Transgender medicine and the treatment of children
Letter to the Editor | Thursday, September 26, 2019
A panel entitled “Transgender Medicine and Children: What are the Facts?” will explore the issue of medical treatments for children with gender dysphoria this Thursday, Sept. 26 at 7 p.m. in Carey Auditorium in Hesburgh Library. The panel will feature Dr. Paul Hruz, professor of pediatrics and endocrinology at Washington University School of Medicine in St. Louis, and Dr. Michelle Cretella, a general pediatrician and the Executive Director of the American College of Pediatricians. Dr. Hruz and Dr. Cretella will speak for one hour, and a question and answer session will follow at the panel sponsored by Students for Child-Oriented Policy.
Children are experiencing gender dysphoria and seeking medical treatments at a skyrocketing rate. Some doctors utilize new treatments that take an affirmative approach to gender dysphoria, supporting transitions through medications and surgeries. Other medical professionals reject medication and surgery, noting that the majority of cases of gender dysphoria resolve on their own or through counseling by the end of puberty. Some clinicians in the UK, for example, have challenged the affirmative approach, as have clinicians in the U.S. While there are disagreements as to the best path of treatment, we recognize that everyone wishes to do right by children.
In the United Kingdom, the number of children treated for gender dysphoria — a condition where a person “experiences discomfort or distress because there’s a mismatch between their biological sex and gender identity” according to the National Health Institute — increased 4,000% between 2009 and 2017. There are similar increases in the U.S., which now has over 45 pediatric gender programs following the affirmative approach.
What medical treatments are these children receiving?
Under the affirmative approach, children who experience gender dysphoria are prescribed puberty-blocking drugs at the onset of puberty. These drugs suppress the production of testosterone or estrogen, therefore preventing the changes that normally occur during puberty.
After several years on puberty blockers, a child might be prescribed cross-sex hormones around age 16. These hormones trigger the development of secondary-sex characteristics of the desired sex, like breasts, facial hair and muscular structure.
The World Professional Association for Transgender Health (WPATH) protocols encourage waiting for gender reassignment surgery until after a patient reaches the age of majority in their countries, though doctors increasingly perform chest surgeries (double mastectomies) earlier, even on children as young as 13.
Proponents of the affirmative treatment approach for children argue the transition will relieve the stress of gender dysphoria. They argue puberty-blockers make a transition easier because secondary sex characteristics — such as a deep voice and an Adam’s apple — have developed to a lesser extent. In particular, proponents support the affirmative approach as a means to decrease the high rate of suicidal thoughts and suicide attempts among transgender teens.
Critics of this approach argue the treatments, which are not approved by the FDA for these purposes, have not been adequately studied. They raise concerns about the unintended side effects of widespread off-label drug doses that bring about significant physical alterations. Critics dispute whether transitioning actually decreases the high suicide rate of those with gender dysphoria. The case against the affirmative approach is compounded by the fact that gender dysphoria resolves in the majority (~80%) of children by the end of puberty.
Moreover, many who are against the affirmative approach point out that people cannot change their biological sex — hormones and surgery modify the body’s external appearance and the function of body parts. They argue altering puberty and removing healthy body parts is never warranted to alleviate gender dysphoria. This is the position taken by Students for Child-Oriented Policy.
This event will focus on analyzing medical studies. Dr. Hruz and Dr. Cretella will explain the available data on the effects of puberty-blocking drugs, cross-sex hormones and mastectomies on children. Dr. Cretella will also detail normal gender development in children from a medical perspective.
Everyone is welcome to attend this event and engage respectfully with Dr. Hruz and Dr. Cretella. We extend an invitation in particular to students who are pre-med and professors concentrating in a scientific field.
The event is intended to provoke intellectual discussion that utilizes scientific information. You may disagree with the medical conclusions reached by Dr. Cretella and Dr. Hruz — that hormone-blockers and cross-sex hormones should not be used to treat gender dysphoria in children — but please come and ask a question, as a scientific debate will enable all of us to gain in knowledge and direction.
There is no intention to inflict anxiety on any member of the Notre Dame family through this lecture on an admittedly controversial topic. But we believe the most harmful thing for an academic community is to censor arguments on issues that matter. Thousands of children are receiving these drugs, and the medical debate matters to them and to the kids who will come after them. We need to be free to discuss the treatment of children so we can proceed forward as a society in the manner that best protects them.
students for child-oriented policy co-president, junior