Summary

In 2018 the American Academy of Pediatrics (AAP), the main US children's doctors' group, issued a policy backing a "gender-affirming" approach for children and teens. It rejected both conversion therapy and "watchful waiting", meaning supporting a child without pushing either way. James Cantor, a psychologist, read the papers the AAP cited and argued they did not back it. Papers cited about conversion therapy were about sexual orientation, and papers cited to criticise watchful waiting actually recommended it. He also said the AAP left out the follow-up studies of children with gender distress, all of which found most stopped wanting to transition by puberty. The piece became influential. In 2023 the AAP kept its policy but ordered a formal review of the evidence. This is one author checking citations, not new data, and the childhood studies it relies on are themselves disputed.

Key findings

• 이 글은 트랜스젠더 및 성별 다양 아동과 청소년 진료에 관한 미국소아과학회의 2018년 정책(Rafferty 등)에서 인용된 근거를 점검합니다.
• 캔터는 AAP가 당시 거의 모든 클리닉과 전문 단체가 사용하던 접근인 ‘지켜보며 기다리기’를 거부하고 확정을 유일하게 받아들일 수 있는 접근으로 지지했다고 주장합니다.
• AAP가 ‘전환’ 또는 ‘교정’ 요법에 반대하려고 인용한 논문들은 아동의 성 정체성이 아니라 성적 지향에 관한 것이었다고 보고합니다.
• AAP가 지켜보며 기다리기를 비판하려고 인용한 논문 여럿이 실제로는 그것을 지지했다고 보고합니다.
• 성별 불쾌감이 있는 아동에 대한 추적 연구 11건이 모두 대부분이 사춘기까지 전환을 원하지 않게 되었다고 밝혔는데, AAP는 하나(Wallien과 Cohen-Kettenis 2008)만 인용하고 그 결과는 언급하지 않았다고 지적합니다.
• 2023년 8월 AAP는 2018년 정책을 재확인하면서 개정에 참고할 근거에 대한 공식 검토를 지시했습니다.

Abstract

The American Academy of Pediatrics (AAP) recently published a policy statement: Ensuring comprehensive care and support for transgender and gender-diverse children and adolescents. Although almost all clinics and professional associations in the world use what's called the watchful waiting approach to helping gender diverse (GD) children, the AAP statement instead rejected that consensus, endorsing gender affirmation as the only acceptable approach. Remarkably, not only did the AAP statement fail to include any of the actual outcomes literature on such cases, but it also misrepresented the contents of its citations, which repeatedly said the very opposite of what AAP attributed to them.

Conclusion

Cantor concludes that the AAP policy statement is not based on the evidence it claims: it omitted the outcomes literature on gender-dysphoric children (every follow-up study finding that most desisted by puberty) and misrepresented its citations, which repeatedly supported watchful waiting rather than the affirmation-only approach the AAP endorsed. The AAP is free to adopt any policy it wishes, he argues, but any assertion that its policy is evidence-based is demonstrably false.