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BMJ Editor Warns About U.S. Rushing Kids Into Gender Affirming Surgery ‘Without Any Psychological Supports’

So-called “gender affirming care” favored in the United States is heavy on politics and light on evidence-based medicine.

Kamran Abbasi, the senior editor of the prestigious British Medical Journal, wrote in an editorial that he is concerned about the risk of “overtreatment” of gender dysphoria in children and teens in the United States with the increased use of medical and surgical interventions that often bypasses psychological supports.

He said that the way that the U.S. handles care for the sudden explosion of minors claiming to have gender dysphoria is “not in line with the strength of the evidence.”


Recently, the United Kingdom, Sweden, Norway, and Finland have pumped the brakes on recommending pharmaceutical or surgical treatments for minors because of flimsy evidence, troubling side effects, scant probing into other underlying mental health issues or neurological and developmental disorders such as autism, and questions about long-term outcomes. However, in the United States, medical and surgical interventions have become increasingly common.

“The US, however, has moved in the opposite direction. An investigation by The BMJ finds that more and more young people are being offered medical and surgical intervention for gender transition, sometimes bypassing any psychological support,” writes Dr. Abbasi. “Much of this clinical practice is supported by guidance from medical societies and associations, but closer inspection of that guidance finds that the strength of clinical recommendations is not in line with the strength of the evidence. The risk of overtreatment of gender dysphoria is real.”

The BMJ probe cited data showing prescriptions for puberty-blocking drugs among under-18s have doubled between 2017 and 2021, while scripts for hormone therapies have seen a similar rise.
Influential groups like the World Professional Association for Transgender Health (WPATH), American Academy of Pediatrics (AAP) and the Endocrine Society all recommend hormonal and surgical interventions for children with gender dysphoria.
But Dr Abbasi points out that the evidence which those recommendations are based on is scant and inconclusive, and there is a lack of large-scale, long-term research…
…No national data is available, but one study found the number of mastectomies — sometimes called ‘top surgery’ — performed on girls under 18 in California had risen 13-fold in the last decade, with children as young as 12 offered the irreversible operations.
Source: Daily Mail

Jennifer Block, who conducted the BMJ investigation, said the discourse around “gender affirming care” is more “polarized” in the US than other countries.

While Dr. Abbasi is warning about the dangers of “overtreatment” of gender dysphoria when most children who are left alone will eventually become comfortable with their bodies, he isn’t a fan of state laws that ban those light-on-evidence treatments.

If we have the best interests of young people at heart, then surely our duty is to offer evidence informed care? And, if the evidence base is weak, we must provide the necessary support to young people as well as prioritising research to answer questions on issues that are causing a great deal of distress, much of which is amplified by social media. Taking this route is essential: an evidence void not only exposes people to overtreatment but can also be used to deny people the care that they seek, such as through the draconian laws now being introduced in some US states. A better appreciation of the evidence, as well as the limits of medicine, is also the basis of a more constructive dialogue.
Source: BMJ

Activist and dad of two daughters, Chris Elston, known on Twitter as “Billboard Chris” posted a thread on the editorial on Monday.

The number of ninors presenting with gender dysphoria has exploded in recent years, and it’s a whole new demographic of patients. Historically, most children with gender dysphoria have been boys below the age of 5, but there has been a surge of teen girls suddenly insisting that they are suffering from gender dysphoria without any prior evidence of discomfort. Teen girls, the group most susceptible to social contagion, are more likely to identify as transgender or non-binary if their friends also claim to be suffering from gender dysphoria.

Dr. Marci Bowers, who performs gender transition surgeries and identifies as a transgender woman, admitted in an interview with New York Times columnist Michelle Goldberg that social contagion is probably a factor in the spike in trans-identifying youth.

“There are people in my community who will deny that there’s any sort of ‘social contagion’ — I shouldn’t say social contagion, but at least peer influence on some of these decisions,” Bowers told the New York Times. “I think that’s just not recognizing human behavior.”
This is not the first time Bowers has made such comments. In 2021, the celebrity gender surgeon who has performed more than 2,000 vaginoplasties acknowledged the possibility that the surge in teenage girls identifying as boys was a social trend.
“I think there probably are people who are influenced. There is a little bit of ‘Yeah, that’s so cool. Yeah, I kind of want to do that too’,” Bowers said in an interview with Abigail Shrier, author of Irreversible Damage.
Source: The PostMillennial

The Daily Mail included a chart that shows the jump in insurance claims for diagnoses with gender dysphoria of children between the ages of 6-17 years.

As gender-affirming surgery becomes more popular among minors, an increasing number of ‘detransitioners’ who regret having the irreversible procedure have come forward and claimed they were not challenged enough as children…
…Gender-affirming operations, often called top or bottom surgery, will either make changes to a child’s genitalia or chest to match that of their new sex. These are irreversible and can leave a person infertile.
The success of surgery in particular is a contentious topic.
Finland’s chief psychiatrist for a state-approved pediatric center said four out of five young people who do not receive intervention from professionals will come to accept their bodies.
She warned there was a problem of ‘purposeful disinformation’ among American doctors who pressure parents into transitioning young people.
Source: Daily Mail

Chloe Cole, 18, began transitioning from female to male at 13 and had a double mastectomy at 15 with very little warning about the long-term effects of surgery or psychiatric consultations to discuss why she was suffering from gender dysphoria.

During a hearing of Medicaid officials last year in Tallahassee, Cole said, “No child should have to experience what I have. My consent was not informed.”

Parents are often told that “gender affirming care” is the only option that will keep their child from suicide. Cole said that her parents were asked by medical professionals that they have a choice between having a live son or a dead daughter when she began seeking treatment.

Cole is now suing the medical professionals that have altered her life forever.

There are significant harms including early osteoporosis, an increased risk of cancer, and even possible complications with “affirming” surgeries when using puberty blockers and cross-sex hormones.


The United States and Canada are becoming outliers in their push for “gender affirming care” for minors and kids like Chloe Cole are paying the price.

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1. Abbasi, Kamran. “Caring for young people with gender dysphoria.” British Medical Journal. March 9, 2023.

2. Tilley, Caitlin. “Editor of prestigious medical journal the BMJ warns trans children in America are being rushed into sex change surgery ‘without any psychological support’.” Daily Mail. March 13, 2023.

3. Ashton, Mia. “President of leading trans org admits social contagion is driving surge in kids identifying as transgender.” The PostMillennial January 24, 2023.

K. Walker

ClashDaily's Associate Editor since August 2016. Self-described political junkie, anti-Third Wave Feminist, and a nightmare to the 'intersectional' crowd. Mrs. Walker has taken a stand against 'white privilege' education in public schools. She's also an amateur Playwright, former Drama teacher, and staunch defender of the Oxford comma. Follow her humble musings on Twitter: @TheMrsKnowItAll and on Gettr @KarenWalker