A well-known plastic surgeon has refused to perform gender-affirming surgeries on minors in his practice because he does not believe they are effective in helping children who question their gender.
California-based plastic surgeon Dr. Steven Williams, who serves as president of the American Society of Plastic Surgeons (ASPS), cited a lack of long-term research on the effects of transitioning in adolescence.
Transition medicine, also known as gender-affirming care, is a relatively new field of research and doctors are still investigating the effects of puberty blockers and hormone treatments on young people’s brains and their development into adulthood.
At the same time, it has been shown that the transition… reduce suicidal ideationreduce rates of depression among gender-questioning youth and Improve your overall well-being.
California-based plastic surgeon Dr. Steven Williams does not perform transition surgeries on young people and has never considered doing so, citing questionable long-term evidence.
Dr. Williams said NewsNation:’I don’t do gender-affirming care for adolescents, and the reason is because I don’t think the data supports it.
“In my office we don’t even consider that.”
Transition surgery, which can include breast removal (also called “top surgery”) and genital changes, in children under 18 is extremely rare and is decided on a case-by-case basis by teams of primary care physicians, psychologists, endocrinologists and surgeons.
Trans kids often begin their transition with puberty blockers. These medications delay the onset of puberty to give kids and their families more time to decide whether they should pursue hormone therapies.
Meanwhile, hormone therapies are often started in the teen years to help children develop secondary sexual characteristics. For example, a girl who is transitioning to become a boy might take hormones to deepen her voice and grow body hair.
After undergoing hormone therapy, a trans person may choose to undergo surgery to medically transition, although not everyone does.
In the past, the typical route involved a psychological evaluation, followed by hormones and culminating in surgery. But not all transgender people seek out all interventions and Some may not look for any.
“Personally, for teenagers, I don’t think you’ll be able to undo all of that,” Dr. Williams said.
“I know I’m not comfortable with the level of evidence that’s out there, and this is a particularly vulnerable population, so I think it’s important to proceed with caution.”
The chart above shows the number of gender-affirming top surgeries performed in the US by year.
Professional medical organizations, including the American Academy of Pediatrics, the American Medical Association and the American Psychological Association, maintain that gender-affirming care, including surgery, is necessary for the emotional and physical well-being of trans youth.
Critics of allowing children access to gender-affirming care that includes hormones and surgery, on the other hand, have described reassignment surgeries as experimental, given the paucity of long-term research on their benefits, as well as the lack of consensus among doctors on the best surgical techniques.
Jay Richards, a fellow at the conservative Heritage Foundation, previously told DailyMail.com that it was “tempting” to compare clinics that perform such “macabre procedures” to Dr Frankenstein’s lab.
“But that would be uncharitable to Dr. Frankenstein,” Dr. Richards said.
Critics of gender-affirming care for children have also pointed to cases of children and parents feeling forced to go through the transition process without adequate psychological support.
Responding to a Dutch study suggesting that children with gender dysphoria may outgrow it by the time they reach age 25, Patrick Brown, a fellow at the conservative Ethics and Public Policy Center, said this provides “even more reason to be skeptical of aggressive measures to facilitate gender transition in childhood and adolescence.”
He added that for the vast majority of people, “prudence and caution, rather than rushing toward permanent surgeries or hormone therapies, will be the best approach for adolescents struggling to understand the world and their place in it.”
‘Therefore, policies that prohibit gender transition for minors make a lot of sense.’
He most common type Gender affirmation surgery involves removal of the breasts to make the chest more masculine, followed by genital reconstruction and then facial procedures.
But research has shown that surgeries among children and teens, who typically begin the transition process by changing their pronouns and clothing and meeting with a psychologist, are rare.
Researchers at Harvard’s T.H. Chan School of Public Health looked at millions of adults and children across different age groups to determine how frequently transition surgeries were performed in the U.S. in 2019.
The results showed that in 2019, around two in every 100,000 children aged 15 to 17 underwent gender transition surgery. For children aged 13 to 14, the rate dropped to 0.1 per 100,000, and no gender reassignment surgeries were performed on children aged 12 or younger.
Dr. Elizabeth Boskey, a social worker and Harvard researcher who co-led the research, saying“We found that gender-affirming surgeries are rarely performed on transgender minors, suggesting that U.S. surgeons are adequately following international guidelines around evaluation and care.”
Allowing young people access to these transition services has become a contentious culture war issue that has led to bans on gender-affirming care in nearly two dozen states.
While surveys of trans youth who have begun the transition process tend to show improved mood and anxiety levels, experts are increasingly concerned that doctors are prescribing medications without a wealth of data on their long-term effects to support them.
Gender researchers in the UK, where doctors are no longer allowed to prescribe puberty blockers, have argued in a Historical review Commissioned by the NHS, previous studies on the topic are of “poor quality” and there is “very limited evidence on the long-term outcomes” associated with medical transition.
According to the government-sponsored report: “This is an area where the evidence is remarkably weak, and yet the results of studies are exaggerated or misrepresented by people on all sides of the debate to support their point of view. The reality is that we do not have good evidence on the long-term outcomes of interventions to manage gender-related distress.”
Earlier this year, Oxford University endocrinologist Ashley Grossman weighed in, saying there is “no good evidence” to show that puberty blockers help trans children, highlighting a new study that found they damage the testicles and sperm of boys who take them.
Sex-reassignment surgery rates have skyrocketed in recent years, with one in six trans adults in the U.S. opting for gender-affirming surgery. Most who undergo sex-reassignment surgery have genital surgery (84 percent between 2006 and 2011), but nearly half of people who undergo vaginal reconstruction surgery experience complications years later. Most trans men (64 percent) who undergo penile reconstruction surgery also have problems.
Grossman said blockers can be “helpful” for some trans kids, but the drugs were too risky to be given to the “huge increase” in young people who identify as trans today.
She added: “Routine puberty blocking treatment for this use has not yet been adequately studied, and many of these children may have other problems for which they need help,” she added, alluding to a growing body of evidence showing that gender-confused youth often have other underlying mental health problems.
Norway, Finland, Sweden, the Netherlands and the UK are part of a growing list of countries that have restricted or completely suspended trans interventions in children.
But the United States, whose health care system is run by both the government and the private sector, has no such sweeping regulations, allowing different doctors in various states to operate at their discretion.
Dr. Sheila Nazarian, a board-certified plastic surgeon based in Beverly Hills, said: ‘I think some doctors and some medical associations have been overtaken by a vocal minority and are politicized.
“This is 100 percent an American political issue. If you look at Europe, very progressive governments have backed off these procedures in minors because they only look at the data, as we should do with any procedure. Why, in the case of this procedure and this patient population, do we have to keep quiet?”
