‘Appalling’: Unearthed Documents Reveal How Hospital Pushes Medical Transitions on Children

By Published on April 28, 2023

Seattle Children’s Hospital encourages medical professionals to offer swift biomedical interventions as the default treatment for young patients with gender identity issues, even when parents are skeptical, and largely avoids recommending mental health services to gender dysphoric youth, according to documents published by the hospital.

The hospital, which recently attracted criticism for advertising transgender surgical procedures for minors, published several guides to instruct medical professionals on their treatment decisions regarding “gender affirming medical care” for youth. The guides promote puberty blockers and menstrual suppression drugs for young patients, do not list mental health screenings as a necessary step before medications are administered and instead indicate that mental health treatments are optional and must be sought externally.

“The most damning aspect of these documents is the repeated assertion that the gender clinic does not provide mental health services,” Dr. Stanley Goldfarb, former associate dean for curriculum at the University of Pennsylvania School of Medicine and current chair of Do No Harm, told the Daily Caller News Foundation. “The notion that these children, who are often depressed, anxious, and even autistic, are not provided with those services in a way that is closely linked with the activities of the gender clinic is appalling.”

Children with autism are vastly overrepresented in the population of transgender-identified youth, and mental health problems including anxiety and depression are common among this demographic.

A Seattle Children’s Hospital guide titled “Algorithm: Gender Affirming Medical Care for Youth” listed interest in cross-sex treatments as the sole necessary qualification for patients getting puberty blockers and cross-sex hormones. It lists various pathways to biomedical interventions while mentioning mental health treatment as an “additional resource” only in the context of patients who are not interested in blockers, hormones or surgeries.

Parental Consent?

If the patient is interested in cross-sex treatments but the parents are unsure, practitioners should follow the “yes” path, meaning they should make puberty blockers available, refer the child to a gender clinic and provide advice on binding and tucking, according to the document. A spokesperson for the hospital told the Daily Caller News Foundation that parental consent is required for “gender-affirming medical care” for minors and did not respond to a follow-up about the discrepancy between this claim and the guidance.

“Screen for depression, anxiety, and suicidality, and refer to a mental health therapist if there are any concerns, or for continued gender exploration. Please note: Gender Clinic does not provide long-term mental health therapy,” the guide says under a section for patients who aren’t interested in transgender medical procedures.

“These algorithms are designed to save clinic time, so that only patients that are eager for so-called gender affirming care will appear at the clinic. They represent pathways for primary care physicians to begin patients down this pathway, no place in this set of algorithms is there room for care for mental health assessment of the patient,” Goldfarb said.

Children who are interested in cross-sex treatments but have not yet started puberty should undergo a physical exam every six months to monitor for signs of puberty, and in the meantime should receive guidance on chest-binding and “tucking,” according to the guide. Blockers become an option in early puberty, and patients aged 13.5 and older can be referred to gender clinics if they’re interested in taking cross-sex hormones.

Blocking Menstruation

Similarly, a November 2021 guide from the hospital titled “Algorithm: Menstrual Suppression for Gender Diverse Youth” only mentions mental health services in the context of patients who aren’t interested in menstrual suppression, in which case it tells medical workers to “consider referral to a mental health therapist if there are any concerns for depression or anxiety, or for continued gender exploration.” The majority of the guide is about when and how to block a patient’s menstruation.

“If the patient is distressed by menses, discuss options for menstrual suppression. Menstrual suppression can help alleviate dysphoria for many patients,” it says. The only qualification the document lists for menstrual suppression is that the patient is interested in pursuing it.

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Cross-sex procedures come with a wide range of negative side effects, according to the hospital’s protocols for “gender affirming” hormones, which were last updated in February. Puberty blockers can cause menopausal symptoms, decreased bone density, limited growth including height and, when followed by cross-sex hormones, limited fertility, according to the protocols.

Puberty lockers also limit a patients’ options should they eventually decide to undergo cross-sex surgeries, according to the protocols; male patients who have their natural puberty blocked may be unable to have penile-inversion vaginoplasty, and may instead have to use intestinal tissue to construct a neovagina. Meanwhile, cross-sex hormones can cause thromboembolic disease, stroke, breast cancer and fertility problems, according to the same document.

Treating Teens With Surgery

Seattle Children’s Hospital previously came under fire in September after online activists drew attention to their “Surgical Gender Affirmation Program,” which “treats teens and young adults” through “complex procedures, including face and neck surgery, top surgery (breast/chest), bottom surgery (genitals) and body contouring,” according to its website. The program boasts about its programs offering “gender-affirming surgery for young people, as well as adults;” the hospital offers a wide range of cross-sex surgeries, though it has said it does not offer genital surgeries to minors.

The hospital also conspired with University of Washington (UW) to cover their tracks in the summer of 2022 after falsely claiming their study had found that puberty blockers and cross-sex hormones improved mental health for transgender youths. Researchers had claimed their study found hormonal treatments were linked to improved mental health for trans youth, but those in the study who took puberty blockers and hormones saw no significant difference in depression and suicide risk.

Staff acknowledged internally that their initial press release was inaccurate, but spokespeople from both institutions agreed not to correct inaccurate news articles based on it and to ignore questions from outlets they characterized as conservative, including the Daily Caller News Foundation, internal emails revealed.

“Gender-affirming care is provided in line with the evidence-based standard of care guidelines for adolescents published by the WPATH and the Endocrine Society,” a Seattle Children’s spokesperson told the DCNF. “For patients under age 18, gender-affirming medical care requires consent from any parent or guardian that has medical decision-making rights for that patient.”


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