Originally
posted March 21, 2016 – a temporary statement with references. A full statement
will be published in summer 2016. Updated with Clarifications on April 6,
2016.
The
American College of Pediatricians urges educators and legislators to reject all
policies that condition children to accept as normal a life of chemical and
surgical impersonation of the opposite sex. Facts – not ideology – determine
reality.
1. Human sexuality is an objective biological binary trait: “XY” and
“XX” are genetic markers of health – not genetic markers of a disorder. The
norm for human design is to be conceived either male or female. Human sexuality
is binary by design with the obvious purpose being the reproduction and
flourishing of our species. This principle is self-evident. The exceedingly
rare disorders of sex development (DSDs), including but not limited to
testicular feminization and congenital adrenal hyperplasia, are all medically
identifiable deviations from the sexual binary norm, and are rightly recognized
as disorders of human design. Individuals with DSDs do not constitute a third
sex.1
2. No one is born with a gender. Everyone is born with a biological
sex. Gender (an awareness and sense of oneself as male or female) is a
sociological and psychological concept; not an objective biological one. No one
is born with an awareness of themselves as male or female; this awareness
develops over time and, like all developmental processes, may be derailed by a
child’s subjective perceptions, relationships, and adverse experiences from
infancy forward. People who identify as “feeling like the opposite sex” or
“somewhere in between” do not comprise a third sex. They remain biological men
or biological women.2,3,4
3. A person’s belief that he or she is something they are not is, at
best, a sign of confused thinking. When an otherwise healthy biological
boy believes he is a girl, or an otherwise healthy biological girl believes she
is a boy, an objective psychological problem exists that lies in the mind not
the body, and it should be treated as such. These children suffer from gender
dysphoria. Gender dysphoria (GD), formerly listed as Gender Identity Disorder
(GID), is a recognized mental disorder in the most recent edition of the
Diagnostic and Statistical Manual of the American Psychiatric Association
(DSM-V).5 The psychodynamic and social learning
theories of GD/GID have never been disproved.2,4,5
4. Puberty is not a disease and puberty-blocking hormones can be
dangerous. Reversible or not, puberty- blocking
hormones induce a state of disease – the absence of puberty – and inhibit
growth and fertility in a previously biologically healthy child.6
5. According to the DSM-V, as many as 98% of gender confused boys and
88% of gender confused girls eventually accept their biological sex after
naturally passing through puberty.5
6. Children who use puberty blockers to impersonate the opposite sex
will require cross-sex hormones in late adolescence. Cross-sex hormones
(testosterone and estrogen) are associated with dangerous health risks
including but not limited to high blood pressure, blood clots, stroke and
cancer.7,8,9,10
7. Rates of suicide are twenty times greater among adults who use
cross-sex hormones and undergo sex reassignment surgery, even in Sweden which
is among the most LGBQT – affirming countries.11 What compassionate and reasonable
person would condemn young children to this fate knowing that after puberty as
many as 88% of girls and 98% of boys will eventually accept reality and achieve
a state of mental and physical health?
8. Conditioning children into believing that a lifetime of chemical
and surgical impersonation of the opposite sex is normal and healthful is child
abuse. Endorsing gender discordance as normal via
public education and legal policies will confuse children and parents, leading
more children to present to “gender clinics” where they will be given
puberty-blocking drugs. This, in turn, virtually ensures that they will
“choose” a lifetime of carcinogenic and otherwise toxic cross-sex hormones, and
likely consider unnecessary surgical mutilation of their healthy body parts as
young adults.
Michelle
A. Cretella, M.D.
President
of the American College of Pediatricians
Quentin
Van Meter, M.D.
Vice
President of the American College of Pediatricians
Pediatric
Endocrinologist
Paul
McHugh, M.D.
University
Distinguished Service Professor of Psychiatry at Johns Hopkins Medical School
and the former psychiatrist in chief at Johns Hopkins Hospital
For a PDF
version click here: Gender Ideology Harms.
CLARIFICATIONS in response to questions regarding points 3 & 5:
Regarding
Point 3: “Where
does the APA or DSM-V indicate that Gender Dysphoria is a mental disorder?”
The APA (American Psychiatric Association) is
the author of the Diagnostic
and Statistical Manual of Mental Disorders, 5th edition(DSM-V).
The APA states that those distressed and impaired by their GD meet the
definition of a disorder. The College is unaware of any medical literature that
documents a gender dysphoric child seeking puberty blocking hormones who is not
significantly distressed by the thought of passing through the normal and
healthful process of puberty.
From the DSM-V fact sheet:
From the DSM-V fact sheet:
“The critical
element of gender dysphoria is the presence of clinically significant distress
associated with the condition.”
“This
condition causes clinically significant distress or impairment in social,
occupational, or other important areas of functioning.”
Regarding
Point 5: “Where does the DSM-V list rates of
resolution for Gender Dysphoria?”
On page 455 of the DSM-V under “Gender
Dysphoria without a disorder of sex development” it states: “Rates
of persistence of gender dysphoria from childhood into adolescence or adulthood
vary. In natal males, persistence has ranged from 2.2% to 30%. In natal
females, persistence has ranged from 12% to 50%.” Simple math allows one
to calculate that for natal boys: resolution occurs in as many as 100% – 2.2% = 97.8% (approx.
98% of gender-confused boys) Similarly, for natal girls: resolution
occurs in as many as 100% – 12% =
88% gender-confused girls
The bottom line: Our
opponents advocate a new scientifically baseless standard of care for children
with a psychological condition (GD) that would otherwise resolve after puberty
for the vast majority of patients concerned. Specifically, they advise:
affirmation of children’s thoughts which are contrary to physical
reality; the chemical castration of these children prior to puberty with GnRH
agonists (puberty blockers which cause infertility, stunted growth, low bone
density, and an unknown impact upon their brain development), and, finally, the
permanent sterilization of these children prior to age 18 via cross-sex hormones.
There is an obvious self-fulfilling nature to encouraging young GD children to
impersonate the opposite sex and then institute pubertal suppression. If a boy
who questions whether or not he is a boy (who is meant to grow into a man) is
treated as a girl, then has his natural pubertal progression to manhood
suppressed, have we not set in motion an inevitable outcome? All of his same
sex peers develop into young men, his opposite sex friends develop into young
women, but he remains a pre-pubertal boy. He will be left psychosocially
isolated and alone. He will be left with the psychological impression that
something is wrong. He will be less able to identify with his same sex peers
and being male, and thus be more likely to self identify as “non-male” or female.
Moreover, neuroscience reveals that the pre-frontal cortex of the brain which
is responsible for judgment and risk assessment is not mature until the
mid-twenties. Never has it been more scientifically clear that children and
adolescents are incapable of making informed decisions regarding permanent,
irreversible and life-altering medical interventions. For this reason, the
College maintains it is abusive to promote this ideology, first and foremost
for the well-being of the gender dysphoric children themselves, and secondly,
for all of their non-gender-discordant peers, many of whom will subsequently
question their own gender identity, and face violations of their right to
bodily privacy and safety.
References:
1. Consortium on the Management of Disorders of
Sex Development, “Clinical Guidelines for the Management of Disorders of Sex
Development in Childhood.” Intersex Society of North America, March 25, 2006.
Accessed 3/20/16 from http://www.dsdguidelines.org/files/clinical.pdf.
2. Zucker, Kenneth J. and Bradley Susan J.
“Gender Identity and Psychosexual Disorders.”FOCUS:
The Journal of Lifelong Learning in Psychiatry. Vol. III, No. 4,
Fall 2005 (598-617).
3. Whitehead, Neil W. “Is Transsexuality
biologically determined?” Triple Helix (UK),
Autumn 2000, p6-8. accessed 3/20/16 from
http://www.mygenes.co.nz/transsexuality.htm; see also Whitehead, Neil W. “Twin
Studies of Transsexuals [Reveals Discordance]” accessed 3/20/16 from
http://www.mygenes.co.nz/transs_stats.htm.
4. Jeffreys, Sheila. Gender Hurts: A Feminist Analysis of the Politics of
Transgenderism. Routledge, New York, 2014 (pp.1-35).
5. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth
Edition, Arlington, VA, American Psychiatric Association, 2013
(451-459). See page 455 re: rates of persistence of gender dysphoria.
6. Hembree, WC, et al. Endocrine treatment of
transsexual persons: an Endocrine Society clinical practice guideline. J Clin
Endocrinol Metab. 2009;94:3132-3154.
7. Olson-Kennedy, J and Forcier, M. “Overview
of the management of gender nonconformity in children and adolescents.”
UpToDate November 4, 2015. Accessed 3.20.16 from www.uptodate.com.
8. Moore, E., Wisniewski, & Dobs, A. “Endocrine
treatment of transsexual people: A review of treatment regimens, outcomes, and
adverse effects.” The Journal of Endocrinology & Metabolism, 2003;
88(9), pp3467-3473.
9. FDA Drug Safety Communication issued for
Testosterone products accessed 3.20.16:
http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm161874.htm.
10. World Health Organization Classification of
Estrogen as a Class I Carcinogen:
http://www.who.int/reproductivehealth/topics/ageing/cocs_hrt_statement.pdf.
11. Dhejne, C, et.al. “Long-Term Follow-Up of
Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in
Sweden.” PLoS ONE, 2011; 6(2). Affiliation: Department of
Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet,
Stockholm, Sweden. Accessed 3.20.16 from
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0016885.
