The University of San Francisco Benioff Children's Hospital's Child and Adolescent Gender Center (UCSF) is offering treatments through its transgender health center to children as young as two. Speaking on a promotional video to potential patients and their families, mental health director Diane Ehrensaft said that they "see children as young as two and as old as 25." Ehrensaft describes her own child as "gender creative."
"We support children and their families through their social, medical, and/or surgical transition," says UCSF's Child and Adolescent Gender Center (CAGC) website.
The ushering of young children into trans medicine is done in the "absence of solid evidence" on the use of puberty-blocking drugs, hormones, and surgeries they administer to minors, they rely on the "opinions of innovators and thought leaders." This was written in an editor's note on 2016 guidelines on "Health considerations for gender non-conforming children and transgender adolescents" penned by Dr. Johanna Olson-Kennedy for UCSF.
Olson-Kennedy has actively worked to deplatform those who detransition from gender identity from having their stories told.
Olsen-Kennedy has also advocated for double mastectomies for gender dysphoric 13-year-old girls, claiming that "If you want breasts at a later stage in your life, you can go and get them."
UCSF explicitly adheres to the World Professional Association for Transgender Health (WPATH) guidelines, which recommends that children as young as 8 could begin medical transition. WPATH is set to release its new 8th edition guidelines this year, which plans to lower the minimum age for teens to obtain hormones, as well as face, chest, and genital surgeries.
"If and when children and their families are ready to pursue medical therapies, we prescribe and manage puberty blockers, menstrual suppression, and gender affirming sex hormones," says the UCSF children's gender clinic, adding "Lastly, we are able to connect young adults, and occasionally older adolescents (16+) to gender-affirming surgeons."
The UCSF children's clinic refers to puberty blocking drugs as "fully reversible" and a "pause" on puberty, but these claims rely entirely on referencing their approved on-label use to treat precocious puberty, not for their off-label use for treating gender dysphoria.
Dr. Marci Bowers, a biological male who identifies as transgender, has stated "An observation that I had," said Bowers, "every single child who was, or adolescent, who was truly blocked at Tanner stage 2," which is the beginning of physical development, when hormones begin their work of advancing a child to adulthood, "has never experienced orgasm. I mean, it's really about zero."
Yet UCSF states that "Puberty blockers are a fully reversible treatment that are sometimes used to allow young people time to achieve greater self-awareness of their gender identification while putting a 'pause' on their natal puberty and preventing the overt development of secondary sexual characteristics."
The FDA has never approved the use of puberty blocking drugs for the purpose of treating gender dysphoria, and no randomized controlled trials have ever studied the effects of taking these drugs during adolescence, during such a crucial window of rapid growth and development. The FDA has issued warnings about using these drugs for the treatment of gender dysphoria.
UCSF abides by the "gender-affirmative" model of care, meaning that a child’s asserted belief about their "gender identity" are taken at face value without question. "We were early adopters of the Gender Affirmative model and putting into practice some of the best thinking about how to care for trans and gender-creative kids," said Erica Anderson, a trans-identified psychologist for two locations of UCSF's gender clinic for children.
The gender-affirmation model prevents medical professionals from questioning a child’s self-reported transgender identity, and from exploring possible underlying factors causing their dysphoria. The standard protocol for gender affirmation is administering puberty blockers, followed by cross-sex hormones and then surgery, if desired.
"If a child is not feeling seen about who they are, they're at risk for some pretty serious psychological problems, including anxiety, depression, even suicidal thoughts," said Ehrensaft, referring to the debunked affirm-or-suicide myth used to pressure parents into green lighting their child’s transition under the threat of suicide.
A clinical diagnosis of persistent gender dysphoria isn't even necessary. Aside from transgender patients, UCSF also treats children they describe as "gender creative," "gender diverse" and "gender-expansive."
"The CAGC team believes that being transgender is a normal variation in gender identity," reads their website, citing the May 2013 update from the American Psychiatric Association that replaced the term "gender identity disorder" with "gender dysphoria" as a justification for their belief.
This is because they view "gender identities" as relating to sex-based stereotypes of masculinity and femininity. Yet few if any people identify with, much less exhibit, such extreme stereotypes. Personalities and preferences vary greatly within each sex, but breaking sex-based stereotypes is incorrectly being conflated with being "gender creative" or "gender expansive."
Adolescents seeking surgery are referred to the UCSF Transgender surgery center, whose website displays in bold font: "Our goal is to get you to surgery, with a minimum of barriers or gatekeeping."
In an editor's note in their treatment guidelines for children and adolescents, UCSF reveals they lack evidence to support their conclusions and instead rely on opinions from questionable sources. "In the absence of solid evidence, providers often must rely on the expert opinions of innovators and thought leaders in the field; many of these expert opinions are expressed in this youth guideline," the editor's note reads.
Additionally, another section of the guidelines reads "sparse data exist regarding the impact of puberty suppression and gender-affirming hormones administered during adolescence." And, in a section for surgical interventions on "transmasculine youth," UCSF acknowledges "There are currently no available data that report the positive impact of male chest reconstruction in minors."
Regardless of the admitted lack of evidence, the youth guidelines recommend double mastectomies, an elective procedure to remove healthy breasts, to adolescent girls as "medically necessary." To reinforce their pro-surgery stance, they discourage "chest binding" (flattening the breasts with duct tape and other “binders”), which they call an "inappropriate method" that may lead to "serious medical complications."
"Male chest reconstruction is a medically necessary part of phenotypic gender transition," the guidelines read. The guidelines advocate for minors to be able to obtain the surgery, and dismiss age requirements as arbitrary: "There are often arbitrary barriers to surgery citing that youth need to be at least 18 years of age prior to undergoing this procedure."
According to the guidelines, minors can access genital surgery as well, "As youth are transitioning at increasingly younger ages, genital surgery is being performed on a case-by-case basis more frequently in minors." These sterilizing procedures, WPATH notes, can be done with parental consent.
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