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- RE: Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents
Thank you for the opportunity to submit a comment on the article mentioned above. Upon reading what I submitted initially, I realize that one salient point was not included in my comments. I would like to submit my comments in their entirety as below:
The excellent points made by Dr. Sax (see comment from 23 Oct 2018 below) encompass many of my concerns about this AAP statement. His clear writing and references clearly call for amendments to this policy statement. Two other important considerations regarding this policy statement are as follows:
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1) This AAP statement clearly mischaracterizes watchful waiting as unsupportive and a way of pathologizing. This could not be further from the truth. A watchful waiting approach acknowledges that changes happen as the brain develops and humbly realizes that the ultimate outcome is unknown at an early age. It allows the child self-expression without strict adherence to a label that may not fit in the future. Watchful waiting is both compassionate and flexible; there is no reason to demonize this legitimate clinical approach. Please revise the statement to provide a more accurate description of watchful waiting.
2) The 4th bullet of gender-affirming care states "if a mental health issue exists, it most often stems from stigma and negative experiences rather than being intrinsic to the child". However, the policy statement reports that 20% of matched controls have experienced suicidality and 11% have a...Competing Interests: None declared. - RE: Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents
What is best practice, when a 7-year-old boy announces that he is really a girl? We do have longitudinal cohort studies which provide useful evidence. Wallien and Cohen-Kettenis (2008) reported on 45 boys and 14 girls who presented with gender dysphoria with a mean age of 8.4 years. Ten years later, 28 of those boys, and 5 of the girls, were no longer gender dysphoric. In other words, of 45 boys followed over ten years, 28 boys, or 62%, did not persist in gender dysphoria. In another study (Singh 2012), 139 boys with gender dysphoria were enrolled at an average age of 7.5 years; at follow-up, averaging 13 years later, only 17 boys out of 139 (12.7%) were still gender-dysphoric. These studies, and others like them (see Zucker 2008 for review), suggest that the majority of boys who identify as gender-dysphoric prior to the onset of puberty will not persist in gender dysphoria after the onset of puberty.
Suppose parents consult a physician regarding their 7-year-old son who has said that he is really a girl. Suppose the physician, mindful of Wallien & Cohen-Kettenis (2008), Singh (2012), and Zucker et al. (2012), advises a cautious wait-and-see approach. The 7-year-old wants to study ballet? Excellent. But he will study ballet as a boy, not a girl, at least for the next year.
Rafferty & Committee (2018) savagely denounce such an approach as “outdated.” Even worse: that physician is trying “to prevent children and adolescents from identifying as transg...
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