Politicizing Pediatrics: How the AAP’s Transgender Guidelines Undermine Trust in Medical Authority

The new guidelines from the AAP explicitly eliminate any role for age in evaluation of the child.

The five-year-old boy who transitions to identify as a girl has taken a major step on a road that may lead to treatment with cross-sex hormones, castration, and infertility. Most five-year-old boys who say they are girls will not persist: fifteen years later, in the great majority of cases, that boy will say he is a man, not a woman. But the American Academy of Pediatrics is now on record prioritizing the opinion of a five-year-old over the considered judgment of the child’s parents.

 

What should you do if your five-year-old son tells you that he is a girl?

 

The proportion of children and young adults who say that they are transgender is rising at an extraordinary rate, not only in the United States but in other countries as well. In 2009–2010, only forty girls in the United Kingdom requested reassignment to the male gender. In 2017–2018, that number was 1,806 girls, a rise of more than 4,000 percent in less than a decade. The UK Government Equalities Office (yes, it’s a thing) has announced that it will investigate.

 

What’s going on?

 

Our nation’s largest association of pediatricians, the American Academy of Pediatrics (AAP), recently released new guidelines for the evaluation and management of children and adolescents who identify as transgender. Previous guidelines have recognized that best practice depends on the age of the child. The great majority of five-year-old boys who say that they are girls will not persist in that conviction; ten years later, most of those boys will say that they are boys. They may be gay, they may be straight, but they are now sure that they are boys. They no longer want to be girls.

 

Five-year-olds are not mature adults. They are young children. As they grow up, they change in profound ways, particularly after the onset of puberty.Expert pediatricians used to understand that. They no longer do, at least not with regard to transgender identification. The new guidelines from the AAP explicitly eliminate any role for age in evaluation of the child. According to the new guidelines, any child who wants to transition to the other sex should be “affirmed.” Regardless of age. If a five-year-old boy tells you that he is a girl, your job is to buy him a dress and change his name to Emily. Any other response is outdated and transphobic. The authors specifically reject any “watchful waiting” for prepubescent children.

 

Where’s the Evidence?

 

These new guidelines are not based in evidence. On the contrary, they contradict the available research. For example, in one study, 139 boys who persistently said they were girls were enrolled around seven years of age. When researchers tracked down those boys many years later (averaging thirteen years later) only seventeen out of 139, or 12 percent, still said they were girls or had doubts about their gender identity. This study, and others like it, demonstrate that the majority of boys who say they are girls prior to the onset of puberty will not say they are girls after the onset of puberty. But the American Academy of Pediatrics is now on record prioritizing the opinion of a five-year-old over the considered judgment of the child’s parents, even suggesting that the pediatrician should take (unspecified) legal action if those ignorant parents refuse to obey their child’s wishes to transition to the other gender.

 

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