They Support Sex Changes for Children, With Safeguards. A Top Child Psychiatry Group Won’t Let Them Speak at Its Annual Conference.

The American Academy of Child and Adolescent Psychiatry has vetoed at least three panels with European clinicians about their efforts to limit gender care.

Transgender rights protesters / Getty Images
August 11, 2023

A top pediatric psychiatry organization has nixed at least three panels with leading European psychologists about Europe’s move away from chemical interventions for children with gender dysphoria, raising questions about the politicization of American medicine and underscoring a clinical divide between the United States and much of the world.

The American Academy of Child and Adolescent Psychiatry (AACAP), which sets practice guidelines for the field, rejected one panel in 2022 and two more this May on the advice of its "Gender Identity Committee," whose co-chair, Aron Janssen, has described restrictions on puberty blockers and cross-sex hormones as an "effort to oppress."

Each panel would have taken place at the group’s annual conferences—research-cum-networking bonanzas that draw thousands of professionals—and would have featured clinicians from countries that have restricted access to those drugs, allowing their use only in clinical trials or after long periods of psychological vetting. The speakers planned to discuss the data that led Finland, Sweden, and England to abandon the more laissez-faire treatment model now dominant in the United States, according to emails and panel proposals reviewed by the Washington Free Beacon.

It is "highly unusual" for the academy to axe events with international speakers, said Kristopher Kaliebe, a psychiatrist at the University of Southern Florida who organized the panels. And it was odder still given that the speakers were some of the biggest names in gender medicine, most with a long track record of transitioning children.

All three panels would have included Riittakerttu Kaltiala, the chief psychiatrist at one of Finland’s two pediatric gender clinics, who has been prescribing puberty blockers since 2011 but—amid skyrocketing referrals to her service—has in recent years called for more guardrails on what can sometimes be irreversible treatments.

"There are people who benefit from medical transition, even early transition initiated during developmental years," Kaltiala told the Free Beacon. But, she added, there are also people for whom "rapidly proceeding to gender reassignment will result in harm."

The academy’s unwillingness to host Kaltiala and other likeminded clinicians suggests that even this moderate stance may now be a bridge too far for America’s premier child psychiatry association, where even senior officials are raising concerns about ideological capture.

AACAP has chosen "advocacy over science," Kaliebe said in an email to James McGough, who oversees conference programming, after the second two panels were nixed. In response, McGough conceded that politics likely played a role.

"I actually share some of your concerns about AACAP … coming down too heavily on one side of politically charged topics," McGough told Kaliebe in a May email. Decisions about conference programming, he added, are "based on input from various AACAP committees." If the gender committee is "too one sided, the program committee is in a tough spot. Our committees are considered our experts."

The exchange illustrates how a small group of activist doctors can suppress the viewpoints of clinicians who disagree with them, creating the appearance of medical consensus where none exists.

A similar dust-up occurred at the American Academy of Pediatrics in 2021 when it barred clinicians skeptical of "gender-affirming care" from setting up a booth at its annual conference. The pediatric group—which has close ties to AACAP—also blocked two separate resolutions calling for a review of its gender policies, only agreeing to such a study last week after years of pressure.

The belated reckoning reflects what Kaliebe says is a "spiral of silence" in which professional associations look to each other for cues. "Until they change their stance, we don’t want to change ours," said Kaliebe, who served as an AACAP liaison to the American Academy of Pediatrics.

The no-guardrails approach to gender care now commands support from nearly every major medical group in the United States. Citing guidance from the World Professional Association for Transgender Health—which last year endorsed "castration" for "those who identify as eunuchs"—the American Psychological Association in 2021 condemned restrictions on puberty blockers and cross-sex hormones. The American Psychiatric Association, the American Medical Association, the American College of Physicians, and the Endocrine Society have all issued similar statements, partly in reaction to red states outlawing hormone therapy for minors.

The panels with European clinicians were an attempt to puncture that consensus. The first one, rejected from AACAP’s 2022 conference in Toronto, Canada, would have presented new research on the changing demographics of gender dysphoria, which used to present mostly in young boys but is now concentrated among teenage girls, many of whom have other mental health problems. Invited speakers included Kaltiala and Lisa Littman—the doctor who popularized the idea that gender dysphoria could be driven by social forces—as well as two laypeople, Corinna Cohn and Grace Lidinsky-Smith, who had gender reassignment surgery but later regretted their transition.

The inclusion of detransitioners was "not appropriate given our format," McGough wrote in a 2022 email explaining the rejection. But an academy member familiar with the approval process said it was unheard of for the group to nix a panel presenting new research, especially from such prominent doctors.

"I’ve never seen a research symposium be rejected," the member said.

McGough and Janssen, the gender committee co-chair, did not respond to requests for comment. The American Academy of Child and Adolescent Psychiatry did not respond to a request for comment.

After the first rejection, Kaliebe took pains to make his next submissions as evenhanded as possible. He organized two other panels, both without detransitioners, and asked Janssen in February to appear on one of them, meaning there would be at least one voice in favor of unrestricted transition.

Janssen refused, Kaliebe said, so the clinicians tapped Colleen Craft—a former president of the American Academy Academy of Pediatrics who presided over its embrace of "gender-affirming care"—to participate instead. Other big names included Swedish psychiatrist Mikael Landen, whose research on puberty blockers prompted the country to restrict their use, as well as Kaltiala and Michael Biggs, an Oxford sociologist who studies suicidality in transgender adolescents, according to the panel proposals.

The academy declined to host both panels, which had been handpicked to include affirmative perspectives, at its October 2023 conference in New York City, citing "space and time constraints."

It nonetheless accepted over 10 other presentations on transgender issues, including "InterSEXionality: Discussing Sex and Gender with Gen Z in A Politicized World," "BIPOC LGBTQ Media Matters: Tools for Facilitating Discussions of Intersectionality and Mental Health," and "Beyond the Sum of Its Parts: The Intersectionality of Chinese/Chinese American Sexual- and Gender-Minority Transitional-Aged Youth and Young Adults," according to a list of scheduled programming.

The double standard reflects a widening gulf between the organization’s party line and the views of its rank-and-file members. While Janssen has attacked the idea that social forces play any role in gender dysphoria—dismissing it as "speculation" in an amicus brief submitted to a Tennessee district court—83 percent of AACAP members say social media is "often" a factor in their patients’ gender identity, according to a poll conducted by the group’s Social Media Institute.

Driving that perception is an unprecedented uptick in gender dysphoria among young people, which is now being felt in clinicians’ day to day work. "10 years ago, maybe one out of every 500 of my patients identified as trans," one psychiatrist said, adding that his practice focuses on children with severe mental health problems. "Now, among middle school girls, it’s something like 40 percent."

Clinics across the world have experienced similar spikes, with rates of gender dysphoria rising by 1,500 percent in Sweden and 4,000 percent in England between 2008 and 2018. The pattern was one of the main reasons why European countries pivoted on puberty blockers, which were first used to treat gender dysphoria in the Netherlands—only in children without other conditions and after at least six months of therapy.

Eventually, Kaltiala said, those "original safeguards were dropped and the intervention was applied to patient populations that did not at all match the original group." By 2015, 68 percent of her clinics’ patients had preexisting mental health problems, and many "did not benefit from hormonal treatments."

In some patients, she added, psychiatric functioning even declined. "It was necessary to reconsider the situation."

While the debate about gender care has broken down along partisan lines in the United States, it is considerably less polarized in other parts of the world. Liberals formed an important part of the coalition that pushed for restrictions on puberty blockers in England, and when Kaliebe attended a conference on gender therapy in Finland, "nobody there was a conservative," he said.

"The people raising questions about this type of care are not coming from a political point of view. But the people squashing debate are."