Multiple doctors and therapists pushed back against Assistant Secretary for Health Rachel Levine's recent assertion that "there is no argument" about gender-affirming care among medical professionals who specialize in children and adolescents.
Several medical professionals told Fox News they have seen rates of gender dysphoria skyrocket among young people in recent years, but that many of their colleagues are reluctant to speak publicly against transgender ideology for fear of both professional and personal retaliation.
‘No debate’ on gender-affirming care?
Medical professionals took issue with Levine's blanket claim, including the Florida Department of Health. Citing peer-reviewed studies as well as a "lack of conclusive evidence, and the potential for long-term, irreversible effects," Florida Surgeon General Joseph Ladapo released a fact sheet on April 20 advising against the HHS's list of treatment options for children and adolescents experiencing gender dysphoria.
Levine, who is the highest-ranking transgender person in the U.S. government, made headlines last month for claiming during an interview with NPR that "there is no argument among medical professionals – pediatricians, pediatric endocrinologists, adolescent medicine physicians, adolescent psychiatrists, psychologists, etc. – about the value and the importance of gender-affirming care."
According to definitions laid out in a fact sheet from Levine's Department of Health and Human Services (HHS) in March, "gender-affirming care" includes social affirmation at any age, puberty blockers during puberty and cross-sex hormone therapy starting during early adolescence. Irreversible surgery is "typically used in adulthood or case-by-case basis in adolescence," according to the agency.
Ladapo's office told Fox News he believes Florida's guidance and fact sheet speak for themselves, and that "the burden of proof to support the outlandish claims made on NPR falls on Dr. Levine."
When reached for comment, Levine's office doubled down on the assistant secretary's claims. "There is no debate in the medical community about the medical or scientific validity of gender-affirming care," Levine's communications director Adam Sarvana told Fox News.
Sarvana said the standards of care from the World Professional Association for Transgender Health (WPATH) have been endorsed by multiple medical organizations, including the American Academy of Pediatrics (AAP), the American Medical Association (AMA), the American Psychiatric Association (APA) and the American Academy of Child & Adolescent Psychiatry (AACAP).
Unsettled science on gender
Dr. William Malone, an Idaho-based assistant clinical professor of endocrinology, is a member of the Society for Evidence-Based Gender Medicine (SEGM), which is an international group of more than 100 clinicians and researchers concerned about what they call the "lack of quality evidence for the use of hormonal and surgical interventions as first-line treatment for young people with gender dysphoria."
On April 7, SEGM released an extensive rebuttal of the March guidance from the HHS, alleging that the department failed to adequately review available literature and also rendered biased recommendations without taking into account the low quality of evidence, diversity of clinician viewpoints or possible alternative treatments.
A board-certified endocrinologist, Malone has waded into the international debate on such issues by raising concern about the potential long-term physical effects of treating gender-dysphoric youth with puberty blockers, cross-sex hormones and surgery, as endorsed by the Endocrine Society (ES).
In March 2021, he and several colleagues penned a letter to the editor of The Journal of Clinical Endocrinology & Metabolism, pointing out that the "standards of care" laid out by WPATH and the ES are technically only practice guidelines that are potentially subject to the bias of their sponsor.
The ES forwarded Fox News to a published response to Malone that claims he and his colleagues "overstate concerns and conflate appropriately conservative statements from the existing literature with absence of data." WPATH did not respond to request for comment in time for publication.
"They're trying to make it seem that the evidence base is a done deal and is settled science, and that's just simply not the case," Malone told Fox News. "And so the language that they're using does not reflect the actual medical evidence."
Malone pointed out how other countries are urging caution regarding gender-affirming care, especially for minors.
In February, the Swedish National Board of Health and Welfare (NBHW) updated its health care service guidelines to recommend "restraint when it comes to hormone treatment," noting increasing reports of detransition and transition-related regret among youth who transitioned in recent years. The National Academy of Medicine in France also advised caution that same month.
In 2020, the Finnish Health Authority (PALKO/COHERE) issued similar guidelines deviating from WPATH and recommending psychotherapy as the first-line treatment for gender-dysphoric minors.
In October 2021, the Royal Australian and New Zealand College of Psychiatrists (RANZCP) also released a statement citing a lack of quality evidence and emphasizing the necessity of receiving a proper mental health evaluation before undergoing irreversible hormone therapy or gender reassignment surgery.
Doctor warns of ‘psychic epidemic’
Dr. Miriam Grossman, a child and adolescent psychiatrist who has treated young people for nearly 40 years and written extensively about gender ideology, said Levine is misleading the American public by claiming there is no disagreement among physicians regarding gender-affirming care.
"There is a complete lack of high-quality, long-term data that these medical interventions actually help, and it is very disturbing to me as a fellow physician that Dr. Levine is arrogantly announcing that all pediatricians, all physicians and therapists agree with her position," said Grossman, who described the rising rates of gender dysphoria among young people as "a psychic epidemic."
"I attribute it to the gender ideology, which has made its way into our schools, into our entertainment industry, into the social media platforms," she said. "Children who have various emotional issues are being led to believe that being transgender is going to solve their emotional issues."
Grossman also noted that among female adolescents especially, such ideas and behaviors spread rapidly within friend groups.
Psychologist: ‘We're definitely in hiding’ in gender controversy
Several medical professionals who spoke to Fox News said many of their colleagues have misgivings about the gender-affirming model, but are afraid to voice them.
"There's kind of like an underground group of therapists and pediatricians and doctors who have to meet in secret groups to talk about their concerns with this, because everyone kind of sees it as being transphobic if we challenge this narrative," said Dr. David Haralson, a Colorado-based marriage and family therapist who is part of a group called the Gender Exploratory Therapy Association (GETA), which encourages therapy instead of medicalization to help resolve gender dysphoria.
Dr. Oren Amitay, a registered psychologist and lecturer at Ryerson University in Toronto, told Fox News he believes Levine's claims are hyperbolic, especially given the number of medical professionals he knows worldwide who question the long-term safety of puberty blockers and cross-sex hormones on youth.
"We have a number of colleagues who say no, this is wrong, and it's not on ideological grounds, it's on the science," said Amitay, who also revealed that he and other skeptical doctors communicate through various groups, some of which remain secret.
"I don't know if we're in the minority, but we're definitely in hiding, so to speak, because speaking out can get us in trouble," he said. "So yes, there are quite a few of us who disagree."
Amitay described how recent Canadian legislation such as Bill C-4, which outlaws conversion therapy, has had a chilling effect on his own practice.
"I will tell you that in today's day and age, I'm less inclined to ask certain questions that I would have in the past, because I'm worried that it would be mischaracterized as conversion therapy," said Amitay, who explained that his approach with clients who struggle with such issues is exploratory and not intended to push them toward any particular outcome.
As defined in Canada, conversion therapy encompasses any practice intended to "change a person’s gender identity to cisgender," or to "repress or reduce a person’s gender expression that does not conform to the sex assigned to the person at birth." Such therapy is banned even for consenting adults who want to receive it.
Therapists who run afoul of Bill C-4, which became law in January, risk half a decade in prison. Similar conversion therapy bans have sprung up in various states, cities and municipalities in the U.S.