The American Academy of Pediatrics endorsed gender-specific treatments for children on Thursday, reaffirming that position from 2018 in a medical approach that has since been banned in 19 states.
But the influential group of doctors also took the further step of ordering a systematic review of medical research on the treatments, following similar efforts in Europe that found inconclusive evidence for their effectiveness in young people.
Critics across the political spectrum — including a small but vocal group of pediatricians — have called for a closer look at the evidence in recent years, especially as the number of young people identifying as transgender has rapidly that increased.
The treatments are relatively new, and few studies have tracked their long-term effects. Health bodies in England and Sweden have limited access to treatments after conducting systematic reviews, the gold standard for evaluating medical research.
“The board is confident that the existing evidence is such that the current policy is appropriate,” said Mark Del Monte, the chief executive of the AAP “At the same time, the board recognizes that additional detail would be helpful.”
Regarding policy changes in Europe, he said, “they are engaged in their process, we are engaged in our process.”
After the review is complete, he said, the group will issue additional clinical guidance for doctors and likely update its recommendations.
All 16 AAP board members, representing 67,000 pediatricians across the United States, voted to reaffirm the 2018 guidelines at a meeting Thursday in Itasca, Ill. The vote comes at a time of intense political pressure on transgender people and doctors to care for them.
In the past two years, Republican lawmakers have banned so-called gender-affirming care nationwide, which can include psychotherapy, anti-puberty drugs, hormones and, rarely, surgeries. Opponents of foster care argue that it is experimental and that children lack the maturity to consent to it.
AAP has strongly condemned outlawed by the legislature as a dangerous intrusion into complex medical decisions between doctors and families, and filed amicus briefs to support numerous legal challenges brought against the bans by civil rights groups.
Much of the academy’s support for gender-affirming care rests on its previous position statement in 2018, which said the treatments are essential and should be covered by health insurers. Transgender adolescents have high rates of anxiety, depression and suicide attempts, and early evidence has suggested that gender-affirming care can improve their mental health.
Position statements such as those voted on today remain in effect for five years before they are up for review, where they can be reaffirmed, retired or modified according to new evidence. An example of such a return is the 2017 academy endorsement of infant peanut consumption, based on a landmark study showing that early exposure can help prevent life-threatening allergies.
Some scientists criticized the decision to continue recommending treatments for young people before completing a rigorous review.
The move “very clearly puts the cart before the horse,” said Dr. Gordon Guyatt, a clinical epidemiologist at McMaster University who helped develop the field of evidence-based medicine.
Based on previous systematic reviews, Dr. Guyatt, the AAP report is likely to find low-quality evidence for child gender care. “The Europeans’ policies are more aligned with the evidence than the Americans’,” he said.
In June, England’s National Health Service announced it would restrict the use of puberty blockers in clinical trials because “there is insufficient evidence to support their safety or clinical effectiveness as a routinely available treatment.” Last year, Sweden’s national healthcare administration did the same determined that, on the basis of its systematic review, “the risks of puberty-inhibiting and sex-affirming hormone treatment for those under 18 years of age currently outweigh the possible benefits.”
In the United States, a small group of pediatricians pushed for a similar review from the AAP, one of the few institutions with enough centralized power to influence health care practices. Dr. Julia Mason, a pediatrician in Gresham, Ore., founded a group called the Society for Evidence-Based Gender Medicine that has been highly critical of gender treatments for minors. Since 2020, he said, he has lobbied unsuccessfully academic leadership to conduct a systematic review.
said Dr. Mason said he was glad the group finally decided to take a closer look at the data. “We make strong recommendations based on weak evidence,” he said.
But Dr. Marci Bowers, a gynecologic and reconstructive surgeon and the president of the World Professional Association for Transgender Health, was heartened by the AAP’s endorsement of the care, which she said greatly improves the lives of many children.
“They know this population,” said Dr. Bowers, who is a transgender woman. “They know the stories. Anecdotally, it’s very positive.”
He also pointed out that doctors in many specialties, and especially in pediatrics, routinely use drugs that have not yet been tested in large, rigorous clinical trials. And Europe, unlike many states in the US, has not completely banned care.
“What they are saying is that this population needs to be studied,” he said, referring to European policies. “And I agree with that.”