". . . and having done all . . . stand firm." Eph. 6:13


Military Doctor Hopes Gender Transitions for Kids Will Cause Psychotic Disorders to ‘Melt Away’

May 2, 2023

The military’s frenetic embrace of transgender ideology is being implemented too slowly, complained a team of five researchers led by Air Force Colonel Dr. David A. Klein, in an article presenting eight policy recommendations to expand gender transition procedures for minors in the military hospital system.

The article asserts “unwanted” puberty is “demonstrably harmful, while claiming that “gender-affirming health care … optimizes patient-oriented outcomes” and alternative strategies are “unethical.” A year earlier, Klein had stated his belief that “optimized” gender transition procedures for minors would cause diagnoses of psychotic disorders to “start to melt away over time,” even after publishing research showing the contrary.

Dr. Klein, who works at Travis Air Force Base in California and the Uniformed Services University in Maryland, noted a dramatic increase in “the number of new pediatric-age patients presenting for gender-affirming care in the MHS [Military Health System],” rising “from 109 individuals a year in 2010 to over 600 a year in 2016.” He complained that “health care system barriers to gender-affirming treatment include discrimination, poor access, fear of mistreatment, and lack of trained clinicians willing to provide gender-affirming care.” Specifically, he noted “new legal barriers” enacted by states seeking to protect minors from gender transition procedures, a movement which has only accelerated in recent months.

He noted that many laws are “currently blocked by court injunctions” but predicted those injunctions would not last, “given the ‘Originalist’ judicial philosophy of the majority of the current Supreme Court and the recent rejection of substantive due process protections for private health care decisions” — a reference to the Dobbs decision overturning Roe v. Wade.

For Klein and his colleagues, such barriers constituted a “crisis” — both a “public health crisis” and a “threat to military readiness.” They claimed, “gender-affirming health care, such as puberty suppression and affirming hormones … optimizes patient-oriented outcomes.”

“The DOD should not be providing medical services that may contribute to harming the psychological wellbeing of military families, especially when they target the youth of military dependents, which many consider child abuse,” FRC Executive Vice President Lt. Gen. (Ret.) William G. Boykin told The Washington Stand.

The article went on to dismiss any method of caring for children who identify as transgender other than immediate and total affirmation. “Some well-intentioned military-affiliated clinicians may not be aware that a ‘watchful waiting’ approach has a different risk profile than a gender-affirmative approach (which allows for gender identity exploration), and that ‘conversion therapy’ is unethical, harmful, and generally illegal,” they said. By contrast, FRC’s director of the Center for Family Studies, Dr. Jennifer Bauwens, has said that “any procedure causing infertility in minors should be viewed as a serious ethical problem.”

But they went further. “Unwanted discontinuation of GnRH-a [puberty blockers] or gender-affirming hormones will lead to demonstrably harmful and nonsensical partial masculinization or feminization [effects of puberty] and may lead to depression, suicidality, poor quality of life, and other untoward outcomes.”

Dr. Quentin Van Meter, former president of the American College of Pediatricians, insisted, “puberty is not a disease. It’s not something you want to get rid of. You need it to move from a pre-reproductive state to a reproductive state. And, without it, you can’t get there.”

“Deontological and consequentialist reasoning, rooted in empirical evidence and human rights, suggests that youths with decisional capacity, in an informed consent model of care, have an inherent ability and right to consent to gender-affirming therapy,” the article continued, suggesting that “children can begin participating in their medical decision-making as early as age seven.”

Van Meter said “there’s no way an adolescent can wrap their head around infertility, complete lack of sexual function.” WPATH-affiliated physician Dr. Daniel Metzger has admitted that some young people “have transitioned and [have] reproductive regret,” but still justified performing gender transition procedures on them to make them “happier in the moment.”

The article was not Klein’s first published work on the topic of military children who identify as transgender. He participated in a study published in the August 2021 edition of the Journal of Sexual Medicine titled, “Mental Healthcare Utilization of Transgender Youth Before and After Affirming Treatment,” where he “was responsible for assisting with conception and design of the study, interpretation of results, revising the paper critically for important intellectual content, and final approval of the paper.”

According to the data used in that study, transgender “youth were over 7 times as likely to have diagnosed suicidal ideation/self-harm … over 6 times as likely to have a mood/depressive disorder … [and] over 5 times as likely to have a psychotic disorder (eg, schizophrenia) diagnosed” as their siblings who did not identify as transgender. Additionally, “of the youths who received gender-affirming pharmaceutical care, the majority (89%, n = 857) also used a psychotropic medication during the study period.”

The study found that “mental healthcare and psychotropic medications did not decrease after gender affirming care.” In fact, “psychotropic medication use increased from mean of 120 days per year to a mean 212 days per year following gender affirming pharmaceutical care.” After gender transition procedures were begun on young people suffering from other psychotic disorders, their use of psychotropic medication nearly doubled.

The study’s results, which Klein helped to interpret, “strongly support clinical recommendations for screening of mental health conditions in TGD [transgender-identifying] youth.” Additionally, “the need for mental health treatment appears to persist after the initiation of gender-affirming pharmaceutical treatment.” These results are consistent with Bauwens’s argument that it should be normal protocol to “look for underlying conditions” in clinical evaluations of youth experiencing gender dysphoria.

Only a month later, Klein appeared to back away from the study’s conclusions. “It doesn’t mean that the surgery that urologists are considering or subsequent medications that other providers are considering is not going to have long-term benefit,” he said on a podcast.

Throughout the podcast, he repeatedly emphasized his goal to eliminate all stigma from gender dysphoria through adopting a minor’s preferred named and pronouns and other means. This extended to denying that people who identify as transgender are more likely to suffer from psychotic disorders. Said Klein:

“I think just this by looking at the rates of psychotic disorders, it’s easy to make assumptions [that] this is something inherent to transgender and gender diverse people. I don’t think that we know that. And I think that more likely it’s that when treatment’s optimized, these diagnoses start to melt away over time. So more research over time will show that definitively, hopefully.”

The 2021 study in which Klein participated found that gender transition procedures did not reduce psychotic disorders in minors. However, Klein stated that he hoped future research would reverse that finding once gender transition treatments were “optimized.”

“Hormone therapy is not a treatment for psychotic conditions,” Defense Department spokeswoman Commander Nicole Schwegman responded. “DOD clinicians follow current evidence-based clinical practice guidelines for the management of gender dysphoria, published by the Endocrine Society and the World Professional Association for Transgender Health [WPATH].” WPATH guidelines endorse the use of puberty blockers, cross-sex hormones, and performance of at least some gender transition surgeries on minors.

Klein and his colleagues noted in 2022, “Among military-affiliated physicians in the MHS, 87% indicated they did not have sufficient training to prescribe gender-affirming hormones to transgender adults and 53% said they would not prescribe gender-affirming hormones regardless of training.”

The U.S. Food and Drug Administration (FDA) has not approved puberty-blocking drugs for the purpose of postponing normal puberty; last summer, the FDA issued a warning label that puberty blockers could result in brain tumors, hallucinations, headache, vomiting, increased blood pressure, and visual impairments.

Joshua Arnold is a senior writer at The Washington Stand.