Professional bodies, including the American Academy of Paediatrics, have endorsed “gender-affirmative” care, which accepts patients’ self-diagnosis that they are trans. This can mean the prescription of puberty blockers for children as young as nine. Trans medicine is not a core part of medical schools’ curriculums. But an academic paediatrician (who did not want her name, institution or state to appear in this story) says that all medical students understand that they are expected to follow the affirmation model “uncritically and unquestioningly”. For most doctors that will mean referring a patient to a gender clinic, some of which prescribe blockers or cross-sex hormones on a first visit.
Affirmative care has done irreversible harm to some young people’s bodies. This has become especially clear from the experience of “detransitioners” who regret taking hormones or having their breasts or genitals removed. Puberty blockers also prevent bones from developing properly; when combined with cross-sex hormones they can lead to infertility and inability to have an orgasm. A 26-year-old student at a medical school in Florida who plans to become a paediatrician is shocked by what she has not been taught about these treatments. “With other diseases and treatments we are taught in such depth about every possible side-effect,” she says.