Trans-Driven Medicine

When Ideology Overtakes Evidence-Based Care for Children

Background

Founded in 1930, the American Academy of Pediatrics (AAP) is the largest professional association of pediatricians in the U.S. The first president, Isaac A. Abt, anticipated that “the founding of the Academy will have a far-reaching significance in developing the scope and field of pediatrics and, I hope, a beneficent influence on the life and health of those patients whom the pediatricians will reach.” Like many medical associations, the AAP publishes policy positions, standards of care, patient-education materials, a news magazine, and a peer-reviewed flagship journal.

Reason for Surveillance

In 2018 the AAP released its first official policy statement addressing support and care for transgender and gender-diverse children and adolescents. According to lead author Jason Rafferty, MD, parents are to “listen, respect and support their child’s self-expressed identity” because doing so is “key to the child’s mental health and the family’s resilience and wellbeing.” The statement further asserts that a “gender-affirming” approach helps the child to “feel safe,” thus enabling him or her to “experience better physical and mental health” and focus on school, friends, and other normal developmental activities. It also recommends that electronic health records, billing systems, notification systems, insurance plans, clinical research, and policymaking comply with the child’s expressed gender identity.

Parents, doctors, and the American public have long assumed that AAP policies represent the gold standard in pediatric care, in the belief that AAP guidelines are informed by evidence. However, in her book Lost in Trans Nation: A Child Psychiatrist’s Guide Out of the Madness,Dr. Miriam Grossman documents many practitioners’ concerns with the 2018 statement. James Cantor, for example, a psychologist and expert in treating gender dysphoria, noted that the majority of clinics taking a “watchful waiting” approach —a protocol by which children are not treated with medical interventions until they grow into late adolescence or adulthood —observe a very high degree of natural desistance (resolution without medical treatment, as the patient reconciles with biological sex). Cantor also pointed out that eleven follow-up studies documenting this natural desistance in the psychiatric literature were excluded from the AAP’s policy statement. Moreover, those references the AAP cited as evidence for gender-affirmation “outright contradicted” recommending affirmation and instead “repeatedly [endorsed] watchful waiting.”

Most Recent Offense

Despite pushback from many dissenting pediatricians and the accumulating data on desisters, the AAP doubled down on the policy in 2023. In the words of pediatrician and AAP member Dr. Julia Mason, AAP’s acquiescence to agenda over evidence seems to be the result of “a few activists that have captured key committees at these medical societies . . . to ensure the voice of regular pediatricians isn’t heard.”

Policy statements informed by such activism have potentially irreversible and life-altering impacts on children and their families. Not only are children being fast-tracked into “gender-affirming” medical interventions as the solution to their dysphoria, but, as Grossman notes, those parents expressing any reluctance to “affirm” are being assailed as “bad, toxic, unsafe bigots” for daring to question “an irrational belief system with no scientific foundation.” While the AAP may well have been launched to promote child wellbeing, today’s AAP appears to serve the interests of trans ideologues and the pharmaceutical-and-medical-industrial-complex bureaucracies. This is surely a far cry from the “beneficent influence” its founders intended.