‘Not Settled’: AAP Commissions Review of Science on Gender Reassignment Procedures

The American Academy of Pediatricians (AAP) “authorized development of an expanded set of guidance for pediatricians based on a systematic review of the evidence” on gender reassignment procedures, the organization announced Friday. “I think that they’re succumbing to a bit of pressure,” said Dr. Jennifer Bauwens, director of Family Research Council’s Center for Family Studies, on “Washington Watch.” “We certainly are seeing a number of lawsuits that are coming out from brave young men and women who are saying that how much damage this has done.”

The AAP’s 16-member Board of Directors “voted to reaffirm the 2018 AAP policy statement,” which had come up for a five-year review, “until there is an updated version.” That document endorsed a “gender-affirmative care model,” in which health care providers “destigmatize gender variance, promote the child’s self-worth, facilitate access to care, educate families, and advocate for safer community spaces where children are free to develop and explore their gender.” The process includes social affirmation, puberty blockers from the earliest signs of puberty, cross-sex hormones from “early adolescence onward,” gender reassignment surgeries for “adolescents on a case-by-case basis,” and legal affirmation.

The board authorized the systematic review because of “concerns about restrictions to access to health care with bans on gender-affirming care in more than 20 states,” said the AAP. This language refers to the SAFE-Act style laws now passed in 21 states (18 of which passed this year), which protect minors from the harmful, irreversible effects of gender reassignment procedures.

“Washington Watch” guest host and former Congressman Jody Hice called the AAP review “nothing but another political ploy.”

“They’re going to have this little study, and they’re going to say, ‘Okay, we studied this, but our study says it’s all safe. It’s good for us to proceed,’” he suggested. “So, they’re going to try to give the appearance of doing [an] authentic study and following the science. But at the same time, they’re trying to attack states that are trying to put it to an end.”

For their part, the AAP seems to embrace political overtones to their gender reassignment procedure messaging. AAP CEO and executive director Mark Del Monte, J.D. (a legal degree) pledged to “ensure young people get the reproductive and gender-affirming care they need and are seen, heard and valued as they are.” The AAP recently published a discussion in which the president-elect candidates “outline how they would support AAP Equity Agenda.”

The AAP press release further declared, “The AAP opposes any laws or regulations that discriminate against transgender and gender-diverse individuals, or that interfere in the doctor-patient relationship.” Yet the AAP often asks the government to interfere. In 2022, it asked the federal government to declare weighted swaddles, blankets, and sleepers to be unsafe for infants and urged President Biden to declare a national emergency over the adolescent mental health crisis.

“To ensure the policy update process is transparent and inclusive, the AAP will invite members and other stakeholders to share input,” the organization declared. But “some AAP members now tell journalists that … they ‘no longer trust the AAP,’” wrote dissenting Irish psychotherapist Stella O’Malley. In fact, she alleged, “some insiders have already accused the AAP of preordaining an analysis that will re-confirm the 2018-era position.”

“Regardless of their motivation, I think we can celebrate one point here, which is this: the fact that they’re doing the review is an admission that the science indeed is not settled,” said Bauwens. “There’s nothing settled about this practice.”

In fact, “the science itself should tell you that we are not in a place to move forward with the kinds of interventions that are at this level of invasion of a child’s body,” Bauwens added. “There are so many unanswered questions in the research, not to mention the research methods themselves. … [Gender reassignment procedures have] the least amount of evidence for the most invasive type of interventions.”

“We don’t understand the psychological ramifications of stopping puberty, of introducing social transition, [of] introducing these hormones. There are psychological implications as well, and those haven’t even been discussed,” said Bauwens. “Not to mention … the questions that haven’t been asked. Why isn’t anyone curious about this new cohort of young women who are identifying as transgender when that has not been the historical norm?”

Systematic evidence reviews have actually prompted European countries known for their progressive, pro-LGBT policies to backtrack on providing gender reassignment procedures for minors. Medical authorities in Sweden, Finland, the U.K., and Norway have all endorsed caution over the past three years. The U.K. shut down its gender transition mill, while Sweden banned puberty blockers.

Yet Bauwens said she is “very cautious about what the results of this [AAP] review will be because I know firsthand the political nature of science.”

“European countries come out and say this is not a helpful practice,” explained Bauwens. But will the AAP’s review reach the same conclusion? “If the review comes back, and it looks very different than the other countries, then we should be raising more red flags and asking for greater transparency of the reviewers themselves.”

“If the AAP keeps trying to suppress dissent, while insisting on a false consensus that never existed in the first place,” said O’Malley, “its leadership may find themselves discredited and dismissed in similar fashion.”