Guest columnist Roy Eappen: America should follow other countries on trans treatments for children

What do other countries know that America doesn't?

This question needs to be asked - and answered - in Chicago this week, specifically in regards to transgender treatments for children and adolescents.

One of the first medical organizations to encourage gender transitions for young people is holding its annual meeting here through Sunday. It's called the Endocrine Society, and while few people have ever heard of it, it has shaped the highest levels of policy since 2017. While European countries are rapidly pulling back from these treatments, based on growing evidence that children are suffering, America continues to promote them based on the society's endorsement.

I say this as a 30-year member of the Endocrine Society, which does vital work in many areas of public health. I have no doubt my fellow medical professionals are doing what they think is best. But the mental and physical health of American children is now at risk. Thousands of teens and preteens are transitioning genders every year, a number that's rising fast. Yet to date, no professional medical association in the U.S. has fully reviewed the evidence to determine whether children are being helped or hurt.

I and my fellow members are endocrinologists, which means we specialize in treating hormonal issues. They affect people of all ages and require careful medical care.

Hormones are also at the center of child gender transitions. The first major step in a gender transition is providing hormone blockers that stop a child's body from fully developing. This is usually followed by cross-sex hormones, which cause a child to develop characteristics that differ from their biological gender. When my fellow endocrinologists prescribe these treatments, they genuinely believe they are providing the best care.

The challenge is the lack of evidence. When the Endocrine Society endorsed transgender care for children in 2017, there were only a handful of studies on the effects of these treatments. The group frankly admitted that the quality of evidence was "low" or "very low." Yet the Society still recommended that children get medications and procedures for gender transitions.

This gave policymakers and the public confidence that such treatments are harmless and even necessary, hence the explosion in child transitions. The more prudent course of action would have been to wait for better science.

That science is now rolling in. Hormone blockers, it turns out, can decrease bone density and contribute to infertility. They may also inhibit cognitive development. Ditto cross-sex hormones, which can irreversibly change the body, cause infertility, and even lead to strokes, heart attacks, and diabetes. Then there's mental health, which appears to deteriorate in many children who get transgender treatments. More study is needed before anyone can unequivocally recommend these treatments to teens and preteens.

Other countries are waking up to this reality. Last month, Norway became the latest country in Europe to ban adolescent medical transition outside of research settings. It joins Finland, Sweden and the United Kingdom in enacting strong guardrails to protect vulnerable children and rigorously evaluate experimental medical treatments.

Other countries, from Italy to Ireland to Australia, are also urging greater caution. They're going where the science points. It increasingly points to the likelihood that giving children these treatments carries far more risks than benefits.

Why hasn't America caught up with the science? Why is it standing still, or perhaps going backward, while other countries are moving forward? The answer is that groups like the Endocrine Society haven't updated their guidelines to keep up with the times. Maybe it's waiting for even more research. Maybe it's worried about the blowback from the very vocal activist community. I've talked with many of my fellow endocrinologists who are afraid of speaking up. Yet inaction potentially endangers more children with every passing day.

This is one of the most difficult and debated medical issues in history. Given that the stakes are the mental and physical health of children, the least medical professionals and societies can do is be cautious and seek out better science. Other countries understand this. For the sake of children, America needs to follow suit, and soon.

• Dr. Roy Eappen, a practicing endocrinologist, is senior fellow at Do No Harm, an association of health care professionals and patients that seeks to keep politics out of medicine.

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