AAP guideline on transgender youth

In 2018, the American Academy of Pediatrics published a policy statement titled 'Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents', endorsing the 'gender-affirmative model'.

2018 Policy Statement

In 2018, the American Academy of Pediatrics published a policy statement titled 'Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents', endorsing the 'gender-affirmative model'.

Systematic review announced

In 2023, the AAP announced a formal systematic evidence review of its own recommendations, partly in response to international developments including the Cass Review. The findings are expected in the coming years.

Debate within the AAP

At AAP meetings in 2023 and 2024, arguments were made both for and against revising the statement. A minority of members explicitly supports a more cautious approach similar to the British and Scandinavian reorientation. Another American professional association, representing plastic surgeons, stated in 2026 that there is insufficient evidence for gender surgery in minors. The article on gender-affirming care in the United States explains how policy in the country is developing.

What the statement says

The statement was published in the journal Pediatrics, with pediatrician Jason Rafferty as its first author. In it, the AAP recommends that children and adolescents have access to care that affirms their gender identity, that insurers cover this care, and that families and schools support the child. The statement describes watchful waiting, the so-called watchful waiting, as an outdated approach and equates it with attempts to change a child's gender identity. How watchful waiting works in practice and how it differs from the affirmative pathway is explained at wpath.nl.

Criticism of the evidence base

Psychologist James Cantor published an examination in the Journal of Sex & Marital Therapy of the sources underpinning the statement. According to him, the cited studies do not support the conclusions, and the statement disregards research on children whose gender dysphoria resolves spontaneously, such as the 2013 study by Steensma. Critics also point out that the statement is not a systematic literature review. It is the position of a professional association, not an assessment of the evidence using a standardized method.

Reaffirmation in 2023

In August 2023, the AAP's board decided to reaffirm the 2018 statement while also commissioning a systematic review of the evidence. The association said that it continues to stand behind the existing recommendations. Critics consider this sequence noteworthy: the position was maintained while the research intended to support it had yet to be conducted.

Difference from Europe

The AAP's position contrasts with the direction taken by several European countries. Finland, Sweden, and England had the evidence systematically assessed and subsequently adopted a more cautious approach to puberty blockers and hormones for minors. How this unfolded in each country is explained under policy by country and in the article on the Cass Review.