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The American Academy of Pediatrics (AAP) reaffirmed its calling for minors to receive gender-affirming care and authorized a systematic literature review to give pediatricians more up-to-date advice.

"The board continuously reviews evidence and considers policy renewal on a regular schedule as authorizations expire," the AAP said in a statement Friday. "As a result of that continuing review and the confidence that remains in the existing evidence, this policy was renewed by the board."

The AAP typically reviews each policy for renewal every 5 years.

AAP CEO Mark Del Monte, JD, also noted that "the AAP will be producing two additional documents, a clinical report and a technical report, ensuring clinicians have the best possible evidence available to them as they implement AAP's policy guidance. This process will be supplemented by an external systematic review, which is designed to organize the research in a way that will assist the AAP to broaden and deepen our guidance with additional detail and documentation."

The additional recommendations, the AAP statement said, "also reflect the fact that the board is concerned about restrictions to accessing evidence-based healthcare for young people who need it. In fact, we are seeing unprecedented government intrusion with this care being banned in over 20 states. We therefore need to provide the best and most transparent process possible."

Kellan Baker, PhD, MPH, MA, executive director of the Whitman-Walker Institute in Washington, D.C., and a transgender health researcher at Johns Hopkins University in Baltimore, praised the actions of the 67,000-member group.

"The significance of this is that the AAP has reviewed its existing policy guidance on gender-affirming care and reaffirmed its policy because it continues to reflect best available evidence," Baker said in a phone interview. "It shows a strong degree of confidence in the evidence base."

Baker, who is transgender himself, said the fact that the academy is doing the evidence review after reaffirming the guidelines doesn't concern him. "This isn't just going back to 2018 and saying 'Sure, this looks fine,' but is based on the state of current knowledge and practice in the field, so it doesn't give me any pause at all," he said. "Pediatricians are very aware of the current status of evidence and practice."

"I'm very familiar with the evidence that has continued to come out over the last 5 years since the position statement was originally drafted," Baker added. "And all it does is continue to support the evidence outlined in the statement ... If anything, the evidence base now for gender-affirming care is even stronger."

But not everyone was happy with the AAP's decision. The fact that the organization is conducting its review after reaffirming its position, rather than the other way around, "is awful; things like that should not happen," said Quentin Van Meter, MD, past president of the American College of Pediatricians, a 700-member pediatrician organization that often disagrees with the AAP. "It's like building the airplane while you're flying it. It shouldn't happen in any area of science, let alone this."

Van Meter noted that an earlier effort within the AAP to petition the leadership to put the 2018 guideline on hold while the science was re-examined "was ignored by AAP leadership; they just pretended like it never happened ... AAP does what it wants and publishes what it wants. They have literally quashed dissent." Five AAP members proposed , which called for an update to the 2018 policy, at two different academy leadership meetings in 2022, but the resolution failed.

He suggested that the AAP membership be surveyed about their beliefs, and that the leadership convene a forum and have an open dialogue on the issue, noting that some countries -- including the U.K., France, and Sweden -- have pulled back on gender-affirming care for youths.

Most recently, the U.K. has to youth enrolled in clinical trials.

Baker had a different interpretation of what European countries were doing. "No European country has banned" gender-affirming care for minors, he stressed. "What they are talking about is a desire for more research."

Instead of banning this type of care, he added, "Europe is continuing to practice according to the same standards of care that used to hold sway in the U.S. -- before states started banning care -- a holistic course of care that incorporates a robust mental health component, where teams of clinicians are working very closely with patients, their parents, and mental health providers. That's the standard of care that these European countries are continuing to follow."

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