scorecardresearch Skip to main content

The ‘affirming’ model of youth gender medicine draws some nays

Michael Woloschinow for The Boston Globe

Nuanced approach needs to be mulled, for the sake of kids, families

As a longtime pediatrician, I am very concerned about the current practice of so-called gender-affirming medicine (“Pediatric gender medicine has become a hall of mirrors,” Ideas, Nov. 12). There is minimal evidence to support the medicalization of children and young people in treating gender dysphoria. At the same time, there is very little open societal discussion about this lack of evidence or about other possible approaches to manage gender concerns that doesn’t quickly devolve into a political shouting match.

Much of the media on the left (which is where I have always placed myself politically) seem to gloss over the topic, often conflating a child’s “right” to irrevocably modify his or her body (based on what proponents freely admit may be a “fluid” belief) with rights like abortion or gay marriage. Clearly a more nuanced, deeper approach to these issues is required.


I am well aware this is not an easy topic to broach; it’s complicated and contentious. But it’s also extremely important since children and families are being harmed. So thank you for your courage and your commitment to the ideal of truthful and independent journalism in publishing Jennifer Block’s article raising concerns about this model of care.

Dr. Paula Brinkley

Berkeley, Calif.

Parents are capable of making medical choices for their children

As a parent and a civil rights lawyer, I read Jennifer Block’s Ideas article, “Pediatric gender medicine has become a hall of mirrors,” with great interest. Unfortunately, the article repeats some of the problematic claims that have been made by conservative right-wing politicians defending laws that take away parents’ medical choices for their children.

First, it wasn’t concern over the treatment it provided that prompted the British National Health Service to shut down a gender clinic there. The Tavistock clinic was closed in the interest of providing more accessible care through regional centers.


Second, the quality of research supporting transgender health care is not substandard. It is on par with or higher than research that supports routine care.

Third, solid research demonstrates improvements in mental health outcomes for transgender youth receiving care. Block’s sole focus on two suicides reported in a recently published study ignores substantial findings that such care reduces suicidality, depression, and anxiety among youth receiving care — important determinants of mental health outcomes.

These same arguments have been used to defend total bans on care. As a parent, I place greater confidence in my ability to make medical decisions for my children, guided by trusted medical providers, than in legislators who too often prioritize political gains over the needs of vulnerable individuals.

Jennifer Levi

Senior director of transgender and queer rights

GLBTQ Legal Advocates and Defenders


We need to have a thoughtful debate over the evidence

Thank you for publishing the article “Youth gender medicine has become a hall of mirrors.” As the author rightly points out, European expert clinicians and medical researchers are decisively moving away from the US gender-affirmative care model for gender-nonconforming youth.

As a physician trained in primary care medicine at Massachusetts General Hospital and former vice president of medical policy at Blue Cross Blue Shield of Massachusetts, I have studied the underlying evidence behind the Endocrine Society’s and American Academy of Pediatrics’s claims that gender transition saves lives. This is a questionable conclusion. While there are studies claiming to demonstrate that gender affirmation leads to improved mental health outcomes, these studies have been criticized for low-quality design and low certainty of their results. Experienced European clinicians with decades supporting gender-nonconforming youth are prioritizing psychotherapy and social support and restricting transition and medicalization to experimental controlled settings.


I’ve counseled hundreds of parents of distressed youth about the evidence and about strategies to support their children’s health. I helped dozens of detransitioners find compassionate physicians to help them manage their complications. It’s time for thoughtful debate over the evidence, for the protection of gender-nonconforming and vulnerable youth.

Dr. Kathleen Jennison Goonan

Bel Air, Md.

The writer is affiliated with the international advocacy organization Genspect, which advises in the area of health, sex, and gender.

Their family went through a careful process. Her son’s treatment was life-changing.

As a mother of a transgender male now 18 years old, I felt Jennifer Block’s article discredited the firsthand experience of trans youth and their parents. Families suffer considerably and go though a lengthy process before pursuing youth gender medicine. We went through a careful assessment, starting with therapists, psychiatrists, and several social workers before we were able to access gender-affirming care. It took us more than six months and more than six consultations to be able to start. And this was after months of analysis and consideration.

There are always side effects when treating diseases. Yet dysphoria can plunge trans youth into severe depression, and it can pose a risk of suicide. I watched my son not be able to get out of bed for days. He stopped activities he used to love, like singing and theater, because he didn’t feel comfortable with his soprano voice. I had to see him fully dressed outside the pool or at the beach because he did not feel comfortable wearing bathing clothes because of his breasts. My kid deserved to be able to enjoy activities that other teens do without having to loathe his appearance.


It was obvious how life-changing treatment was for him. He started coming back out of his shell. He would speak more in gatherings, would feel more confident to present in school, and would even consider going to school parties that he avoided before that. We’ve seen how gender affirming-treatment can improve, even save, a life.

Juliana Haddad Litterio