Pentagon doctors say 7-year-olds able to consent to sex changes

A team of healthcare providers at US military bases has come out in support of minors having access to experimental sex change procedures, arguing that children as young as 7 are capable of "medical decision-making," and suggesting that using psychotherapy to treat gender distress is "conversion therapy."

In the March edition of the American Journal of Public Health, the team of doctors claim that in reasoning grounded in human rights, "youths…in an informed consent model of care, have an inherent ability and right to consent to gender-affirming therapy."

According to Fox News, the team also argues that the only pathway for gender-confused children with parents serving in the military is immediate medicalization, "such as puberty suppression and affirming hormones."

The authors - David A. Klein, Thomas Baxter, Noelle S. Larson, and Natasha A. Schvey, assert the need for the military to train its healthcare providers in how to provide minors with experimental and irreversible sex change interventions, despite acknowledging that 53 percent of physicians affiliated with the military in the Department of Defense (DoD) health care system report being unwilling to prescribe hormone therapy with or without training.

Klein, Schvey and Baxter work at Travis Air Force Base in California, and Larson, a pediatric endocrinologist, works at the Department of Pediatrics at Walter Reed National Military Medical Center.

In a statement to Fox News, the DoD stated that the "Department of Defense will train its health care providers in keeping with current science and best medical evidence," but added that it does not support rushing anyone onto the medical sex change pathway and indicating such decisions are made in consultation with a minor and their guardians.

However, the team of healthcare providers suggested the cautious approach of "watchful waiting" for treating gender dysphoric youth was the equivalent of "conversion therapy."

"Some well-intentioned military-affiliated clinicians may not be aware that a ‘watchful waiting’ approach has a different risk profile than a gender-affirmative approach (which allows for gender identity exploration), and that ‘conversion therapy’ is unethical, harmful, and generally illegal," said the military doctors. "Patients may face ‘gatekeeping’ and major delays in care, including protracted and pathologizing psychiatric evaluations that question patient motives."

The team criticized laws that ban doctors from performing medical sex changes on youth still in a stage of identity development, arguing that such laws assume adolescents are not capable of understanding the long-term implications of such interventions.

"These laws also assume that [transgender/gender-diverse] adolescents and their parents are incapable of understanding the risks and benefits of gender-affirming medical care and then deciding what is in the youth’s best interest," said the doctors. "Prior research has found that children can begin participating in their medical decision-making as early as age seven years with gradual increases in decision-making capacity, and adolescents prefer shared decision-making."

Dr. Stanley Goldfarb, of Do No Harm, an organization of healthcare providers seeking better care for minors suffering from gender distress, called such claims "laughable."

"The notion that 7-year-old children are capable of such decisions is beyond laughable," Goldfarb told Fox News. "The existence of a large, perhaps as much as 25 percent cohort of 'detransitioners,' suggests the folly of assuming the soundness of childhood decisions."

"Just because a child states that they understand the implications of gender transitioning does not mean that they can conceive of their future regret," he added. "These physicians should exam the literature and face the reality that the reason that Finland, Norway, Denmark, and the UK have opted to severely restrict the use of puberty blockers and sex-characteristic altering hormones is that we have little if any evidence that we are not hurting more children that we are helping."

Goldfarb then took aim at a study used by the team to support the that children are capable of making informed decisions about such life-changing interventions.

"The article from the military physicians would have to accept an extraordinary claim of capability of children to make an informed decision about life-altering treatment based on interviews of 21 selected participants who were then interviewed by researchers who were apparently fully invested in support of the concept of ‘gender-affirming care.’ This is no random study of the attitudes of children with gender dysphoria, this descends into propaganda," he told Fox News. "This is the type of research base for ‘gender-affirming care’ that has led European experts like Cass in England to conclude that the evidence in favor of ‘gender-affirming care’ is of ‘low quality’ and that only highly selected children should be considered for such treatment."

The doctors also called on the Defense Health Agency to provide legal services to help circumvent state laws that prohibit doctors from performing sex changes on minors, suggesting military youth should be permitted to receive puberty blocker implants prior to relocating to states where such laws exist.

"[A]n implantable puberty blocker, which is generally effective for at least two years, can be administered at a tertiary care military hospital, requiring only routine services easily accomplished in primary care over time. This could be a temporizing measure prior to relocation," said the doctors.

The team further added that the DoD should provide legal services to healthcare providers who choose to violate state laws prohibiting child sex changes.

"[DoD] clinicians… may be forced to choose between withholding… treatments to act in accordance with state law, and providing ethical and evidence-based treatment while facing legal or financial persecution, dishonorable military service, or allegations of child abuse," explained the team.

"The [Defense Health Agency] should also make a commitment to defending clinicians and families who render gender-affirming care to minors in accordance with DHA legal guidance from prosecution under state laws or policies that criminalize this care," said the doctors.

The doctors also suggested fostering "telehealth capabilities," where state law permits.