When it comes to transgender medical treatments for children, parts of Europe have taken an enviable approach that relies on science rather than politics, advocacy or emotion. The results have been telling.
In recent years, several European countries, including the more progressive nations of Scandinavia, have pulled back on allowing gender-related treatments for minors because some doctors have serious concerns about the risks. As U.S. News reported last year, these changes are being driven by healthcare policymakers and medical professionals, not by lawmakers. This has led to calmer and more rational discussions than what often takes place in the hyper-partisan United States.
In the UK, a report by Hillary Cass, chair of the Independent Review of gender identity services for children and young people, authored a report to the National Health Service that documented several flaws to how young people with gender confusion are being treated. Among her findings is that “The rationale for early puberty suppression remains unclear, with weak evidence regarding the impact on gender dysphoria, mental or psychosocial health. The effect on cognitive and psychosexual development remains unknown.”
Beyond that, she said, a medical pathway for such distress may not be the best way to proceed for a majority of such young people.
These changes lend credence to voices within the U.S. that are calling for a halt to some gender-related treatment for minors. Most recently, a coalition of health policy and conservative groups known as the American College of Pediatricians and “Doctors Protecting Children” issued a strongly worded statement opposing the progressive-driven policies of associations such as the American Academy of Pediatrics and the American Medical Association.
The coalition says U.S. medical associations — including the American Academy of Pediatrics, the Endocrine Society, the Pediatric Endocrine Society, American Medical Association, the American Psychological Association and the American Academy of Child and Adolescent Psychiatry — should follow the science the way many in Europe are doing.
This would mean to “immediately stop the promotion of social affirmation, puberty blockers, cross-sex hormones and surgeries for children and adolescents who experience distress over their biological sex,” the group said.
“Instead, these organizations should recommend comprehensive evaluations and therapies aimed at identifying and addressing underlying psychological co-morbidities and neurodiversity that often predispose to and accompany gender dysphoria.”
The website for Doctors Protecting Children includes references to several academic studies. Among these is one from the Dutch University of Groningen, which followed 2,772 children as they grew from 11 to 22-26 years of age. At the beginning, 11% reported being unhappy with their reported gender. By about age 26, only 4% expressed such concerns, demonstrating, as the group contends, that most thoughts and feelings that are at odds with a person’s gender at birth resolve themselves over time.
The group also believes a person’s sex is an innate trait that occurs at fertilization. “This genetic signature is present in every nucleated somatic cell in the body and is not altered by drugs or surgical interventions.”
But of course, this affirmation, together with the call for a reduction in gender-related treatments among minors, has been lost in much of the American political spectrum that, for too many people, takes precedence over science, or over what science currently suggests in other developed countries.
Everyone ought to agree on one thing, however, and that is that we can’t afford to get this matter, which affects the lives of so many children, wrong. Science is clear that the brain, while full-sized by early adolescence, continues to form and mature until a person is well into his or her 20s. The National Institute of Mental Health says the prefrontal cortex is the last part to mature. “This area is responsible for skills like planning, prioritizing, and making good decisions,” its website says. Recognizing this, a host of laws and policies keep people from making certain decisions, or being able to engage in certain behaviors, until they reach a certain age. Certainly, life-changing decisions concerning gender should wait until such maturing takes place.
Utah lawmakers passed a bill last year that outlawed gender-reassignment surgeries for those under the age of 18, and that placed an indefinite moratorium on hormonal treatments for children and teens not already undergoing treatment for gender dysphoria. So far, 25 states have passed such laws. To no one’s surprise, lawsuits have arisen. And while the U.S. Supreme Court recently issued a ruling allowing Idaho to enforce its ban on treatments for minors, it didn’t rule on the constitutionality of such bans. Some experts believe a case challenging Tennessee’s ban may provide some clarity. That case involves a 15-year-old transgender girl and two other families who have filed anonymously. However, the high court has yet to decide whether to hear the case.
Not all European countries are adopting policies limiting gender treatments, and because many countries are relying on health-care policies, and not laws, to guide medical decisions, it would be inaccurate to say they have banned the practice. Research is ongoing and may further change these policies. The attitude in Sweden is typical of this approach.
The National Board of Health and Welfare in Sweden allows treatments for minors only “within a research context” and for “exceptional cases.” It adds that the “risks of puberty suppressing treatment … and gender-affirming hormonal treatment currently outweigh the possible benefits.”
Much of that concern is based on the results of a 2022 study commissioned by the government.
U.S. News reported that Mikael Landén, a professor and chief physician at the University of Gothenburg in Sweden and co-author of the report, wrote in an email, “From the lack of evidence follows that a conservative approach is warranted.”
Policymakers in the United States should at least acknowledge the need for more data. Children deserve as much.