Earlier this year, the American College of Pediatricians (ACP) issued a position statement rejecting transgender kids. Now, the fake medical organization that exists solely to oppose abortion and LGBT equality — not to be confused with the legitimate American Academy of Pediatricians — has published a more extensive manifesto denying the reality that some kids are transgender and benefit from being respected in those identities.
ACP’s thesis is founded on false statements that begin appearing by the second sentence of the document. Here are 14 claims the ACP makes about kids’ gender identities that are either unsupportable or directly contradicted by the available research:
1. Gender is not biological.
The ACP article opens by insisting, quite matter-of-factly, that gender “is a psychological concept and sociological term, not a biological one.” This sets the tone for the rest of the article, which is largely — and admittedly — dedicated to delegitimizing trans identities as an innate trait.
The problem is that this claim ignores a substantial amount of research that found that there are very much biological components to transgender identities. Researchers at Boston University School of Medicine reviewed this research last year and concluded unequivocally that “there is a biological basis for transgender identity.”
2. Medical decisions for children should be based on philosophical considerations.
The second paragraph of ACP’s article reveals the agenda that it is trying to put forth — an agenda that is not based on science nor what is best for children. “The debate over how to treat children with GD [gender dysphoria] is primarily an ethical dispute,” it insists, “one that concerns physician worldview as much as science.”
It goes on to warn — somehow as proof that there’s an political agenda — that there have been “severe consequences” for those who oppose affirming transgender kids, like the firing of Dr. Kenneth Zucker, who practiced and promoted “reparative therapies” that tried to force kids to act like the sex they were assigned at birth. ACP is explicitly trying to protect these individuals, who it considers victims in this debate.
In other words, ACP has an “ethical” point of view that is anti-trans, and it is more interested in defending adults who agree with that position than it is helping children who are hurt by it. It doesn’t take a study to point out that decisions about how to treat children should be based on what’s actually best for their well-being, not some teleological perspective about the “purposeful design to human nature.”
3. Delaying puberty harms children.
The primary form of medical treatment offered to transgender children is puberty blockers, which delay puberty from making permanent changes to the child’s body, allowing them more time to mature and be sure of their gender identity before taking permanent steps. ACP simply takes for granted that this must be harmful.
While discussing the various philosophical — yes, philosophical — reasons various individuals might oppose pubertal suppression, ACP insists that what unites these groups “is a traditional interpretation of ‘First do no harm.’”
Except, the research says the opposite. Delaying puberty is a “fully reversible medical intervention,” and those who underwent such treatment experienced no negative consequences. When the participants in one study eventually took steps to physically transition — at an average age of 21 — their quality of life and happiness levels were on par with their cisgender peers. Likewise, trans kids have been found to identify as completely with their gender as their cisgender peers.
4. There is a growing community of physicians worried about harming children by affirming their gender identities.
The ACP claims that there is a growing online group of physicians and mental health professionals who are “gay-affirming,” but who are just concerned that affirming trans youths’ identities might not be safe. Such approaches and any apparent benefits from such treatments should be considered “highly suspect.”
The reality is that the group they cite, “Youth Trans Critical Professionals,” is simply a blog with two authors, a social worker and a professor, who never even identify themselves. They link to a number of anti-trans websites affiliated with the Trans-Exclusive Radical Feminist (TERF) movement and rarely identify any of the individuals whose narratives they feature to support their anti-trans mission.
These two anonymous non-physicians represent nothing more than a tiny collective of concern trolls eager to reject all of the documented benefits of affirming transgender youth because of an anti-trans bias they disguise as caution.
5. “Sex change is objectively impossible.”
Because hormones and surgery can’t change a person’s genes, the ACP asserts that “from a purely scientific standpoint… sex change is objectively impossible.”
This is a rhetorical flourish that actually does little to inform the argument the group is trying to make. Nobody’s trying to claim that any treatment changes a person’s genetic makeup. But hormones and surgery have been found to relieve gender dysphoria, the minute-by-minute stress trans people can experience when their body does not align with their gender identity. As trans scholar Julia Serano describes it, “it is very real, intensely felt, and can become all-consuming and even debilitating over time.”
The fact that gender dysphoria has been thoroughly documented and recognized cannot be explained by some ideological scheme to give “gender” a new definition, as the ACP claims. More importantly, such rhetorical arguments do little to assist people who struggle with it.
6. Twin studies prove being transgender isn’t biological.
It’s true that no singular explanation has been found for why people are transgender, but ACP argues that the available research somehow proves that it’s not biological.
Because a trans person’s identical twin is only trans 20 percent of the time, as one study found, ACP believes this is proof that “at least 80 percent” of what contributes to being transgender comes from environmental influences after the children are born. But this doesn’t accurately explain the research about transgender twin studies.
For example, the very study ACP cited specifically stated that the results showed that for transgender participants, “their identity was much more influenced by their genetics than their rearing.” That study built off previous research that found that identical twins are, in fact, more likely to both be trans than fraternal twins. The very studies ACP relies on to claim that being transgender isn’t biological all conclude that it is.
7. Parents are responsible for making their kids trans.
Because ACP is trying to make the case that there’s no biological component to being trans, they then blame parents for making their kids trans.
Examples include claims that mothers who are upset they didn’t have daughters might try to cross-dress their sons and that fathers of feminine boys might spend less time with them. If a mother is depressed and withdraws or a father overworks and isn’t around, “the boy’s anxiety and insecurity intensify, as does his anger, which may all result in his inability to identify with his biological sex.” The citation for all of these claims? Articles by the aforementioned Zucker, who encouraged parents to try to force their kids to engage in gendered behaviors.
ACP thinks that kids might also just be self-diagnosing themselves as transgender after visiting sites like Tumblr, Reddit, and YouTube. Rather than recognize that some kids might just be able to better understand their own inner conflict when they can access resources that explain it, ACP suggests “that social contagion may be at play.”
But no research has ever found that gender dysphoria can be caused or influenced by anything external. It is gender dysphoria itself that causes anxiety and distress. More importantly, research has found that trans kids experience improved mental health when their parents’ affirm their identity. ACP is actually encouraging parents to do the very opposite of what will help their kids thrive.
8. Gender dysphoria is a mental disorder like anorexia.
Though the American Psychiatric Association has declassified being transgender as a mental disorder, ACP asserts that it is anyway. Their reasoning? Anorexia and Body Integrity Identity Disorder (BIID) — a rare condition in which people believe they are better off without certain limbs — are both disorders.
The argument goes that if anorexia shouldn’t be treated with liposuction and BIID shouldn’t be treated with amputation, then gender dysphoria shouldn’t be treated with transition. “A person’s belief that he is something or someone he is not is, at best, a sign of confused thinking; at worst, it is a delusion,” the article explains. These comparisons ignore what the results of these treatments actually are.
Allowing trans people to transition resolves their dysphoria. Trans people are happy, healthy, functional individuals who require no ongoing treatment. Helping someone who is anorexic lose weight doesn’t help that person, because the nature of the psychological problem doesn’t go away. Likewise, BIID is so rare and poorly understood — and not even recognized by the American Psychiatric Association — that it does nothing to inform discussions about something as well-researched and understood as transgender identities.
Once again, ACP is admitting that it wants to impose a “norm for human development,” not a solution that is most helpful to people.
9. Most trans kids grow up to just be gay.
ACP’s attack on trans kids of course includes the popular “desistance myth,” which claims that most kids who identify as transgender will outgrow it. The article claims that “80 percent to 95 percent of gender-dysphoric youth emerge physically and psychologically intact after passing through puberty without social affirmation.”
It’s a myth, because it’s a conclusion based on research (again, by Zucker) that conflated kids who just exhibited gender nonconforming behaviors with those who actually insisted they were a different gender. Indeed, until recently, a child did not actually have to be insistent about their gender identity to be diagnosed with “gender identity disorder.”
In a recent post combating the desistance myth, Julia Serano pointed out that being overly cautious against allowing kids to transition enforces a double standard against them:
Authors often raise fears that some children (i.e., ones who are “really cisgender” in their minds) may be pushed into the “wrong” puberty, and thus may have to undergo expensive medical procedures to correct those bodily changes. But this precisely describes what a trans child would face if they were not allowed to transition until adulthood. If the former example concerns you, but the latter one doesn’t, then that’s a clear sign that you value cis bodies and lives over trans ones.
In other words, relying on the desistance myth reinforces an inherit bias against transgender people. It’s better if they undergo the wrong puberty than if a cisgender kid does, even though there’s very little risk of that happening — and no evidence that it ever has.
10. There’s no big study that confirms that transitioning is helpful.
ACP doubts whether even transgender adults should receive treatment that affirms their identity and allows them to transition. The argument for this concern is borrowed directly from opponents of same-sex parenting — that there’s insufficient research because the studies we have are small or were poorly designed.
Conducting research on both the children of same-sex couples and transgender people faces the challenge of how small both of those populations are. That’s why studies rely on recruitment strategies like snowball samples, which actually ensure that a sizable population of the group can be studied; otherwise, there’s little that can be drawn from the research.
Instead, conservatives insist that only giant national samples are valid, and they’ve concocted several to try to demonstrate negative outcomes for same-sex parenting. Among their many other flaws, these studies still actually found only very tiny populations of same-sex families — numbers they often inflated (and distorted) by counting kids whose parents divorced in comparisons against intact different-sex families. This year, when a study of that scope actually found positive results for same-sex families, conservatives still rejected the results.
If that model is any indication for skeptics of science on transgender research, it’s quite possible that there is no research that will ever satisfy their skepticism. In the meantime, there are already standards of care for transgender people that are informed by decades of research.
11. A thorough analysis of the research casts doubt on benefits of transitioning.
To reinforce the claim that the available research is fleeting and insufficient, ACP relies on a pair of reports issued by the medical technology consulting firm Hayes, Inc. ACP quotes the report as saying that “serious limitations [inherent to the research] permit only weak conclusions” about the positive benefits of gender confirmation surgeries. Likewise, findings about the positive effects of cross-sex hormones were reportedly “sparse,” “conflicting,” and “weak.”
ThinkProgress reached out to Hayes, Inc., but the firm declined to provide access to the full reports and could not provide comment about ACP’s interpretation of the results.
But the one place other than ACP’s article where these Hayes, Inc. reports appear is as references in various insurance policies. These are policies specifically allowing for these treatments to be covered under insurance plans for transgender patients. The fact that insurance companies draw the exact opposite conclusion as ACP suggests that these studies do not actually reinforce its anti-transgender arguments.
12. Kids are too young to consent to life-changing procedures.
“There is a serious ethical problem with allowing irreversible, life-changing procedures to be performed on minors who are too young to give valid consent themselves,” the ACP warns. This claim is a complete straw man, because there really aren’t families consenting to irreversible procedures.
Social transition doesn’t have any impact on trans kids’ bodies, and delaying puberty is completely reversible. The standards of care for transgender procedures specifically require that individuals be of the age of consent before undergoing other procedures.
13. Letting trans kids transition will make them sterile.
Building off the “irreversible” claims, ACP also worries about sterilizing kids: “The treatment of GD in childhood with hormones effectively amounts to mass experimentation on, and sterilization of, youth who are cognitively incapable of providing informed consent.”
Delaying puberty with suppressants poses no such risk at all. It’s technically true that if a young person goes directly from taking puberty-suppressants to cross-sex hormones, they could risk never being able to produce children of their own, but infertility is not guaranteed. What ACP neglects to mention is that the only way trans kids could develop fertility is to go through the puberty that they’re specifically trying to avoid because of the undesired permanent changes it will make to their bodies. For example, trans boys may be trying to avoid the need for a future double mastectomy, while trans girls may be avoiding various permanent changes to their voice, facial hair, and body hair.
ACP wants to force trans kids to go through the wrong puberty, which would guarantee changes that could intensify their gender dysphoria, to avoid the risk of one possible side effect if they don’t. It’s actually proof of the double standard that Serano outlined — that it’s okay for a transgender kid to go through the wrong puberty, but not a cisgender kid.
These are important decisions that families can — and should be able to — make for themselves based on what’s in the best interest of the youth’s well-being.
14. There’s a high rate of suicide among trans people who’ve undergone surgery.
No attack on the veracity of transgender identities is complete without the hackneyed claim that transitioning somehow causes or maintains depression and can lead to suicide. Like everybody else who makes this claim, ACP relies on a study from Sweden that found that “the rate of suicide among post-operative transgender adults was nearly twenty times greater than that of the general population.” This indicates that “sex reassignment alone does not provide the individual with a level of mental health on par with the general population.”
But ACP cites this while arguing against surgery for transgender people entirely, and it’s been widely debunked that the Swedish study does not inform any conclusions about the effectiveness of surgery. In fact, the author of that study, Cecilia Dhejne, has explicitly rebuked attempts to draw such conclusions. “People who misuse the study always omit the fact that the study clearly states that it is not an evaluation of gender dysphoria treatment,” she told Cristan Williams at The TransAdvocate last year. “If we look at the literature, we find that several recent studies conclude that WPATH Standards of Care compliant treatment decreases gender dysphoria and improves mental health.”
Indeed, the struggle many transgender people have is with discrimination and stigma, primarily fueled by rejections of the legitimacy of their identities, regardless of how they have transitioned. By distorting research to discourage affirming care for transgender kids and adults, ACP is exacerbating that very rejection and giving license for others to do the same.