Two prominent providers specializing in transgender medicine slammed the new orthodoxy surrounding transitioning for children which has resulted in doctors rushing people through medicalization without extensive evaluation.
Dr. Marci Bowers and clinical psychologist Erica Anderson blew the whistle in an exclusive interview with writer Abigail Shrier. Both specialists are biological males who identify as transgender and they have seen thousands of patients over the course of their careers.
They are also on the board of the World Professional Association for Transgender Health (WPATH), which sets the standards worldwide for transgender medical care, Shrier reports.
However, the two question WPATH's current health guidelines, such as putting children on puberty blockers at a young age.
Dr. Bowers is a world-renowned vaginoplasty specialist who operated on Jazz Jennings, a reality-tv star that transitioned from male to female at age 16 but reportedly had gender dysphoria from the age of two.
On the effects of puberty blockers, Dr. Bowers said, "When you enter a field like this where there's not a lot of published data, not a lot of studies, the field is in its infancy, you see people sometimes selling protocols like puberty blockers in a dogmatic fashion, like, 'This is just what we do.'"
Dr. Bowers said once a child begins the transition process, it's nearly impossible to return to normal.
"You're going to go socially to school as a girl, and you've made this commitment. How do you back out of that?" Bowers said.
In response to Shrier asking Bowers what her stance was on puberty blockers, Dr. Bowers said, "This is typical of medicine. We zig and then we zag, and I think maybe we zigged a little too far to the left in some cases."
"I think there was naivete on the part of pediatric endocrinologists who were proponents of early (puberty) blockade thinking that just this magic can happen, that surgeons can do anything," Dr. Bowers said.
Erica Anderson, a clinical psychologist at the University of California San Francisco's Child and Adolescent Gender Clinic, said she is "not a fan" of puberty blockers. Anderson said there's not enough data regarding the psychological effects puberty blockers have on adolescents, Shrier reports.
Dr. Bowers said it's difficult to have an opinion different from the board at WPATH, which she considers to be problematic.
"There are definitely people who are trying to keep out anyone who doesn't absolutely buy the party line that everything should be affirming, and that there's no room for dissent," Bowers said. "I think that's a mistake."
"Affirmative care" urges doctors to support patients that believe they are trapped in the wrong body, including young children. It's the idea that the patient knows best. In the past, psychologists treated gender dysphoria with "watchful waiting." This method of psychotherapy sought to understand the root cause of a child's gender dysphoria, attempting to help a child grow comfortable in their own bodies before allowing them to transition.
According to Shrier, Bowers said puberty blockers result in the lack of sexual stimulation, referred to as puberty blockade.
"If you've never had an orgasm pre-surgery, and then your puberty's blocked, it's very difficult to achieve that afterwards," Bowers said. "I consider that a big problem, actually. It's kind of an overlooked problem that in our 'informed consent' of children undergoing puberty blockers, we've in some respects overlooked that a little bit."
"I'm not a fan of blockade... I really am not," Bowers told Shrier. "The idea all sounded good in the very beginning. Believe me, we're doing some magnificent surgeries on these kids, and they're so determined, and I'm so proud of so many of them and their parents. They've been great. But honestly, I can't sit here and tell you that they have better — or even as good — results. They're not as functional. I worry about their reproductive rights later. I worry about their sexual health later and ability to find intimacy."
"My fear about these young children who never experience orgasm prior to undergoing surgery are going to reach adulthood and try to find intimacy and realize they don't know how to respond sexually," Dr. Bowers added.