One of America’s top plastic surgeons refuses to perform gender reassignment surgeries on children in his practice because he is concerned about the long-term consequences.
California-based plastic surgeon Dr. Steven Williams, who is also president of the American Society of Plastic Surgeons (ASPS), noted that there is a lack of long-term research on the effects of transitioning as a teenager.
He also pointed out that the situation in America had become “political”, while the UK and European countries had banned the procedure for children due to a lack of evidence about its efficacy and harms.
Gender-affirming care is a relatively new area of research. Doctors are still investigating the effects of puberty blockers and hormone treatments on the brains of young people and their development into adults.
At the same time it has been shown that the transition Reduce suicidal thoughtsreduce depression rates among gender-contested youth, and improve their overall well-being.
Dr. Steven Williams, a California plastic surgeon, does not perform menopause surgeries on young people and has never considered doing so, citing questionable long-term evidence
Dr. Williams said NewsNation: ‘I don’t do gender-affirming care with adolescents. The reason for that is I don’t think the data supports it.
‘We don’t do that at all in my practice.’
Transition surgery, which involves the removal of the breasts (also called ‘top surgery’) and genitals, is extremely rare in women under the age of 18 and is assessed on a case-by-case basis by teams of general practitioners, psychologists, endocrinologists and surgeons.
Trans children typically begin their transition with puberty blockers. These medications delay the onset of puberty, giving the child and their family more time to decide whether to undergo hormone therapy.
Hormone therapies typically begin in a child’s teenage years to help them develop secondary sexual characteristics. For example, a girl who is becoming a boy may take hormones to deepen her voice and grow body hair.
After hormone therapy, a trans person may choose to undergo surgery to medically transform. However, not everyone does this.
In the past, the typical pathway involved a psychological assessment, followed by hormones, culminating in surgery. But not all transgender people seek all interventions, and some may not be looking for it.
“I personally don’t think I’m capable of unraveling all of these problems in adolescents,” Dr. Williams said.
“I know I’m not satisfied with the level of evidence that’s out there yet – and it’s a particularly vulnerable population – and so I think it’s important to proceed with caution.”
The chart above shows the number of gender confirmation top surgeries performed in the US each year
Professional medical organizations, including the American Academy of Pediatrics, the American Medical Association, and the American Psychological Association, argue that gender-affirming care, including surgery, is necessary for the emotional and physical well-being of trans youth.
Critics of gender-affirming care for children, such as hormones and surgery, on the other hand, have described sex reassignment surgeries as experimental, citing lack of long-term research on their benefits and lack of consensus among physicians on the best surgical techniques.
Jay Richards, a fellow at the conservative Heritage Foundation, previously told DailyMail.com that it is “tempting” to compare clinics performing these “creepy procedures” to Dr Frankstein’s lab.
“But that wouldn’t be kind to Dr. Frankenstein,” said Dr. Richards.
Critics of gender-affirming care for children have also reported cases where children and parents felt forced through the transition process without receiving adequate psychological support.
Patrick Brown, a researcher at the conservative Ethics and Public Policy Center, responded to a Dutch study that found that children with gender dysphoria may have outgrown it by the time they are 25. He said this “gives further reason to be skeptical of aggressive steps to facilitate gender transition in childhood and adolescence.”
He added that for the vast majority of people, “caution and caution, rather than a hasty decision about permanent surgeries or hormone therapies, will be the best approach for teenagers who are struggling to understand the world and their place in it.”
‘A policy that prohibits gender reassignment in minors therefore makes a lot of sense.’
The most common type Gender confirmation surgery involves the removal of breasts to masculinize the chest, followed by genital reconstruction, and then facial surgery.
However, research has shown that surgeries are rare in children and teenagers, who typically begin the transition process by changing their pronouns and clothing and talking to a psychologist.
Researchers from the Harvard TH Chan School of Public Health looked at millions of adults and minors across different age groups to determine how often transition surgeries occurred in the US in 2019.
The findings showed that in 2019, approximately two per 100,000 minors aged 15 to 17 underwent gender reassignment surgery. For minors aged 13 to 14, the rate dropped to 0.1 per 100,000, and no gender confirmation surgeries were performed on minors aged 12 or younger.
Dr. Elizabeth Boskey, a social worker and Harvard researcher who co-led the study, said: ‘We found that gender affirming surgeries are rarely performed on transgender minors, suggesting that US surgeons are appropriately following international guidelines for assessment and care.’
The question of whether young people have access to these transition services has become a thorny issue in the culture war, with nearly two dozen states banning gender-affirming care.
While studies of trans youth who have begun the transition process typically show improved mood and anxiety levels, experts are increasingly concerned that doctors are prescribing medications without adequate information about their long-term effects.
Gender researchers in the UK, where doctors are no longer allowed to prescribe puberty blockers, have found in a milestone assessment Commissioned by the National Health Service, it was stated that previous research on the topic was of ‘poor quality’ and that there was ‘very limited evidence on the long-term outcomes’ of medical transition.
According to the government-sponsored report: ‘This is an area of remarkably weak evidence, and yet the results of studies are exaggerated or misrepresented by people on all sides of the debate to support their position. The reality is that we have no good evidence on the long-term outcomes of interventions to manage gender-related distress.’
Earlier this year, Ashley Grossman, an endocrinologist at the University of Oxford, weighed in. She said there was “no good evidence” that puberty blockers help transgender children, pointing to new research showing they damage the testicles and sperm of boys who take them.
Sex reassignment surgeries have increased dramatically in recent years, with one in six trans adults in the U.S. opting for gender confirmation surgery. The majority of those who go under the knife undergo genital surgery (84 percent between 2006-2011), but nearly half of those who undergo vaginal reconstruction suffer complications years later. Most trans men (64 percent) who undergo penile reconstruction also experience complications
Grossman said blockers may be “helpful” for some trans kids, but the drugs are too risky to be prescribed to the “vastly increased number” of young people who identify as trans today.
He added: ‘There is not enough research yet on routine treatments to block puberty, and many of these children may have other problems that they need help with,’ he added, referring to a growing body of evidence showing that young people with gender inconsistency often have other underlying mental health problems.
Norway, Finland, Sweden, the Netherlands and the United Kingdom are among the growing list of countries that have limited or completely stopped trans interventions for children.
But in the US, where healthcare is run by both the government and the private sector, there are no such general rules, so different doctors in different states are free to practice as they see fit.
Dr. Sheila Nazarian, a board-certified plastic surgeon in Beverly Hills, said, “I think some physicians and medical associations have been overtaken by a vocal minority and have become politicized.
“This is 100 percent an American political issue. If we look at Europe, we see very progressive governments have backed away from these procedures in minors because they are just analyzing the data — as we should be doing with any procedure. Why should we just keep our mouths shut for this procedure, in this patient population?”
