What do Europeans know that American medical elites don’t — or, worse, won’t even consider? Western and Northern European countries are generally much more restrictive in transgender treatments for children, with several recently becoming sharply more so. Yet America is doubling down on invasive and irreversible medical interventions for minors at steadily younger ages — with rare exceptions like Utah, which just banned such treatments this weekend.
Blame radical gender ideology, which blinds American activists to medical reality and the true needs of vulnerable children.
The American approach, “gender affirmation,” assumes gender identity is knowable from as early as toddlerhood, fixed as soon as it is declared and should be medicalized into permanence as soon as possible. It insists merely questioning a minor’s gender self-definition before often-irreversible interventions is harmful.
The American Academy of Pediatrics has embraced an affirm-only/affirm-early policy since 2018, and most states follow its guidance despite withering criticism in peer-reviewed journals.
Western and Northern Europeans generally see affirmation leading to rapid medical interventions as unethical and dangerous. England, Sweden and Finland have largely abandoned gender affirmation for minors in the last three years. Others, such as Ireland and Italy, are raising concerns, even with approaches already more restrictive than America’s. Overall, the most progressive countries in Europe are notably more conservative, with a clear focus on safeguarding children.
The evidence supports such caution. There’s an extremely high likelihood — confirmed by almost a dozen studies — that childhood-onset gender incongruence will resolve on its own by adolescence or adulthood. And the sudden rise of transgender identification in youth, especially teen girls, has occurred too fast to properly study, rendering it too new to properly understand, much less medicalize.
Given these realities, European countries increasingly discourage automatic deference to a child’s self-declarations while making long-term psychotherapy a prerequisite for transgender treatments.
In America, by contrast, psychological assessments and treatments are ignored, abbreviated or led by therapists with the singular goal of confirming the child’s self-diagnosis. Yet preexisting mental-health problems often contribute to a child’s unease with his or her sex. Even so, anxiety, depression, eating disorders, suicidal ideation, self-harming behavior, autism — none stands in the way of children receiving permanent disfiguring and sterilizing treatments. Dr. Diana Tordoff, often cited in support of giving cross-sex hormones to teenagers, has admitted that patients at Seattle Children’s Hospital gender clinic with “depression, anxiety, or suicidal thoughts” are “not precluded access” to treatments.
The practical reality of Europe’s approach: Transgender treatments are increasingly off-limits, with some countries effectively ending them in all but rare cases or outside rigorously controlled clinical trials. America raises few if any barriers, even to younger children.
Consider puberty blockers, known to decrease bone density and contribute to infertility while possibly inhibiting cognitive development. They’re widely prescribed here to minor patients at the earliest hint of puberty — even as young as 8.
Yet a growing number of European countries wait until patients are as old as 13 and require psychotherapy. Sweden’s National Board of Health and Welfare states children should never receive blockers outside clinical trials, and they must be at least 12. Finland and England are pursuing similar changes.
The contrast is even starker with cross-sex hormones, which result almost immediately in irreversible bodily changes and can lead to sexual dysfunction and infertility. They can also cause major health problems such as strokes, heart attacks and cancer.
Our review of 11 of the most progressive Western and Northern European countries shows they almost entirely restrict cross-sex hormones until age 16, once again following psychotherapy sessions. American children can receive cross-sex hormones at 13 (younger in clinical trials).
Finally, there are “gender affirmative” surgeries — the most aggressive and invasive procedures. Every Western and Northern European country we surveyed except one bans surgery until age 16 or, more commonly, 18.
America has documented cases of minors as young as 12 receiving surgeries. While most procedures for underage youth are double mastectomies for teenage girls, cases of genital surgery — such as the inversion of the penis, sometimes with tissue removed from the colon, to create an orifice resembling a vagina — are documented as well.
Why are children in Stockholm protected from these procedures, yet children in Boston are not?
The emerging European approach deserves greater attention, and given the state of research, even more prudence is warranted. Utah is leading the way by largely ending transgender medical treatments for minors.
But the US medical establishment won’t budge. A recent New England Journal of Medicine article called the idea of using psychotherapy to address gender-related distress “inflammatory” while suggesting the need to suppress such “science denialism.”
Yet stifling debate on protecting children is the real affront to science — and a real danger to these vulnerable patients. American policymakers would do well to consider Europe’s caution — and follow Utah’s lead — before the country sacrifices any more children on the altar of gender ideology.
Dr. Stanley Goldfarb is chair of Do No Harm, where Dr. Miriam Grossman, a practicing child and adolescent psychiatrist, is senior fellow.