least six months.”)
The Endocrine Society has recommended starting hormone therapies, such as Lupron, in transgender adolescents at Tanner Stage 2 (a timeline of puberty’s stages named after James Tanner, MD, a pediatric endocrinologist).
“This is an off-label, untested, experimental use. It hasn’t been through any FDA approval process” for this indication, Laidlaw said.
Such treatments lead to infertility, disrupt brain development and bone development, which increases the risk of osteoporosis later in life, he said. Lupron’s side effects also include “neuropsychological” effects such as delusions, anxiety, and nervousness. Users are urged to “monitor for worsening of psychiatric symptoms,” he said.
Laidlaw also warned that cross-sex “wrong-sex” hormones, as he called them, increase the risk of myocardial infarction in both sexes, and that females who receive cross-sex hormones may experience liver dysfunction, hypertension, and cancer.
“This whole thing is an experiment on children,” he said. “We’re ignoring the voices of desistors and people who have come out of this and recognized their sex and the NIH is allowing unethical research to be conducted on children and adolescents, in my opinion.”
Joining Anderson and Laidlaw in the briefing was the mother of a transgender daughter — a “victim of gender-affirming medical procedures.” (The mother did not disclose her full name, presumably for reasons of privacy, but her placard said “Elaine.”)
Elaine questioned the rationale behind conversion therapy bans, which make it “illegal” to question a child’s gender identity, and criticized physicians and parents who, without hesitation, endorse this affirmative approach.
When a 5-year-old boy decides that he is a she, parents are told to let him wear girl’s clothes and take a new name, Elaine said.
But “is it really harmless to tell a child who still believes in the tooth fairy that he is the opposite sex?” she asked.
“The experts tell parents that it is harmful to question their children’s beliefs, that they must support their children’s medical transition, which includes a lifetime dependence on hormones, and that if parents do not comply, their children will be at higher risk of suicide. These parents are being lied to,” said Elaine.
Instead of affirmative therapy, Elaine recommended that children be helped to “love the bodies in which they were born.”
Another speaker on the panel, Walt Heyer, a book author and speaker who lived for 8 years as a woman, said he now regrets that decision.
Heyer said his grandmother dressed him up as a girl when he was age 4. He underwent gender reassignment surgery in 1983, de-transitioned in 1990, and now receives letters to his website from parents and transgender individuals who also wish to de-transition.
“I think it’s important for us to realize that there’s actually nothing good about affirming a young boy, 4-years-old, like my grandma did [to] me. The moment you affirm a child … is at the very same moment … you’re telling them there’s something wrong with them — ‘you’re not right.’ That is child abuse. We need to begin calling it what it is … I don’t believe any doctor who injects a young person with hormone blockers should have a license to do so,” Heyer said.
The American Academy of Pediatrics issued a policy statement in September 2018 recommending that all TGNC youth “have access to comprehensive, gender-affirming, and developmentally appropriate health care that is provided in a safe and inclusive clinical space.”
The Endocrine Society’s clinical practical guidelines also support gender affirmation as a “multidisciplinary treatment in which endocrinologists play an important role.”
The American Psychological Association (APA) in its 2015 practice guidelines describes the trans-affirmative practice as “the provision of care that is respectful, aware, and supportive of the identities and life experiences of [transgender and gender nonconforming] TGNC people.”
The APA underscored the distinction between “guidelines” and “standards,” noting that “state and federal laws may override these guidelines.”
For another perspective on this issue, see MedPage Today’s coverage of a July 2018 congressional briefing on transgender healthcare, hosted by The Endocrine Society.