Overview

The American Academy of Pediatrics (AAP) is the largest professional body for US paediatricians, with about 67,000 members. In 2018 it published its first policy statement on transgender and gender-diverse children and adolescents. The statement endorsed the "gender-affirmative" model and described "watchful waiting" (waiting to see whether a child's gender distress resolves, without transition) as an outdated approach. Since then the AAP has faced four lines of challenge. Researchers said the statement misrepresented its own citations. Some members asked repeatedly for a systematic evidence review. A federal evidence review reached conclusions the AAP rejected. Federal and state authorities then took legal action against it.

Where things stood in October 2026:

• The 2018 statement is still AAP policy. The board reaffirmed it in August 2023 and at the same time commissioned a systematic review of the evidence. We could find no published AAP systematic review, and no updated policy, clinical report or technical report.
• The Federal Trade Commission (FTC) sent the AAP a civil investigative demand in January 2026 and withdrew it on 17 June 2026, the day the FTC sued the World Professional Association for Transgender Health (WPATH) instead. The AAP's own lawsuit against the FTC was closed in August 2026.
• Florida's consumer-protection and racketeering lawsuit against the AAP, WPATH and the Endocrine Society (the main professional body for US hormone specialists) is going ahead in Florida state court. The AAP's federal attempt to block it ended when the AAP voluntarily dismissed that case in 2026. No court has ruled on whether the AAP's statements were false or misleading.

Background

The policy statement Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents was posted online on 17 September 2018 and published in Pediatrics in October 2018 (AAP policy statement; NBC News). Its lead author was Jason Rafferty, writing with AAP committees. It recommended "gender-affirmative" care. For adolescents, this could include puberty blockers (drugs that pause puberty) and later cross-sex hormones, after evaluation. The statement treated approaches that delay affirmation as harmful. For more on these drugs, see puberty blockers.

The statement was not built on a systematic review. It used a narrative review, in which the authors pick and summarise studies without a stated search method or quality grading. This later became central to the dispute. Systematic reviews commissioned in England, Sweden and Finland graded the evidence for youth medical transition as low or very low certainty, and those countries restricted treatment as a result (see evidence reviews). The AAP, the Endocrine Society and WPATH became the three main sources of US clinical guidance. Florida later alleged that their guidelines cited one another in a loop (see the WPATH Files and the Endocrine Society).

What critics alleged

Cantor's 2019 citation check

In December 2019 the psychologist James Cantor published a fact-check of the policy's references in the Journal of Sex & Marital Therapy (Cantor 2019). His main points were:

• Desistance research (on children whose gender distress resolves) was left out. Cantor counted 11 follow-up studies of children with gender dysphoria. In all of them, most children no longer wanted to transition after puberty. He found that the AAP cited only one of these studies and did not mention its outcome data.
• The sources contradicted the policy. Several references the AAP gave against watchful waiting described watchful waiting as the current standard of care.
• "Conversion therapy" was used too broadly. The papers cited on conversion therapy were about sexual orientation, not gender identity. Cantor argued that the AAP had relabelled any non-affirming approach as conversion therapy.

Rather, AAP's statement is a systematic exclusion and misrepresentation of entire literatures. — (Cantor 2019)

McDeavitt's 2025 follow-up

In February 2025 the psychiatrist Kathleen McDeavitt published a letter in Archives of Sexual Behavior checking the part of the statement that dealt with blockers, hormones and mental health (McDeavitt 2025; PubMed). The journal published a correction in March 2025 to make the letter open access (correction). Of the seven citations offered for improved mental health, she found that only one, de Vries et al. (2011), was a clinical outcome study showing improvement. The others described clinics, reviewed literature, or studied children who received no medical treatment. She concluded that the AAP should consider retiring the statement. Later in 2025 McDeavitt was named as one of the authors of the US Department of Health and Human Services (HHS) evidence review discussed below (MedPage Today).

Members' resolutions for a systematic review

The AAP's Annual Leadership Conference lets members propose resolutions. Several proposals asking for a systematic review did not advance:

• 2022: Resolution 27. Five members asked the AAP to update the 2018 statement in light of systematic reviews abroad (MedPage Today; Medscape). Genspect, a group that campaigns for exploratory rather than affirming care, said AAP leadership "disallowed" member comments on it (WPDE/TND). AAP President Moira Szilagyi wrote that the resolution did not advance because its authors could not find a sponsor and it received no second on the floor (AAP Voices).
• 2023: Resolution 37. According to The BMJ, members had submitted formal resolutions for two years running asking the AAP to stop relying on narrative reviews. An April 2023 resolution with about two dozen signatories asked for an urgent systematic review (BMJ 2023). Its lead author was the paediatrician Julia Mason, a co-founder of the Society for Evidence-Based Gender Medicine (Gender Clinic News, a gender-critical newsletter).
• After 2023. One gender-critical newsletter described the 2023 resolution as the fifth such proposal in four years (Buttons Lives, advocacy). We could not confirm a 2024 resolution or its outcome from AAP records.

At both the 2023 and 2025 conferences, the resolution ranked first by voting members was one supporting federal protection of gender-affirming care (AAP News). The call for a review did not win comparable backing among voting delegates.

The 2023 reaffirmation and the review that has not appeared

On 4 August 2023 the AAP board reaffirmed the 2018 statement and authorised "an expanded set of guidance for pediatricians based on a systematic review of the evidence". It promised an updated policy statement plus companion clinical and technical reports (AAP News). The AAP said the decision reflected "the confidence that remains in the existing evidence" (MedPage Today). The BMJ reported that the review would be external, and that in 2022 the AAP had told the journal its policy rested on a "rigorous evidence review" (BMJ 2023).

Critics asked how a policy could be reaffirmed before the review meant to test it had been done (Manhattan Institute, a conservative think tank). In March 2026 Senator Bill Cassidy, chair of the Senate Health, Education, Labor and Pensions (HELP) Committee, wrote to the AAP asking for "the process and proposed timetable" and "the expected publication of this review" (Senate HELP letter). As of October 2026, more than three years after it was commissioned, we could find no published AAP systematic review or updated guidance.

The HHS review and the declined peer review

On 1 May 2025 the US Department of Health and Human Services (HHS) published Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices. AAP President Susan Kressly said within hours that the report "misrepresents the current medical consensus". She also said the AAP "was not consulted in the development of this report" (AAP News). HHS published the final, peer-reviewed version on 19 November 2025. In the accompanying supplement, HHS says it invited the AAP, the Endocrine Society and the American Psychiatric Association to peer-review the report:

Unfortunately, the AAP and the Endocrine Society refused HHS's offer to participate. We are grateful to the APA for accepting the invitation. — (HHS peer-review supplement 2025)

UnHerd reported that, according to report co-author Leor Sapir, the AAP first agreed to review the report and then withdrew (UnHerd). We found no AAP statement giving its reasons for declining. For the US policy context, see United States law on sex and gender.

The AAP's responses

Throughout, the AAP has defended its policy and described the legal actions against it as political retaliation:

• On scope. The AAP has said critics misdescribe the policy. It says the policy does not recommend hormones as a first-line treatment and instead calls for a systematic, collaborative evaluation by clinicians and mental health professionals (MedPage Today). In 2022 Szilagyi wrote that gender-affirming care "doesn't push medical treatments or surgery" for most children, a statement critics welcomed as a change of position (City Journal, conservative).
• On the evidence. When it reaffirmed the policy in 2023, the AAP said its leaders were "confident the principles presented in the original policy … remain in the best interest of children" (AAP News). Supporters told the health news site STAT that commissioning a review was routine maintenance, not a sign of doubt (STAT).
• On surgery. In February 2026 the American Society of Plastic Surgeons and the American Medical Association said gender surgery for minors should generally wait until adulthood. The AAP said its position was unchanged (US News/HealthDay).
• On the FTC. AAP President Andrew Racine said the administration "has politicized health care for transgender and gender-diverse young people". The AAP's lawsuit called the investigation an "unauthorized fishing expedition" into protected speech (AAP News).
• On Florida. AAP chief executive Mark Del Monte said the Florida attorney general's suit was an "attempt to suppress AAP's ability to engage in essential medical discourse" (AAP News).

A coalition of 19 Democratic state attorneys general filed a brief supporting the AAP against the FTC (California AG). Over the same period the AAP was also in disputes with HHS over vaccine policy and the termination of about $12 million in grants. In January 2026 a court temporarily ordered the grants restored (Clearinghouse). The AAP presents all of these as part of one pattern of retaliation against it.

Investigations, legal and regulatory outcomes

Show details: what the FTC and Florida actually alleged

The FTC's demand was part of an investigation into whether the AAP "or any other person" had made false or unsubstantiated claims, or engaged in unfair practices, in marketing "Pediatric Gender Dysphoria Treatment" (FTC order). Florida's complaint says the defendants falsely advertised that credible evidence shows these interventions reduce gender dysphoria and suicidality, that puberty blockers are fully reversible, and that their guidelines are evidence-based. It also alleges a racketeering "enterprise" built on guidelines that cited one another (Florida complaint). Judge Kennelly wrote that the complaint "goes out of its way to include provocative misrepresentations" of the AAP's conduct (AAP News). The full Seventh Circuit later set aside the panel ruling that had upheld his injunction, without explaining its reasons. None of these rulings decided whether the AAP's statements were true.

Significance and wider impact

The AAP case matters because of the AAP's reach. Many paediatricians, insurers, schools and courts treat AAP policy as the US standard of care, and opponents of state restrictions cited the 2018 statement in litigation for years. The citation critiques raised a question that applies across evidence reviews: can a narrative review, written without a stated search method or grading, carry that much weight? In England, Sweden and Finland, systematic reviews led to more cautious practice. In the US, the leading paediatric body reaffirmed its position before its own review was done. More than three years on, that review has not been published.

From 2025 the dispute moved from journals into government and the courts. Supporters of the AAP see the FTC demand, the grant terminations and the Florida suit as an attempt to punish a medical society for its speech. Two federal judges found that argument likely to succeed at a preliminary stage, one for the AAP and one for the Endocrine Society and WPATH. Critics reply that professional bodies whose guidelines shape treatment should answer for their claims like anyone else, and that the AAP turned down the main chance to answer them on the scientific record by declining the HHS peer review. The FTC's decision to sue WPATH and drop its demand to the AAP means the federal test case is now about WPATH's Standards of Care rather than the AAP statement. For detransitioners suing their own doctors, see detransitioner lawsuits.

Criticisms of how the case has been framed

Some fair points complicate the "scandal" framing:

• The desistance studies have limits. The 2018 statement itself said the early studies had "validity concerns, methodologic flaws, and limited follow-up" (quoted in Cantor 2019). Older follow-up studies used earlier, broader diagnostic criteria, small samples and varied definitions. A review in the site archive notes that reported desistance rates range widely and that current data are unreliable because patient groups have changed (Butler & Hutchinson 2020). Cantor's point that the AAP ignored those studies stands. Whether their figures apply to today's adolescents is a separate question. See desistance.
• Several critics have taken public sides. McDeavitt later co-authored the HHS review. Mason co-founded the Society for Evidence-Based Gender Medicine. Much of the coverage of the lawsuits comes from conservative or advocacy outlets. That does not make their citation checks wrong, but readers should know it.
• No court has found the AAP misled anyone. The FTC withdrew its demand without bringing a case against the AAP. Ayala's lawsuit was settled with no findings. The Florida case has not been tried. The preliminary rulings so far, before they were set aside or became moot, favoured the AAP's retaliation claim.
• The policy is not always described accurately. The 2018 statement does not recommend medical treatment for prepubertal children. The AAP says it requires assessment before any medical step. Critics argue that in practice assessment was often brief, and the detransitioner accounts below describe that. The statement's own wording is the fairest guide.

What detransitioners say

Commenters on r/detrans rarely mention the AAP by name. Many do describe the kind of care its policy supported: quick affirmation by a paediatrician, being told blockers or testosterone were safe and reversible, and no exploration of other problems. These accounts come from a self-selected group and cannot show how common such experiences are. For aggregated data from about 4,300 r/detrans stories, see /stats.

What detransitioners report

One woman described being prescribed testosterone at her first visit to a paediatrician:

I wonder where my team of doctors and psychiatrists were when I was getting prescribed testosterone on my first visit to a pediatrician, lol. … Don't even get me started on "puberty blockers are totally reversible!" Uggggggh —Rougesugar, detrans female

Another said her doctors never told her that teenage distress often resolves, and that she was assured treatment was safe and necessary:

She never made me aware as a minor that my feelings were common in teen girls and that there was a high likelihood I would grow out of it.

When I went to my endocrinologist, my father and I were assured T was safe, that it was medically necessary for trans youth and their mental health. —SnooCompliments8762, detrans female

A detransitioned man linked his decision to what his doctor told him:

It would've prompted me to actually do research instead of just taking my doctors word for it being safe and reversible. —Tawayy13, detrans male

Cantor argued that the 2018 statement effectively relabelled non-affirming approaches as conversion therapy. One man describes how a similar fear played out with his own clinicians:

From therapists and docs about ten years ago, no discussion at all of how to be comfortable in my skin. I think they were afraid that was conversion therapy. —No_Improvement4310, detrans male

Others argue for the watchful-waiting approach the AAP dropped:

Yes it's extremely normal, which is why gender clinics used to primarily use "watchful waiting", to see if the child grew out of it or not. It's especially common for gay kids. —PeregrinePanic, detrans female

Some paediatricians in the forum have described the policy from inside the profession. One wrote in 2019:

My professional organization, the American Academy of Pediatrics, came out for "affirmative care" just about a year ago. They didn't ask me about that! —DrFood1, paediatrician (no flair)

Julia Mason, later lead author of the 2023 resolution, described an AAP conference session:

In October of 2019 I went to the AAP National Conference, and I attended a presentation on pediatric transgender medicine. … I got the distinct impression that none of them knew what they were doing. —JuliaMasonMD, verified professional

These accounts match the concerns in the citation critiques. Young people who were told treatment was reversible and well-evidenced say they learned otherwise only after the changes had happened. For more, see informed consent critique and gender-exploratory therapy.

Trans perspectives

For many trans people and their families, the AAP's endorsement is reassurance that the care is mainstream medicine, and they see the legal attacks as political:

The people who disbelieve the literal experts in the field do so because they have no idea that gender as a study is more complicated than their simple worldview tells them. —One_Katalyst, trans woman (MTF)

Some trans men describe paediatric care that worked as the AAP intended:

My mom's incredibly supportive and did a lot of her own research, so when we talked to my pediatrician who said I could start T at 14, it was just like starting any other life-saving medication. —son-of-may, trans man (FTM)

The two sets of accounts are not as opposed as they first look. Both describe paediatricians acting quickly on the AAP's framing. They differ on how it turned out. The question for the AAP's promised review is how clinicians can tell these groups apart in advance, and that is the question its 2018 statement never answered with a systematic review. Support for people questioning a transition is listed in the support directory.

Related pages

• Gender medicine scandals and whistleblowers
• Evidence reviews
• The Endocrine Society
• The WPATH Files
• United States: sex and gender in law
• Puberty blockers
• Suicide and transition
• Detransitioner lawsuits
• Study archive

References

• Rafferty, J., et al. (2018). Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents. Pediatrics 142(4). source.
• Cantor, J. M. (2019). Transgender and Gender Diverse Children and Adolescents: Fact-Checking of AAP Policy. Journal of Sex & Marital Therapy 46(4):307–313. source.
• McDeavitt, K. (2025). Citation Issues in the American Academy of Pediatrics Policy Statement on Transgender and Gender-Diverse Children and Adolescents (Rafferty, 2018). Archives of Sexual Behavior 54(4):1297–1305. source; correction.
• Butler, C. & Hutchinson, A. (2020). The pressing need for research and services for gender desisters/detransitioners. Child and Adolescent Mental Health. study page, source.
• American Academy of Pediatrics (2023). AAP reaffirms gender-affirming care policy, authorizes systematic review of evidence to guide update. source.
• Block, J. (2023). US paediatric leaders back gender affirming approach while also ordering evidence review. BMJ 382:p1877. source.
• Szilagyi, M. (2022). Why We Stand Up for Transgender Children and Teens. AAP Voices. source.
• MedPage Today (2022). AAP Stands by Policy on Gender-Affirming Care for Trans Youth. source.
• American Academy of Pediatrics (2025). AAP speaks out against HHS report on gender dysphoria. source.
• American Academy of Pediatrics (2025). Leadership conference: Top 10 resolutions. source.
• U.S. Department of Health and Human Services (2025). Supplement to Treatment for Pediatric Gender Dysphoria: Peer Reviews and Replies. source.
• Cassidy, B. (2026). Letter to the American Academy of Pediatrics, 24 March 2026. Senate HELP Committee. source.
• American Academy of Pediatrics (2026). Petition to Quash or Limit Civil Investigative Demand. source.
• Federal Trade Commission (2026). Order Denying Petition to Quash Civil Investigative Demand (AAP). source.
• Federal Trade Commission (2026). FTC, States Sue World Professional Association for Transgender Health Over Deceptive Claims Regarding the Treatment of Children. source.
• Bloomberg Law (2026). FTC Refocuses Investigations of Three Transgender Health Groups. source.
• Reuters (2026). Medical groups sue over US FTC launching gender-affirming care probe. source.
• Reuters (2026). US FTC's investigation of trans youth care was 'retaliatory,' judge says. source.
• Office of the Attorney General of Florida (2025). Complaint: State of Florida v. WPATH, Endocrine Society and American Academy of Pediatrics. source.
• U.S. District Court, N.D. Illinois (2026). American Academy of Pediatrics v. Uthmeier, Memorandum Opinion and Order. source.
• U.S. Court of Appeals, Seventh Circuit (2026). American Academy of Pediatrics v. Uthmeier, No. 26-2238 (22 June 2026). source.
• U.S. Court of Appeals, Seventh Circuit (2026). American Academy of Pediatrics v. Uthmeier, No. 26-2238 (en banc, 14 September 2026). source.
• Reuters (2026). Florida can pursue lawsuit against group over trans youth care, US court rules. source.
• American Academy of Pediatrics (2026). New AAP lawsuit argues FTC investigation into gender-affirming care guidance is unconstitutional; AAP files lawsuit over Florida AG's attempt to suppress 'essential medical discourse'; Federal judge says Florida AG likely 'retaliating against AAP'. source, source, source.
• HealthDay / US News (2026). American Medical Association Says Gender Surgeries for Minors Should Wait. source.
• MedPage Today (2025). HHS Names Authors of Its Gender Dysphoria Report. source.
• STAT (2023). What AAP's gender-affirming care evidence review actually means. source.