At Last, the Medical Establishment’s Support for “Gender Affirming Care” Begins to Crack

As many Western countries reverse their former embrace of so-called “gender-affirming care” as it applies to children, the American medical establishment has obstinately pretended that puberty blockers and transition surgeries are medically uncontroversial. The latest example: An advocacy article published in the February 12, 2025 New England Journal of Medicine — yet again — decrying laws passed to protect children from transition interventions. From “Advancing Transgender Health amid Rising Policy Threats” (citations omitted):

Gender-affirming care is a cornerstone of multidisciplinary health support for transgender and nonbinary people; it is widely recognized as essential, evidence based, and often lifesaving. The standards of care issued by the World Professional Association for Transgender Health emphasize the critical role of interventions such as pubertal suppression, hormone therapies, and gender-affirming surgeries in improving the health and well-being of transgender and nonbinary people. Research consistently demonstrates the positive effects of these interventions, including substantial reductions in depression, anxiety, and suicidal ideation, and improvement in overall quality of life…

Despite robust evidence supporting the need for gender-affirming care, efforts to ban it inaccurately portray these interventions as experimental and harmful, classifying this care as “chemical and surgical mutilation” when it is offered to transgender young people. Such misrepresentations foster mistrust in the health care system, introduce legal risks for clinicians and parents, and intensify barriers for transgender and nonbinary people…

The stakes are clear, and the urgency is undeniable. The policies being implemented in many states and proposed at the federal level lack scientific justification and fail to align with the ethical principles of medicine.

This is disgraceful. A truly scientific article would acknowledge the growing body of contrary evidence and, if available, bring forth data to rebut it. It would at least grapple with the credible discrediting of WPATH. But no. The authors never mention these developments, instead relying on the usual “the science is settled” kind of naked assertions.

That’s not science. It’s ideology.

Then, just as I was despairing about whether the medical powers that be would ever emerge from their gender ideological swoon, the Journal of the American Medical Association published an article that acknowledges the new day in evaluating standards for treating pediatric gender confusion. From “Toward Evidence-Based and Ethical Pediatric Gender Medicine:”

The contrast between US and European physicians is clear in their policy statements. The lead author of the 2018 policy statement of the American Academy of Pediatrics (AAP), Jason Rafferty, has explained that children themselves should judge whether treatment should be given. “[T]he child’s sense of reality and feeling of who they are is the navigational beacon to sort of orient treatment around,” he said. By contrast, Sweden’s National Board of Health and Welfare concluded that “the risks of puberty blockers and gender-affirming treatment are likely to outweigh the expected benefits of these treatments.” The board recommends that children with gender dysphoria be carefully evaluated and compassionately treated but that hormonal interventions be limited to “the context of research” or “exceptional cases” only.

Yes. The “science” is far from settled. And that should lead to changes in treating these disturbed children (my emphasis):

The lack of good data, especially in the US, reflects deep professional inertia. For example, in 2023, the AAP announced it would conduct a systematic review of the evidence on which its 2018 policy statement was based. That review should have been done before the statement was issued, not after. Now, it is too little, too late. Vulnerable patients, their families, and their physicians deserve better.

Given this state of knowledge, it is ethically problematic to view the routine use of hormonal or surgical interventions in youth with gender dysphoria as evidence-based. We need high-quality studies to better understand the risks and benefits of various interventions. In the meantime, pediatricians should inform parents of disagreements within the field. Parents need to know how current practices in the US diverge from those in Europe. They need to know that systematic reviews of the clinical research find many flaws. Clinicians should also be aware that the Endocrine Society and WPATH guidelines as well as the AAP’s policy statement differ substantially from the approach adopted in the UK and a growing number of European countries.

This is a huge step in the right direction toward ending the moral panic that has put so many of our young people at risk of irreversible bodily, well, mutilations.

This much is sure: Any physician who does not disclose the existing scientific disagreement to parents seeking assistance for their gender-dysphoric children will have violated their duty to provide the information needed to make a properly informed decision.

Not only that, but states like California that treat parents who refuse to consent to radical “gender-affirming” interventions as so many abusers no longer have the scientific bases for justifying such draconian policies.