A clinical psychologist, who is transgender herself, is sounding the alarm on the approach many of her colleagues have taken in recent years regarding medical and social treatment for gender dysphoria among children and teens in the United States.
Erica Anderson told Fox News Digital that health professionals need to explore all the factors related to what is going on with a child and "not to dissuade them of their assertive gender, but to understand how other things might be related," including mental health issues like a history of abuse, developmental problems, anxiety or depression.
Anderson has practiced as both a pediatric and adult psychologist for over four decades and has also worked in the healthcare field, most recently in behavorial pediatrics at the University of California San Francisco (UCSF), where she primarily worked in pediatric endocrinology at the Adolescent Gender Center.
If a child has had serious mental health issues prior to asserting a gender difference, then a professional should wonder if there is a relationship between them, Anderson said.
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"I've never seen a major mental illness cured by a gender transition," Anderson said. "I don't think there's any empirical evidence to suggest that depression or anxiety or autism or any other condition is going to be cured by a gender transition."
Despite belief among some of her colleagues in the industry that "the distress that kids experience is all due to gender issues," Anderson said she rarely sees that to be the case. She said cases where a child is gender questioning are "quite simple" and in her experience, "rare."
"We need to explore the course of this gender journey on the part of the young person and find out, is it occurring because of their own organic awareness of who they are, or is it in part because they realize that a lot of other kids are doing this and why shouldn't they?" Anderson asked.
"We have no reason to believe that exploration of gender on the part of teenagers is less subject to peer influence than anything else," she added. "Pretty much everything going on with teenagers is subject to peer influence. So why isn't gender? No one's ever given me an adequate explanation for why they think gender can't be subject to peer influence. I would submit it is."
While at UCSF, Anderson said she saw a lot of gender questioning among patients and worked with them and their families, along with physicians, to address their needs. She now works in private practice and because she herself didn't transition until midlife, Anderson argued her personal experience has given her a lot of life experience about the area in which she practices.
Anderson warned that children are "not just mini adults," but that "they're developmentally different."
"If you facilitate a social transition, it's not a neutral act, it has consequences," Anderson told Fox News Digital. "I'm not interested to direct them one way or another. I routinely say to kids and their families, I don't have any vested interest in you being trans or not. I just want to help you and help you discover who you are."
Anderson said she has been doing a lot of writing and speaking about the concerns she has, which started about five years ago when she began to see what she described as "concerning trends" in terms of who is coming to gender clinics.
At UCSF, Anderson said the shift in patients went from a fairly defined population seen in the past, made up of primarily natal males who assert a female gender identity at a young age to a very heterogeneous population that "completely flipped" and was made up of predominantly natal females, "most of whom have not exhibited any gender questioning until more recently" and "didn't match the historic pattern we expected, which was to see someone who was gender questioning from childhood and maybe their questioning and distress accelerated during puberty."
In many of these cases, she said children never indicated to anyone, parents, teachers or professionals, that they were questioning their gender, which challenges the current protocols for treating transgender kids.
Because the current population of transgender-identifying individuals has become "quite complex," health authorities in Europe have decided "to pivot and take a more cautious approach to dealing with the kids who are coming to gender clinics."
"We've seen that in the United Kingdom, most notably Sweden, Finland, France and more recently Norway and Denmark, who have very publicly indicated the same things that I've been talking about, that the population has shifted," she said. "Protocols that we've had in the past no longer seem to apply, and so we need to ask ourselves what do we need to do with this population? That's where I think the issues lie right now in the United States."
Anderson said that historically if a young person comes to a gender clinic asserting a gender different than their sex assigned at birth, "we would call someone like that transgender, but a number of things have happened in recent years that are unprecedented," like the pandemic, which prompted social isolation among adolescents and more online activity.
"A lot of young people have resorted to going online and what they have found there is a lot of material that, in my judgment, is probably unhelpful to gender questioning kids," Anderson said. "They're getting advice from social influencers and from people who purport to have something to say to them, even though they're strangers, of course, and they're not trained health professionals."
She said a lot of young people take this advice to heart and then discuss what they read and watch online with their friends.
"Large social surveys in recent years have confirmed what I've been saying, which is a huge number of kids questioning their gender beyond anything we ever expected, as many as one in five kids who are adolescents in the United States are expressing a gender sexuality different than straight and cisgender. That's a huge shift," she said. "We used to think of transgender kids as a very small proportion, maybe half a percent, 1% or less."
Most trans advocates, Anderson explained, have welcomed this shift, celebrating the uptick as a sign of larger societal acceptance of alternate sexual and gender identities, but she doesn't think that is the only reason.
"It is obviously common for kids to talk among themselves, so we have to wonder, well, what's going on with these kids?" Anderson asked. "Are they all going to be transgender? The research in the past told us that some proportion of kids who are gender questioning when they're younger persist and become what we call transgender, but not all."
"The question is, who are these kids?" she asked. "Then, are we doing the required individualized assessment of every child to determine what that child needs and when they need it? That's been a big concern of mine, I don't think the assessments that should be occurring, are occurring."
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Anderson said she is regularly told by parents who consult her expertise on gender dysphoria that other professionals are quick to affirm their child without questioning other factors that are frequently present and proceed along the path toward medicalization.
"I've been worried that too often kids are rushed towards medicalization and that this is not good," she said.
If professionals don't conduct proper individual assessment of a child before they make life-altering decisions, Anderson said this could be potential malpractice.
"What we're talking about is a proper assessment to determine what intervention is indicated for an individual at that specific time and the hallmark of clinical medicine and clinical psychology is individualized assessment," Anderson said. "We can't use a cookie cutter approach."
"Furthermore, there may be other needs that a child, young person or adolescent has that go unmet," she added.
In addition, she mentioned the growing awareness around the long-term consequences of the medical intervention used to treat transgender patients, like cross-sex hormones and puberty blockers.
"There don't seem to be any serious long term effects of" using puberty blockers for their original use, to treat precocious puberty, Anderson said. "However, we do know that there is some potential effect of puberty blockers on bone mineralization, the building of bones and by implication, perhaps brain."
Puberty blockers, or gonadotropin-releasing hormone analogues (GnRHa), are a class of drugs which suppresses sex hormones by continually stimulating the pituitary gland. The health authorities in Europe, following evidence reviews, have emphasized that the long term effects of the treatment is not well-understood, she said.
Anderson pointed to an infamous case in Sweden, where a child was put on puberty blockers for four years and at 15-years-old, developed osteopenia, a condition where an individual lacks bone density that can lead to osteoporosis if left untreated. The Swedish transgender boy named "Leo," reportedly cannot stand for longer than 15 minutes, and lives in constant pain and with a series of issues in his spine.
"One of my concerns has been that the kind of caution that my European colleagues are exercising is not occurring here in the United States and it should be," she said. "Pausing puberty, in theory, while beneficial in terms of providing longer time for a child to question their gender, it has the effect of slowing down development and keeping it at the pre-puberty level and we can't do it indefinitely."
Anderson said "hubris" is to blame for her American colleagues continued backing of gender-affirming care among minors, citing the American Academy of Pediatrics (AAP), which she said has been "stonewalling the idea that they need to do an evidence review."
"Their guidelines are stemming from some discussions that occurred in 2018," she said. "It's five years ago, and a lot more information has arisen. And of course, others, as we're saying in Europe, have looked at all the evidence and said, 'Hey, wait a minute, we need to slow down.'"
She said many pediatricians, have been advocating for an evidence review of the standards for care for several years and "finally" at the beginning of this month, the AAP agreed." Anderson described their enthusiasm for an evidence review as "lukewarm," citing the news release from the AAP announcing the review, whIch reaffirming their basic guidelines from 2018 at the same time.
AAP CEO/Executive Vice President Mark Del Monte, J.D., "emphasizes that policy authors and AAP leadership are confident the principles presented in the original policy, Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents, remain in the best interest of children," the announcement read.
"You do the evidence review and then you derive your protocols," Anderson said. "You don't say we have protocols and oh, we're going to do an evidence review. No, the protocols are derivative of the evidence review."
"I think there's widespread recognition in the ranks of doctors and some mental health people that time has come to really get real about all of this and not to blame anybody, but simply get together and try to do what's best for children," she added.
She explained that if you go to a medical provider and report certain symptoms, they will do further evaluation to come up with their own assessment.
"They don't just say, 'Okay, based on your self-report, here's what I'm going to do,'" Anderson said. "We don't rely on self-report in medicine or psychology."
One of the most distressing claims parents of a transgender-identifying individual hear from doctors is that if they don't unequivocally affirm their child's chosen gender identity, they are at a high risk of committing suicide.
"I call that emotional blackmail," Anderson said. "Parents love their children, they don't want any harm to come to their children, so if a responsible professional, a doctor tells them that … " Anderson said this claim is also a "misreading of the literature."
"The most often quoted 40% or 41% suicidal ideation rate is based on a retrospective study, self-report of adult trans people from five, six years ago and other reports … comport to rates of suicidal ideation and other young people who have mental health challenges," she said. "It's out of context, it's a scary statistic and inappropriately used, I think."
"That statistic has been used to bludgeon lots of parents and manipulate them, in my opinion, into consenting to treatment that they had reservations about," she said. "I think that's wrong."
She said the health authorities in Europe have done that and realized as a result, that there are a multiplicity of factors at work in what's going on with teenagers as it relates to gender, which could offer a more complex picture of the mental health of teenagers
"I would go so far as to say we have a crisis of mental health among American teenagers and so in that context, everything potentially is a source of distress and that's why it's important to examine all aspects of a child's life," Anderson said.
As a scientist, Anderson said her job is to question everything, not stopping until you have reliable answers, not opinions.
"My appeal is don't decide to do things before you know what's true and before there's a consensus among everybody involved, the kids, the parents, professionals, including teachers," she concluded.
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Fox News Digital's Hannah Grossman contributed to this report.
