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Two shockwaves recently upended the world of youth gender medicine.
One, secret files revealed last month that members of the leading transgender health-care organization privately admitted that children and adolescents were incapable of giving informed consent to the irreversible, stomach-churning medical procedures to which they were subjected.
Second, a 388-page report from the UK, named after the chief author, British pediatrician Hilary Cass, excoriated the lack of scientific evidence for the use of hormones and surgery for gender questioning minors.
One result is Britain’s banning of puberty blockers for those under 18.
Sense is finally starting to prevail, and there are calls to favor counseling as the first course of action for a child who isn’t sure about their gender — rather than an immediate jump to medication and surgery.
The problem is that therapy — at least what the American Psychiatric Association endorses in a radical new textbook — could make things much worse.
Taking over the APA
“Gender-Affirming Psychiatric Care” promotes itself as “the first textbook dedicated to providing affirming, intersectional, and evidence-informed psychiatric care for transgender, non-binary, and/or gender-expansive people.”
A close examination reveals, however, it is an extremist handbook that will put kids on a fast track from the therapist’s chair to life-changing hormones and surgery.
The textbook is more than just a curiosity.
With the American Psychiatric Society’s imprimatur, it is a reference book that will be widely used in medical schools and by specialists, mental health professionals, psychologists, social workers, even nurses, in clinical settings and training programs.
“As a practicing psychiatrist, and a mother of three children,” Oklahoma City-based psychiatrist, Lauren Schwartz, told me, “I’ve lost sleep over knowing this ‘textbook’ is being taught in medical schools and residencies, sold as peer-reviewed, necessary, lifesaving and evidence-based, and it is simply not.”
Schwartz, an APA Fellow, was one of four physicians who wrote an open letter to the APA’s leadership last December, expressing “grave concerns” that the book “glaringly ignored scientific developments in gender-related care” and “was out of date before its publication.”
Aside from a pro forma “we are in receipt of your letter,” the country’s leading psychiatric society has ignored that open letter, which has garnered a remarkable 7,000 signatures from clinicians, scientists, and researchers in the U.S. and Europe.
Psychiatrists MUST affirm
The APA textbook’s central theme is that psychiatrists must always affirm the self-diagnosis of patients since “nonaffirmation is associated with higher odds of experiencing depressive symptoms [and] suicidal ideation.”
Two psychiatry residents at a prestigious institution shared with me off the record that they are instructed that gender-questioning children will kill themselves if not prescribed puberty blockers and cross sex hormones.
They are barred from talking to their young patients about other treatment options.
The fear of suicide has been used also as a cudgel to scare many parents of gender questioning children.
Chloe Cole, a 19-year-old detransitioner, told Congress last year that, “They [medical specialists] asked my parents a simple question: Would you rather have a dead daughter or a living transgender son? . . . This is the moment that we all became victims of so-called gender-affirming care.”
“It is one of the most egregious, immoral and emotionally manipulative fallacies doctors are telling parents,” Dr. Schwartz told me. “It is compassion-hijacking.”
The insufferably preachy textbook does much more though than simply give a full-throated endorsement to gender affirming care.
It also gives outdated and dangerous advice, with more than a dozen citations to the largely discredited World Professional Association for Transgender Health.
It recycles the disproven claim that puberty blockers are “a fully reversible intervention that allows young patients time to mature.”
Neurodivergent editor behind book
How did the APA, the world’s oldest specialty medical society, publish such an outlier textbook?
There is no simple answer since the APA has not been transparent about its peer review process in selecting and approving the project.
It refuses to disclose, for instance, how it chose the textbook’s lead editor, Teddy Goetz, a first-year transgender psychiatric resident at the University of Pennsylvania.
Goetz self-identifies as “a non-binary/trans, queer, neurodivergent, chronically ill, Jewish person.”
Besides the APA textbook, Goetz is the author of two other books published last year.
One is a “poetry chapbook” about her journey from a girl to a boy and then stopping testosterone and restarting estrogen to get pregnant called “TRANSabdominal Retrieval: A (Gender) Queer Jewish Quest to Make an Embryo.”
The second is an illustrated novel, “Gender is Really Strange,” that promotes a far radical history of gender.
Goetz contends, for instance, that “gender diversity and non-binary genders” are common among indigenous people of color around the globe, what some call a “third gender.”
Such terminology, however, warns Goetz, “is a violent construction of (white dominated) Western academic discourses and erases indigenous experiences and cultures.”
Goetz drives home the point: “Binary gender norms” — men and women — “are fake news from European colonialism and white supremacy.”
Why weren’t all the different genders among indigenous people of color recognized much earlier?
“To maintain power (white) doctors and scientists argued that Black, Indigenous, and people of color (BIPOC) communities were subhuman because men and women were indistinguishable.”
‘Lived experience’ over research
Such fringe gender views are reflected throughout the textbook’s 26 chapters.
In the forward, Goetz sets the anything-goes groundwork by contending “that scientific neutrality is a fallacy” and what matters is “prioritizing lived experience.”
Therefore, 89% — 50 of 56 — of the textbook contributors are “transgender, non-binary, and/or gender expansive.”
Still, Goetz feels compelled to apologize that so many contributors are “obscenely privileged . . .English-speaking American physicians who had access to rarefied medical education and training at some of the world’s best resourced academic institutions.”
Psychiatrists are reminded frequently they must mitigate their own subconscious transphobism.
There are chapters on “Two-Spirit People” (indigenous North Americans); Black transgender patients who are marginalized from “slavery in the United States, structural racism, and ongoing traumatization . . .”; and transgender migrants who have “high rates of mental distress” since they “must live with great uncertainty about the asylum process and their future.”
One chapter pioneers “DoubleQueer,” a subcategory of “gender diverse patients” who also happen to be “neurodiverse,” defined broadly as “the uniqueness of all brains.”
As for “pregnant transgender men,” it is important that “we must constantly check our own unconscious biases.” When it comes to prisons, it is “best practice for inmates to be housed based on gender identity and not sex assigned at birth.”
Not listening to disagreement
The open letter to the APA signed by the 7,000 healthcare professionals concluded by asking the preeminent psychiatric society “to withdraw this book” in order “to avoid discrediting itself as a professional organization and a reliable source of gender related psychiatric care, and to minimize the risk of legal liability to itself.”
There is precedent. The American Academy of Pediatrics’ publishing division took pre-orders last year for a textbook, “Pediatric Collections: Gender Affirming Care.”
After a lawsuit charged the Pediatric Association had “improperly endorsed harmful care that is not backed by evidence,” it canceled that book and refunded all pre-orders.
My inquiries to the APA for comment went unanswered.
Most of the practicing psychiatrists I interviewed, all members of the 38,000-strong APA, were not surprised.
“It is a very insular organization,” one told me. “They believe that if they ignore the controversy, it will subside and fade away.”
The APA silence makes a mockery of medicine’s slogan “Do No Harm.”
Gerald Posner is the author of 13 books; his latest is “Pharma: Greed, Lies and the Poisoning of America.”