The Gender and Sexuality Development Program at the Children\u2019s Hospital of Philadelphia (CHOP) offers drastic medical interventions as part of the gender transition process to children as young as eight, according to statements and documents reviewed by the Daily Caller News Foundation.
CHOP\u2019s youth gender clinic, one of the first in the U.S., is a major trans medical provider in Pennsylvania and has strong ties to Rachel Levine, a former trans activist who currently serves as the U.S. assistant secretary for health. The clinic recently came under fire for holding seminars where teachers were instructed to hide students\u2019 trans identities from their parents. Clinic employees also promoted cross-sex procedures for children while downplaying the risks, documents and statements reveal.
The clinic has referred children as young as 14 for \u201ctop surgery,\u201d a euphemism for mastectomies or breast construction, though most referrals are for patients aged 16-18, Dowshen told lawmakers at a Pennsylvania House of Representatives Health Committee hearing in 2020. (RELATED: \u2018We Were Wrong\u2019: Pioneer In Child Gender Dysphoria Treatment Says Trans Medical Industry Is Harming Kids)
The clinic\u2019s co-founders, Dr. Linda Hawkins and Dr. Nadia Dowshen, advocated for \u201ctop surgery\u201d for minors in a 2021 paper published in Pediatrics, the medical journal of the American Academy of Pediatrics.
\u201cWe observed consensus that chest dysphoria is a major source of distress and can be functionally disabling to transmasculine youth. MCS performed during adolescence, including before age 18, can alleviate suffering and improve functioning,\u201d they wrote in their paper.
The clinic worked to secure surgical referrals for minors and even employed a social worker who served as a \u201csurgery advocate,\u201d collecting letters of support on behalf of gender dysphoric minors in order to persuade insurance companies to cover their surgeries, according to a 2021 report from CHOP. A staffer had previously pushed for such a position to be funded with the help of then-acting secretary of health for the state, Rachel Levine, and argued that the position would yield a high return on investment.
\u201cI think it\u2019s really important to remember that age is a number,\u201d she said at the hearing. \u201cBut as an adolescent medicine and developmental specialist, we know that where a child is cognitively and socially is more important than that exact number of their age.\u201d
CHOP professionals laid out the gender clinic\u2019s guidelines for sex change procedures in a webinar on the clinic\u2019s standards of care, which the hospital created in partnership with the Pennsylvania Department of Human Services and the DCNF obtained through a public records request.
The clinic advised \u201caffirmation\u201d of a child\u2019s gender identity and social transition to the opposite sex for kids under the age of eight, who are too young for medical interventions under the clinic\u2019s guidelines.
For medical interventions, patients must experience long-lasting gender nonconformity, which emerged or worsened at the onset of puberty, and have any coexisting medical, social and psychological issues addressed prior to the onset of medical treatment, according to the webinar.
Dr. Zachary McClain, webinar host and former adolescent specialty provider at CHOP, claimed there was \u201cno regret\u201d among patients who undergo cross-sex hormones during his webinar lecture.
\u201cWhat are the long-term outcomes after starting hormone replacement therapy?\u201d he said. \u201cThese are all really great. No regret to transition. Despite some of the lay press that\u2019s out there, the medical literature does not support that at all.\u201d He also claimed hormones resulted in \u201csignificant or complete resolution of gender dysphoria.\u201d
It\u2019s impossible to gather long-term data on regret rates for individuals who underwent hormones and other procedures in recent years amid the massive surge in transgender identification and the explosive growth of transgender clinics, since most of those patients are only a few years into their medical journeys. But numerous detransitioners have come forward to express regret over undergoing cross-sex procedures in their youth, including hormones.
The clinic prescribes puberty blockers after the onset of puberty, which the webinar says can occur in children as young as eight. Dowshen also stated that children were placed on blockers as young as age eight or nine in her testimony to state lawmakers.
\u201cFor kids who are going through puberty at normal ages, that could start as early as 8 or 9 \u2026 we\u2019re making a decision to start the blocker based on when that child hits puberty,\u201d she said. \u201cWe have a series of tests that we do, as well as the main thing being our physical exam to understand when a child is starting to have, for example, testicular development or breast development to clue us in to when they\u2019re starting puberty. And we would start the puberty-blocking medications at that time.\u201d
\u201cWe look to a few organizations to guide us in medical care for the youth,\u201d McClain said in the webinar, explaining that CHOP\u2019s guidelines follow standards of care developed by the World Professional Association for Transgender Health (WPATH), the Endocrine Society and the UCSF Center for Transgender Excellence. \u201cThere are currently no medical interventions recommended prior to the onset of puberty. That brings us to our second block, which is pubertal or eight to 14 years old. And the eligibility \u2026 to start [pubertal] suppression is they must have been diagnosed with gender dysphoria and have started puberty.\u201d
The use of puberty blockers as part of the gender exploration process is an off-label use of a prescription drug developed to delay premature puberty in young children; it\u2019s been linked to serious health problems, and some experts have argued that blockers can cement a transgender phase that most children would otherwise outgrow.
\u201cThe benefits are that it can delay irreversible secondary sex characteristics,\u201d Dowshen told an audience during a 2018 lecture at a women\u2019s health seminar series hosted by the National Institutes of Health (NIH). \u201cThe other benefits of the blockers are that they are fully reversible, and this allows some time for the young person to mature and be ready to make decisions that may be more irreversible.\u201d
The irreversibility of puberty blockers has been called into question by numerous experts, including 31 psychologists, neuroscientists and hormone experts who urged further study on the drugs in a 2020 paper that concluded \u201cthe full consequences (both beneficial and adverse) of suppressing endogenous puberty are not yet understood.\u201d
\u201cIf the brain is expecting to receive those hormones at a certain time and doesn\u2019t, what happens?\u201d Dr. Sheri Berenbaum, head of a gender research lab at Penn State and one of the authors of the paper, told The New York Times. \u201cWe don\u2019t know.\u201d
Puberty blockers cost up to $49,000 for an 18-month implant, and insurance covers it about 72% of the time, according to the webinar. McClain acknowledged that the drug is not FDA-approved for use in kids with gender dysphoria and that it is not associated with a decrease in gender dysphoria \u2014 the sense of deep discomfort with one\u2019s body that drives some individuals to transition to the opposite sex. (RELATED: \u2018Horrifying\u2019: Huge Proportion Of Children Pursuing Gender Transitions Are Actually Autistic, Experts Believe)
The CHOP webinar recommended the administration of cross-sex hormones and \u201cgender affirming surgeries\u201d in the post-pubertal phase of development, which it defines as occurring at age 14 and up. For natal females, taking testosterone is tied to clitoral enlargement, severe acne, insulin resistance and an increased risk of heart disease and cancer, while for natal males, estrogen causes lower libido and increased risk of blood clots, according to the CHOP webinar; both can cause infertility and emotional changes.
Dowshen acknowledged the fertility risks associated with these drugs to the Pennsylvania House of Representatives Health Committee in 2020, but downplayed concerns about patients being unable to start families after undergoing cross-sex procedures as children.
\u201cQuestions about fertility, these are important ones that we discuss with patients and families early on and often,\u201d she said. \u201cWhat\u2019s interesting is that the field of assisted reproductive technology is rapidly evolving and our understanding of the impacts of these medications on biological fertility are also evolving.\u201d
\u201cI also want to take a step back for a second to say that \u2026 there are other ways to build families beyond having a child biologically. Folks can adopt as well, and many transgender children and adolescents are interested in having biological children and many are not interested in having children at all or are interested in adopting,\u201d she said.
Dowshen, Hawkins, McClain and the CHOP gender clinic did not respond to the DCNF\u2019s requests for comment.<\/p>\n\n\n\n