Dec 15, 2022 – Rich McHugh
(NewsNation) — The demand for medical gender-affirming treatments in children and adolescents has surged in the last few years, even as it has also become one of the country’s more polarizing issues, with some states even outlawing the procedures entirely.
Recent data shows a massive influx of young patients seeking gender-affirming health care. Between 2017 and 2021, more than 17,000 patients aged 6-17 had initiated hormone or puberty blockers.
Most major American medical groups support gender-affirming treatment and procedures for children and adolescents who want it. But now, some prominent doctors in the field are urging the medical community to slow down.
Dr. Laura Edwards-Leeper is a founding psychologist at the first pediatric gender clinic in the country, located at Boston Children’s Hospital. Over the years, the world leader in transgender health has successfully helped hundreds of children transition.
“When I started doing this work, gender-affirming care, basically involved listening to the young person, trusting that they had a sense of who they were, and helping them sort out what was gonna be best for them,” she said.
One of her success stories is 18-year-old Noah Baartmans, who transitioned from female to male under her care.
“All my life I felt kind of uncomfortable in my gender,” Baartmans said. “I always felt like I fit in more with boys and the stereotypes that go with being a boy. It wasn’t necessarily a feeling, it was just something that I felt I was.”
Five years ago, Baartmans says he felt so uncomfortable as a girl that he considered suicide and was hospitalized. “I felt that the only way forward was to transition,” he said.
Baartmans began treatment with Edwards-Leeper, who deploys a deliberately slow and extensive process to transition. That meant months of therapy before he could start hormone therapy and then three additional years of therapy and assessments before he could have a double mastectomy.
“I had top surgery and it went really well and I don’t have any regrets,” he said. “It improved my mental health a lot and my functioning as a human being in society.”
Baartmans says he has no regrets about his transition and his case is a testimonial to supporting gender-affirming care for children and teens who want it.
However, Edward- Leeper says the way gender-affirming care is being handled elsewhere is getting out of control. “What I do in my practice is vastly different than what’s happening in most places,” she said.
“I do think that it has been hijacked. People have changed the meaning behind it,” she said. “Some providers consider gender-affirming care to be a very fast-moving process to get the child like to medical intervention.”
She says the patients she has worked with for longer periods of time are generally doing well, but “the field has gone completely off the rails in many respects.”
While there has been a surge in the number of children and teens seeking gender-affirming care, she often has young people who come in for therapy or assessments and later agree that slowing down their transition is a better option for them. She can sometimes spend years treating a teen before the medical transition begins.
But elsewhere, she thinks gender clinics are “extremely overwhelmed” and “in many places” the health care community is rushing adolescents through the process too quickly. “They don’t have enough providers, particularly mental health providers to help,” she said.
Transgender woman and clinical psychologist Dr. Erica Anderson agrees.
Anderson was the first transgender president of the U.S. Professional Association for Transgender Health and served as a board member for the World Professional Association for Transgender Health (WPATH) from 2019 to 2021.
“I think we need to reevaluate how we’re doing all of this,” she said. According to Anderson, “in many cases” kids in adolescence are going through this process too quickly.
“Some people who are doing work in this area where they say things like, ‘If a child says they’re trans, they’re trans, and I’ll afford them the advantage of medicines,’” Anderson said. “And I think I’m worried that in too many cases that they’re not doing a proper evaluation. Parents have been telling me this for a couple of years.”
According to Anderson, parents have told her some clinics have only conducted 15- to 20-minute evaluations before pronouncing the child transgender and explaining “the pathway to hormones.”
“And in some cases, even more deplorably in my view, they do this privately with the child and then advised the parents after the session, ‘Oh, well we confirm that your child is trans. And we’ve talked to them about hormones without the parent.’”
Edwards-Leeper says she has “colleagues who agree with (their concerns), but they’re terrified to say anything.”
One chief medical director at a large children’s health organization in the U.S. and would only speak to NewsNation anonymously for fear of losing his job.
“This is really the most serious abandonment of scientific principles that I have seen in the medical profession,” he said. “Very reasonable physicians have spoken their mind about this, and they’ve lost their jobs. Even people with tenure.”
He told NewsNation he is “almost certain” that would happen to him.
“What is concerning to me here is that all dialogue, all reasonable dialogue is stopped,” he said.
Dr. Meredithe McNamara is standing behind the current medical protocols. McNamara is an assistant professor of pediatrics at Yale School of Medicine and said the treatment for every transgender person is individual.
“The process depends on the person … not everyone is in distress, and I think that’s something that’s kind of a misunderstanding,” McNamara said. “Not everybody shows up to the doctor on the verge of suicide unless they get some sort of treatment. There’s so much diversity and joy in these experiences when space is held for who they are in a clinical setting.”
Some doctors claim providers cite studies about high suicide rates among transgender youth as a way to scare parents into agreeing to medical transitions.
However, Edwards-Leeper says “there are no studies that show that by intervening medically quickly, it will decrease suicide risk.”
“To have that be used as a lever to force someone to concede to treatment that may or may not be appropriate — I think is unwise and, and borders on malfeasance,” Anderson said.
In Europe, which was early to embrace gender care for minors, several countries have scaled back treatments and mostly paused transgender surgery for children.
“They’ve taken a step back and they’ve recognized that things have gotten out of control in some ways,” Edwards-Leeper said. “You know, just carrying on without the data.”
Now, Edwards-Leeper and Anderson say it is time for the American medical community to pull back, too.
“We are talking about young people, we’re talking about minors,” Edwards-Leeper said. “And I am very concerned about what’s happening in the field. I don’t think that we’re providing good care, and I’m concerned about potential harm being done, not intentionally, but I think that providers are not taking a step back and really questioning why are we seeing these numbers and why aren’t we looking more closely to get an answer to that? Instead, we’re just powering ahead with treatment. And I think that’s really problematic.”
Edwards-Leeper says kids and teens struggling with gender dysphoria should be helped but in a responsible way, which means approaching it in a developmentally appropriate way.
“It means involving the parents, it means understanding the complicating factors. And we should not be stopping care. We should not be closing down clinics. That would be a horrible thing to do. But we also need to slow down and put the breaks on a little bit and take a minute to reflect on where we are and why we’re here and what is the best path forward.”
For McNamara, the best path forward is to get governments out of the equation. Multiple states have enacted various restrictions on transgender health care in the name of protecting children.
For those who say that bans are needed because there are unknowns about the implications of gender-affirming care, McNamara called the argument “deeply hypocritical.”
“I wouldn’t say that a lot of is unknown. We are in a very exciting phase in gender-affirming care where we are learning more and more all the time,” McNamara said. “People are trying to ban it on the basis that we don’t have enough information supposedly, and that feels deeply hypocritical. Why introduce regulations and rules that limit our ability to provide care on the basis that maybe there are unknowns? It just seems like there’s something missing there.”
NewsNation’s Tom Palmer and Tulsi Kamath contributed to this report.