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Founder of first pediatric gender clinic in the US fears providers are rushing gender transitions

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The founding psychologist of the first pediatric gender clinic in the United States believes medical providers are rushing to provide gender transitions to youth and warns that, as far as she can tell, practice is not being regulated as it ought to be. 

New York Times opinion writer Pamela Paul interviewed Laura Edwards-Leeper as part of a piece published Friday profiling detransitioners who once identified as a member of the opposite sex but saw their discomfort with their biological gender subside as they got older.

Edwards-Leeper is the founding psychologist for the Gender Management Service at Boston Children's Hospital, the first hospital-based clinic in the United States to offer assessment and interventions to trans-identified youth.

She also served on the American Psychological Association Task Force that developed practice guidelines for working with trans-identified individuals and chaired the Child and Adolescent Committee for the World Professional Association for Transgender Health, according to her website.

Edwards-Leeper told Paul that when she began her practice in 2007, most patients had longstanding and deep-seated gender dysphoria and that transitioning was the appropriate course of action for most of them. She added that most mental health issues they suffered from were generally resolved through gender transition.

"But that is just not the case anymore," Edwards-Leeper said. "The population has changed drastically."

While Edwards-Leeper does not regret having gender transition procedures performed on her first set of patients and opposes efforts to ban such procedures, she expressed concern that "as far as I can tell, there are no professional organizations who are stepping in to regulate what's going on."

She contrasted her earliest group of patients with her current patients, who she contends has no history of childhood gender dysphoria. 

The doctor stressed that for young people without a long history of experiencing discomfort with their biological sex, "you have to take time to really assess what's going on and hear the timeline and get the parents' perspective in order to create an individualized treatment plan." She warns, "Many providers are completely missing that step."

Edwards-Leeper said many of the students she trained as psychologists have left "gender-related care" behind.

"Some have told me that they didn't feel they could continue because of the pushback, the accusations of being transphobic, from being pro-assessment and wanting a more thorough process," Edwards-Leeper said. 

Another mental health professional who testified about her experience to Paul, licensed professional counselor Sasha Ayad, cited the rise in rapid onset gender dysphoria, where children seemingly declare themselves as members of the opposite sex out of nowhere as an example of how "the job of children and adolescents is to experiment and explore where they fit into the world, and a big part of that exploration, especially during adolescence, is around their sense of identity."

"Children at that age often present with a great deal of certainty and urgency about who they believe they are at the time and things they would like to do in order to enact that sense of identity," Ayad said. "We've always known that adolescents are particularly malleable in relationship to their peers and their social context and that exploration is often an attempt to navigate difficulties of that stage, such as puberty, coming to terms with the responsibilities and complications of young adulthood, romance and solidifying their sexual orientation."

In addition to featuring testimony from mental health professionals, Paul's article included conversations with detransitioners who regret undergoing gender transition surgeries as minors. One of the young women, Grace Powell, began undergoing hormone treatments at age 17 and had a double mastectomy the summer before she went off to college. At college, she identified as a young man named Grayson. 

Powell, now 23, expressed her wish that "there had been more open conversations."

"But I was told there is one cure and one thing to do if this is your problem, and this willhelp you," Powell was quoted as telling Paul. 

"What should be a medical and psychological issue has been morphed into a political one," she lamented. "It's a mess."

Looking back on her gender transition, Powell recalled that "the process of gender transition didn't make me feel better" but rather "magnified what I found was wrong with myself." According to Powell, "I expected it to change everything, but I was just me, with a slightly deeper voice." 

After explaining that "it took me two years to start detransitioning and living as Grace again," Powell expressed hope that "more people would understand that there's not a one-size-fits-all situation."

Another detransitioner profiled by Paul, Paul Garcia-Ryan, "had surgery on his genitals" which led to "severe medical complications." 

"You're made to believe these slogans," Garcia-Ryan asserted. "Evidence-based, lifesaving care, safe and effective, medically necessary, the science is settled — and none of that is evidence based." 

Garcia-Ryan, a practicing psychotherapist who has founded an organization called Therapy First that supports therapists who do not agree with the push to provide all youth with gender dysphoria with gender transitions, has come to the conclusion that no one under the age of 25 should undergo any form of gender transition without psychotherapy to examine any underlying issues behind their discomfort with their biological sex.

"When a professional affirms a gender identity for a younger person, what they are doing is implementing a psychological intervention that narrows a person's sense of self and closes off their option for considering what's possible for them," he said.

Both Garcia-Ryan and Powell reported that the medical professionals who treated them for their gender dysphoria rushed to affirm their identities and pushed for gender transitions without seeking more information about the source of their distress.

Concerns about the long-term impacts of surgical and hormonal gender interventions on youth have prompted 23 states to pass laws prohibiting minors from obtaining them: Alabama, Arizona, Arkansas, Florida, Georgia, Idaho, Indiana, Iowa, Kentucky, Louisiana, Mississippi, Missouri, Montana, Nebraska, North Carolina, North Dakota, Ohio, Oklahoma, South Dakota, Tennessee, Texas, Utah, West Virginia and Wyoming. 

In the United Kingdom, the government shut down what was once its largest gender identity clinic at the Tavistock and Portman Trust in London and moved to the new provider model through specialist children's hospitals after a formal review. 

In 2022, the U.K.'s National Health Service issued guidelines advising doctors not to so easily encourage minors to socially transition during what may be a "transient phase." 

"The clinical management approach should be open to exploring all developmentally
appropriate options for children and young people who are experiencing gender
incongruence, being mindful that this may be a transient phase, particularly for prepubertal children, and that there will be a range of pathways to support these children and young people and a range of outcomes," the guidelines state.  

In the United States, whistleblowers who formerly worked at gender clinics have come forward to reveal a push to transition children with gender dysphoria and highlight the medical consequences of gender transition procedures. After increased scrutiny, some gender clinics have either shut down or are no longer offering hormonal intervention services for minors. 

Ryan Foley is a reporter for The Christian Post. He can be reached at: ryan.foley@christianpost.com

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