Resisting the Post-Truth Era: Maintaining a Commitment to Science and Social Justice in Bioethics

A recent target article in the American Journal of Bioethics (AJOB) considered the right of transgender (trans) children to access pubertal suppression (Priest 2019). We were concerned by publication of one commentary (Laidlaw, Cretella, and Donovan 2019) coauthored by the executive director of the American College of Pediatricians, a well-recognized anti-LBGT (LBGT: lesbian, gay, bisexual, transgender) group (Southern Poverty Law Center n.d.). Dr. Cretella’s writing on gender-affirming health care has been strongly rejected by the executive committee of Society for Adolescent Health and Medicine (SAHM Executive Committee 2017), who in response to a recent publication (Cretella 2017) wrote: “Dr. Michelle Cretella ... penned a scathing attack on the transgender community thinly veiled as an argument against the dangers of transgender surgery and support; an argument based on medical omissions, circumstantial facts, hateful interpretation and peripheral context.” They went on to say that they do not “condone misinformation and hurtful, ideological opinion, [that is] not rooted in science or evidence-based medicine” (SAHM Executive Committee 2017). We concur. There is not space here to address all inaccuracies presented by Cretella and colleagues (Laidlaw, Cretella, and Donovan 2019). To justify our criticism, we highlight five. 1. “Watchful waiting with support for genderdysphoric children and adolescents up to the age of 16 years is the current standard of care worldwide, not gender affirmative therapy” (75). The authors cite de Vries and Cohen-Kettenis (2012), an article written before current standards of care were published (Coleman et al. 2012); the gender-affirmative model has since become the most prominent model of care in the United States and Canada (Ehrensaft 2016; Pyne 2014). The assertion that this source endorses watchful waiting until age 16 is false (de Vries and Cohen-Kettenis 2012). Lastly, version 8 of the WPATH Standards of Care (in process) in no way privileges the watchful waiting model as the accepted practice model. This is directly correlated with adoption of the gender-affirmative model in major gender clinics in the United States and beyond (Ehrensaft 2016). 2. “Continued suppression of the pituitary gonadal axis by [puberty blocking agents] will maintain a state of immaturity of the male and female gonads ... As a result, the patient will be infertile as an adult” (75) This misleading passage conveys the impression that pubertal suppression causes infertility. Pubertal suppression alone is fully reversible, with no direct implications for fertility. There is no clinical expectation that a person accessing pubertal suppression will later initiate hormone therapy and have gender-affirming surgery—interventions that have implications for future fertility—though some do. A minority of trans adults access genderaffirming surgery resulting in infertility (5.5%) (Kailas et al. 2017; Puckett et al. 2018). Furthermore, the data cited are culled from reports of cisgender, heterosexual individuals and couples confronting infertility, and should not be assumed to be representative of the experiences of transgender individuals or inclusive of medical innovations to preserve gonadal tissue and support future biological family creation for youth who have accessed pubertal