[Mis]Adventures at the AAP Conference

"Next time, add some bass"

Meanwhile, upstairs, pediatricians were learning how to talk to their patients about gender and…the thing formerly known as sex

The trick was to look at the subtle change in facial expressions. Most doctors, nurses, administrators and other exhibitors approached the FAIR in Medicine booth at the American Academy of Pediatrics’ annual conference with curiosity. Once they realized what we wanted to talk about, their faces either closed in anger, opened in surprise, or softened with relief. And then, conversations—and sometimes arguments—ensued.

We were a motley crew: two doctors, Patrick Hunter and Carrie Mendoza; an education economist, Ian Kingsbury; a clinical research manager and pediatric gender clinic whistleblower, Jamie Reed; and five detransitioners: Laura Becker, Chloe Cole, Abel Garcia, Camille Kiefel, and Prisha Mosley. We’d come with the Foundation Against Intolerance and Racism, for which I’m an advisor, to talk about controversies in treating gender dysphoric youth.

Our booth, staffed by four young women who’d had their breasts removed and one young man who’d had his breast implants removed, was next to one for breastfeeding support. On our table, we’d laid out books that told a side of the story most people there hadn’t heard: Time to Think, Parents with Inconvenient Truths About Trans, and When Kids Say They’re Trans. We had the AAP’s 2018 policy statement on affirmative treatment, and Dr. James Cantor’s fact check of it. We had a summary of changing guidelines and concerns in Europe. We had detransition stories and Jamie’s whistleblowing debut in the Free Press.

What we didn’t have was a coherent plan for how to talk about these issues. We were as surprised as anyone that we actually made it in the door, let alone that we made it through the whole event without getting kicked out. Our group spanned a broad political spectrum, and perhaps slightly different ideas about why we were there or what we needed to do to fix gender-affirming care. (I wasn’t sure if I was there as a journalist to chronicle it or as someone who wants to learn how to have this impossible conversation. Maybe both. I tried to think of myself as an in-person op-ed.) In many ways, our diversity was a good thing: we were highlighting disagreement about how to care for gender dysphoric youth, after all. We could each speak to conference-goers in different ways, using different tactics.

Many people approached our booth assuming FAIR worked on health equity—and in some ways, it does. After all, as Camille pointed out, there is no ICD code (to classify diseases and help with insurance) for detransition, no gender-affirming care for those whose bodies were hurt; she has founded a nonprofit, DetransHelp, to assist with that care vacuum. And Abel basically corralled every Spanish-speaking conference-goer to us, having long conversations with people from all over Central and South America about his experience and concerns.

Visitors from red states generally started the conversation by lamenting the bans, assuming FAIR shared their sentiments. For me, the trick was to figure out where people were coming from and gently and slowly offer another perspective:

Yes, it’s a shame this is being handled in the legislature. I don’t know if you’ve heard about the blue state laws, some of which can allow for a child to transition without medical consent. It would be so much better if the medical community could acknowledge the problems and controversies and handle it themselves, wouldn’t it? We all want evidence-based care, and we want policy to be made on cost-benefit analyses.

And then I’d ask if they’d like to talk to detransitioners, who’d paid this hefty cost. Some visitors did, and they left in tears. Others refused to even make eye contact with them; sometimes our detransitioner staffers were the ones crying at the cruel dismissal by professionals who’d sworn to do no harm and dedicated their professional lives to ensuring the health and well-being of children.

Others said what I consider to be the magic words: “I’m going to think about this differently after listening to your story.” Those are the reachable people, the ones open to new information and new interpretations, the ones who say, “I hadn’t thought of it like that.”

I’m not an activist. I have no marketing genes. I can’t sell. But I am a professional explicator and momsplainer, so I tried one more tack to ease people in:

So, the medical protocol was based on a study of a small group of teens who’d had gender dysphoria since a very young age, who weren’t socially transitioned, lived in supportive families and didn’t have other serious mental health problems. Many clinicians have noticed that this isn’t the group seeking treatment, for the most part. [Here, some people would nod enthusiastically.] So in several European countries, they conducted systematic evidence reviews and found the evidence, including that original study, to be of low- or very-low quality. So they revised their guidelines to have psychological support as the first-line intervention, with long-term, multidisciplinary care. If a teen is later approached for medical intervention, it’s within the context of a clinical trial and long-term follow-up.

The response from many people: Sounds reasonable. How, then, I’d ask, could clinicians bring this up with colleagues or ask for more guidance? Stumped again, because the most common response we got from concerned clinicians was that they were afraid to broach the subject with colleagues or administrators. We need to create an environment in which this topic can be discussed, and help people figure out how to do that. That’s beyond my ken as a journalist covering this topic.

The most angry and defensive people we encountered, besides one journalist and one young adult who’d just begun transitioning and who flipped us the bird on the way up the escalator, were parents of trans kids. Aside from the concerned doctor father of that angry young transitioning man, they refused to look at any materials, responding with “I already know all that, I already know.” They were sure they knew what we had to say, sure they’d been fully informed, sure that anyone who wanted to talk was a bigot and a transphobe and nothing more. One mom of a happily transitioned 23-year-old yelled that we shouldn’t be there and shouldn’t parade detransitioners around—not realizing that they came willingly, wanting to share their stories in the hopes that there will someday be fewer such stories to tell.

Prisha and I spoke to one doctor who ran a parent-teen communication center at a children’s hospital. We asked him to consider gender as an important topic that needs to be addressed, not affirmed. Prisha told her story of being medically affirmed instead of given treatment for complex mental health issues. I followed up with my evidence spiel. He turned to Prisha and said something like, “I want to thank you for telling your truth. Your truth is beautiful. And of course you know that your truth is not everyone’s truth.” He oozed smarminess. To me, he said, “Thank you for offering your opinion. I need to disengage now.”

I pressed him to tell me what opinion I’d offered. I’d given him nothing but facts. He said I was against gender-affirming care, but that’s not at all what I’d said. In fact, I never say that—I have opinions about these protocols, but I don’t think they’re relevant. What I’m against is telling only one side of the story. It’s kind of wild how speaking the actual truth is perceived as misinformation and opinion. As Prisha pointed out in a recent Substack post, that’s a core cult tactic.

Several doctors insisted that what Prisha and the others had gone though didn’t happen at their clinics. They’d listen to Jamie talk about what she witnessed and agree it was wrong, but that nobody else operated that way. At least two pediatricians, both from California, had never heard of detransitioners. One asked Chloe, “What should I do so I can ensure this doesn’t happen to my patients?”

It’s a great question, and I’m so glad she asked. But it’s hard to answer. As Chloe said, she never should have been allowed to take these drugs or have surgery. If we have no way to determine for whom it will help or hurt, who will persist or desist, how does a health professional know what to do?

I ended up thinking that was the most important takeaway: it’s okay to say that we don’t know. We don’t have good evidence. We don’t have a healthcare system like Europe’s, with a centralized authority. Some doctors have seen their patients blossom on these drugs, and that can’t be denied. Yet those doctors could ask if they’ve monitored the patients for long enough to know if the treatment can be categorized as success, and ask if what they’re seeing are the temporary mood-boosting effects of T and pacifying effects of E.

We weren’t there to say gender-affirming care was wrong. We were there to say that there are very unhappily transitioned people whose experiences must be considered as the AAP finally consents to a systematic evidence review, and in light of the AAP refusal to change its 2018 policy statement.

Instead of getting kicked out on the morning of second day as I’d feared, we were greeted by people eager to talk to us. At times, large groups assembled. (Maybe Laura’s prosthetic breasts laid out on the table drew them over.) I’d estimate that around 90 percent of the interactions were positive—including one very empathetic lactation consultant who offered tears and hugs. But the negative felt deeply stinging. Maybe that’s what some of the gender-affirming clinicians would say: it’s mostly positive, in their experience, thus the deeply stinging “collateral damage”—aka, the bodies and minds of those the treatments hurt—is worth it. Such people seemed almost impossible to reach, their lack of curiosity a forcefield around them. (My big flaw is that it’s hard for me to summon curiosity about the incurious.) It felt like were were little proles, knocking at the castle wall and begging to be listened to as we saw the bridge to the castle door lift and leave us stranded across the moat.

But we’re okay over here. We’ve got the truth on our side.

I’ll admit that there were many tears behind the booth over the course of three days, leaking from many different eyes. It was a rollercoaster of an experience—and one I think should be repeated. We’ve got to open up the floor and debate. That’s especially true because while we were down on in the exhibition hall, talking to pediatricians who were either poorly educated by the AAP or concerned and afraid to speak up, another detransitioner was filing a lawsuit against the AAP and Dr. Jason Rafferty, lead author of the AAP’s 2018 affirmation policy statement. And meanwhile upstairs, pediatricians were learning to use “chesticles” instead of breasts.

As we were packing up, a tall fella with a delectable southern accent came up to us and said, “Y’all had the party booth! Next time, add some bass!” He danced to pretend music and assured us that we’d livened up the otherwise sterile exhibitor hall. I think we did more than that. I think we instilled people with information, courage, and the knowledge that they’re not alone in believing that no medical treatments should be above scrutiny.