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American Academy of Pediatrics and transgender youth

The American Academy of Pediatrics is the largest professional association of pediatricians in the United States. 

2018 position statement

In 2018, three AAP committees involved in healthcare for gender diverse youth published a position statement

AAP rejects gender identity change efforts (GICE) created by conservative 20th-century clinicians who wanted to prevent the “bad outcome” of transgender adults:

In contrast, “conversion” or “reparative” treatment models are used to prevent children and adolescents from identifying as transgender or to dissuade them from exhibiting gender-diverse expressions. The Substance Abuse and Mental Health Services Administration has concluded that any therapeutic intervention with the goal of changing a youth’s gender expression or identity is inappropriate. Reparative approaches have been proven to be not only unsuccessful but also deleterious and are considered outside the mainstream of traditional medical practice. The AAP described reparative approaches as “unfair and deceptive.” At the time of this writing, conversion therapy was banned by executive regulation in New York and by legislative statutes in 9 other states as well as the District of Columbia.

AAP also rejects the outdated non-affirming approach called “gender exploratory therapy” or “watchful waiting.”

Research substantiates that children who are prepubertal and assert an identity of TGD know their gender as clearly and as consistently as their developmentally equivalent peers who identify as cisgender and benefit from the same level of social acceptance. This developmental approach to gender affirmation is in contrast to the outdated approach in which a child’s gender-diverse assertions are held as “possibly true” until an arbitrary age (often after pubertal onset) when they can be considered valid, an approach that authors of the literature have termed “watchful waiting.” This outdated approach does not serve the child because critical support is withheld. Watchful waiting is based on binary notions of gender in which gender diversity and fluidity is pathologized; in watchful waiting, it is also assumed that notions of gender identity become fixed at a certain age. The approach is also influenced by a group of early studies with validity concerns, methodologic flaws, and limited follow-up on children who identified as TGD and, by adolescence, did not seek further treatment (“desisters”). More robust and current research suggests that, rather than focusing on who a child will become, valuing them for who they are, even at a young age, fosters secure attachment and resilience, not only for the child but also for the whole family.

In 2022, AAP President Moira Szilagyi wrote following their annual convention:

“There is strong consensus among the most prominent medical organizations worldwide that evidence-based, gender-affirming care for transgender children and adolescents is medically necessary and appropriate. It can even be lifesaving. The decision of whether and when to start gender-affirming treatment, which does not necessarily lead to hormone therapy or surgery, is personal and involves careful consideration by each patient and their family.”

Szilagyi (2022)

For this stance, the AAP has been attacked by anti-trans activists, including James Cantor, Julia MasonLeor Sapir, Aaron Sibarium, Jamie Reed, Matilda Gosling, Jesse Singal, Colin Wright, and the conservative anti-trans hate group American College of Pediatricians.


Rafferty J et al (2018). Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents. Pediatrics (2018) 142 (4): e20182162. Authors: Committee on Psychosocial Aspects of Child and Family Health; Committee on Adolescence; Section on Lesbian, Gay, Bisexual, and Transgender Health and Wellness Michael Yogman, MD; Rebecca Baum, MD; Thresia B. Gambon, MD; Arthur Lavin, MD; Gerri Mattson, MD; Lawrence Sagin Wissow, MD; Cora Breuner, MD; Elizabeth M. Alderman, MD; Laura K. Grubb, MD; Makia E. Powers, MD; Krishna Upadhya, MD; Stephenie B. Wallace, MD; Lynn Hunt, MD; Anne Teresa Gearhart, MD; Christopher Harris, MD; Kathryn Melland Lowe, MD; Chadwick Taylor Rodgers, MD; Ilana Michelle Sherer, MD

Szilagyi M (August 10, 2022). Why We Stand Up for Transgender Children and Teens


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