DISMEMBERING THE DISORDERED:

The AAP conference is one of many flashpoints in the contentious debate in the United States over if, when, and how children and adolescents with gender dysphoria should be medically or surgically treated. US medical professional groups are aligned in support of "gender affirming care" for gender dysphoria, which may include gonadotrophin releasing hormone analogues (GnRHa) to suppress puberty; oestrogen or testosterone to promote secondary sex characteristics; and surgical removal or augmentation of breasts, genitals, or other physical features. At the same time, however, several European countries have issued guidance to limit medical intervention in minors, prioritising psychological care. [...]

More adolescents with no history of gender dysphoria--predominantly birth registered females2--are presenting at gender clinics. A recent analysis of insurance claims by Komodo Health found that nearly 18 000 US minors began taking puberty blockers or hormones from 2017 to 2021, the number rising each year.34 Surveys aiming to measure prevalence have found that about 2% of high school aged teens identify as "transgender."5 These young people are also more likely than their cisgender peers to have concurrent mental health and neurodiverse conditions including depression, anxiety, attention deficit disorders, and autism.6 In the US, although Medicaid coverage varies by state and by treatment, the Biden administration has warned states that not covering care is in violation of federal law prohibiting discrimination.7 Meanwhile, the number of private clinics that focus on providing hormones and surgeries has grown from just a few a decade ago to more than 100 today.4

As the number of young people receiving medical transition treatments rises, so have the voices of those who call themselves "detransitioners" or "retransitioners," some of whom claim that early treatment caused preventable harm.8 Large scale, long term research is lacking,9 and researchers disagree about how to measure the phenomenon, but two recent studies suggest that as many as 20-30% of patients may discontinue hormone treatment within a few years.1011 The World Professional Association for Transgender Health (WPATH) asserts that detransition is "rare."12

Chloe Cole, now aged 18, had a double mastectomy at age 15 and spoke at the AAP rally. "Many of us were young teenagers when we decided, on the direction of medical experts, to pursue irreversible hormone treatments and surgeries," she read from her tablet at the rally, which had by this time moved indoors to avoid confrontation. "This is not informed consent but a decision forced under extreme duress."

Scott Hadland, chief of adolescent medicine at Massachusetts General Hospital and Harvard Medical School, dismissed the "handful of cruel protesters" outside the AAP meeting in a tweet that morning. He wrote, "Inside 10 000 pediatricians stand in solidarity for trans & gender diverse kids & their families to receive evidence-based, lifesaving, individualized care."13

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