Systematic Reviews of Gender Transition Treatments, Explained

The American Academy of Pediatrics is playing catch-up with European health officials.

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Testosterone treatment. (Photo by Rory Doyle for The Washington Post via Getty Images)

On Wednesday, North Carolina became the 22nd state to restrict gender transition treatments for minors after both Republican-controlled legislative chambers passed a bill to prohibit “surgical gender transition procedures on minors and prescribing, providing, or dispensing puberty-blocking drugs or cross-sex hormones to minors.”

The near-party-line veto override of Gov. Roy Cooper, a Democrat, comes two weeks after the board of the American Academy of Pediatrics (AAP) voted to authorize a systematic review of such treatments—while also reaffirming a 2018 policy statement that calls for health insurance plans to cover “medical, psychological, and, when indicated, surgical gender-affirming interventions.” 

The AAP’s review “reflects the board’s concerns about restrictions to access to health care with bans on gender-affirming care in more than 20 states,” it announced. 

But health authorities in Europe have already conducted systematic reviews over the last five years—which have prompted many countries to change their policies and curtail access to such treatments except in rare cases. Could a similar scenario play out in the U.S.?

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  1. Esther G

    I meet so many adults with different views on vaccines, abortion, Trump, legalization of recreational drugs and so on. Everyone sees the world from their own unique perspective. No matter what the data shows, someone will cry “Foul!” or “Fake News!” Tom Nichols book The Death of Expertise comes to mind.

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    Bill B

    Terrific. About time. Perhaps we needed to go through this for sufficient data to be there but it was at a questionable cost. It would not just be problematic but irresponsible to be making recommendations without a systematic and thorough review.

    Perhaps it will silence some of the more extreme voices but I wouldn’t bet on it.

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    Kevin Johnson

    Much good info here. Thanks. But comments indicate to me that many miss the main point, in my view. This is not like abortion or gay marriage or other controversies. It isn’t, in my view, a problem of extremists on both sides fleeing the common sense middle ground. We have had a hysterical, radical attempt to promote sex changes and wild theories of dozens of “gender” identities among children. The social contagion signs, such as as explosive increase of sex/gender confusion among minor girls (often with other mental issues) and trans activists pushing radical drug and surgical treatments for minors is unprecedented. The fact that some other extremists also wish to stop adults from gender surgery doesn’t discredit the common sense and centrist notion that the revolution’s approach to “CHILDREN” is extreme and dangerous. Those denying the significance of biological sex have every right to make their arguments, as do those arguing the earth is flat. But it is not extreme to object to these ridiculous views and to allow zealots with a temporary hold on elite institutions to disfigure thousands of children is too much. I’m 64 and am very confident “gender affirming care” for minors, which amounts to experimental use of drugs and amputation of healthy body parts will be seen in my lifetime as equal to or worse than lobotomies.

    People with gender dysphoria or other issues deserve decent lives and, as adults, the freedom to seek to live as the opposite sex. But decent people are increasingly calling the anti-science and ghastly medical abuse of children what it is: radical destruction of the weakest among us. Sign your petitions saying men can become women, give birth, etc. But those coming for our kids with this craziness deserve to be stopped, and calling the increasing movement to say no extreme is bad science, bad journalism, and awful policy.

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  4. Token Liberal

    There is something to be said for limiting the ability of teens to make permanent medical changes. Having been a teen, and having raised couple, teens are "often mistaken but never in doubt."

    Nonetheless, in this current atmosphere of celebrities machine gunning Bud Lights, don't say gay laws, libraries being stripped of books, etc... I just do not trust that legislators are truly motivated by real concerns for the health of children. Somehow, these legislators spend the morning carrying on about parental rights, and the afternoon stripping those rights from the parents of trans teens.

    They have earned my distrust.

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    This comment has been deleted

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    Aylene Wright

    Again, this kind of article is one of TDs strong points. So far the comments have also mostly been nuanced.

    One factoid that's quite interesting is the shift from male to female transitioners being the majority, to female to male transitioners being the majority. I don't think this is a widely known thing.

    Especially because anti-trans rhetoric tends to focus on the former, often portraying them as sexual predators.

    Thanks for a sensitive approach to the issue that avoids both extremes. It's telling though that your main source, who decries extremists on both sides, isn't actually based in the US.

    His concession, as "a leader in the field of evidence-based medicine" that “inevitably, there is judgment involved", is something that seems all too rare these days. I respect him for not repeating the "the science supports my position, case closed, anyone who disagrees is an idiot who doesn't Believe Science" silliness that so many prominent scientists got into a few years ago regarding COVID.

    Although I don't totally blame the scientists for the actions of people rebelling against the scientific establishment, either.

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    Magpie

    Interesting explainer, thank you. I hope that decisions and policies surrounding this issue are based on developing the best possible medical understanding of gender dysphoria and treatments, and not on biblical or other religious considerations.

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  8. Vbbark

    This is very helpful. Thank you!

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    CynthiaW

    That was very informative. I did not know that "systematic review" was a technical term with a specific definition in its context.

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  10. Cegoodman85

    Thanks very much for this. Hopefully there will be an honest review.

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