Over 700 Health Experts Criticize ‘Fundamentally Flawed’ APA Book on Gender Affirmation

The book calls scientific neutrality a ‘fallacy’ and is written by people with ‘lived experiences’ rather than those with academic titles.

Transgender demonstrators are seen during a protest against an event by British activist Kellie-Jay Keen-Minshull at the Tasmanian Parliament House lawns in Hobart, Australia on March 21, 2023. AAP Image/Ethan James

More than 700 medical experts and concerned citizens have signed an open letter slamming a recently published book by the American Psychiatric Association (APA) on “gender-affirming” care.

The Gender-Affirming Psychiatric Care (GAPC) textbook was published by the APA on Nov. 8 and is touted as “the first textbook dedicated to providing affirming, intersectional, and evidence-informed psychiatric care for transgender, non-binary, and/or gender-expansive (TNG) people.” However, “the book’s claims of being evidence-informed are untenable,” said the open letter published this month by the Foundation Against Intolerance and Racism (FAIR). Signatories include psychologist Jordan B. Peterson.

“GAPC omits any in-depth analysis of the evidence to date, dismisses ‘scientific neutrality’ as ‘a fallacy’ (p. xix), and chooses authors with the correct ‘lived experiences” and ‘community impact of prior work over academic titles’ (p. xx).”

GAPC “neglects” addressing the various risks of puberty blockers and cross-sex hormones while presenting “fundamentally flawed research” to support their version of gender care.

On page 52, authors claim that the use of puberty blockers for pubertal suppression “is a fully reversible intervention that allows young patients time to mature, explore their gender identity, and understand better the risks and benefits of” gender-affirming hormone therapy (GAHT).

The letter called this statement false. “It is astonishing to see such an outdated fallacy appear in this book, especially referring to a case presentation of a 10-year-old child.”

The signatories cited a September 2022 letter written by a group of medical experts to the ACCP journal’s editor stating that while more than 95 percent of youth who take puberty blockers go on to receive cross-sex hormones, 61–98 percent of youth who received psychological support ended up reconciling their gender identity with their biological sex.

“This contradicts both the reversibility and exploratory nature of puberty suppression claimed by GAPC,” the letter said.

Studies cited by GAPC authors “have been extensively critiqued.” Some of them downplay serious side effects, exaggerate efficacy and benefits, and are not based on randomized, controlled trials, the signatories stated. In some studies, only successful cases of medical transition are presented.

GAPC authors are also “disturbingly nonchalant about the high rate of co-occurring mental and behavioral health challenges seen in the context of gender dysphoria.”

“Autism, ADHD, eating disorders, anxiety, depression, suicidality, substance use disorders, and obsessive-compulsive disorder are all dramatically over-represented in gender dysphoric youth.”

The letter criticized GAPC for overlooking the risk that when an individual’s gender dysphoria is rapidly affirmed, it can end up consolidating the feeling and eventually lead to the person’s “regret post-treatment.”

Moreover, GAPC “wrongly dismisses” many widely accepted treatments of gender dysphoria as “conversion therapy.”

“Instead, GAPC proposes that patients struggling with gender-related distress be taken at their word that ‘gender’ is the source of the problems and rushed to treatments that may lead to irreversible sterility, anorgasmia, surgical complications, and life-long dependence on exogenous hormones and medical interventions.”

Such an “aggressive approach” dismisses the possibility that many of the children experiencing gender dysphoria may grow out of such feelings if they are not initiated into puberty blockers and cross-sex hormones, the letter noted.

“We seek an unbiased scientific investigation and discussion of the harms and benefits of all types of care offered to those with gender-related distress. We have grave concerns about the American Psychiatric Association’s GAPC textbook. Until those concerns are addressed and the textbook’s errors corrected, we call on the APA for its withdrawal.”

“Encouraging any physician, trainee, program or provider to view this book as ‘cutting-edge’ ‘best practices’ is unacceptable, unethical, and unsafe.”

‘Nonsensical Gibberish’

The GAPC textbook has come under intense criticism from several quarters for its promotion of transgender ideology. There are a total of 26 chapters in the book that are written by 56 individuals, 50 of whom are from the transgender community.

The book claims that the field of psychiatry was built on “the work [and assumptions] of European, white, cisgender men, including their colonial, Anglo-centric, cis-heteropatriarchal worldview and pathologization of experiences that did not fit their own ‘norm.’”

“For millennia, outside of European colonial influences, gender diversity has flourished to varying degrees among hundreds of indigenous communities around the world.”

It includes chapters using terms like “two-spirit people” and “double queer” individuals. Two-spirit is a term used to refer to a person who believes they belong to both sexes, while double queer is someone who identifies as a transgender but with a mental disability.

In an interview with The Epoch Times, Alan Hopewell, a prescribing neuropsychologist from Texas, called the GAPC textbook “disturbing” and “nonsensical gibberish which has no foundation whatsoever in science.”

Mr. Hopewell pointed out that hospitals can demand doctors to go by the best practices suggested by the book since the APA published it. The book can also be used to revoke the licenses of doctors who do not align with the ideology. “This reminds me of brain-damaged hippies free-associating at a commune,” he said.

While gender transition is increasingly being pushed as a solution to mental health problems facing individuals with gender dysphoria, some recent studies counter such claims.

A Finnish study found that mental health issues among people continue even after they medically transition. The need for psychiatric care was found to be greater both before and after transitioning compared to the control group.

A May 2023 study published in BMC Public Health looked at the life satisfaction levels of transgender people. It found that 44.1 percent of individuals in the study were “extremely dissatisfied,” “slightly dissatisfied,” or simply “dissatisfied.”

“In our study, the level of life satisfaction in transgender people was not increased in transgender who had undergone gender-affirming surgery as compared to those who were unoperated,” the study said.

“A possible explanation may be that gender-affirming surgery … only had a short-term effect on life satisfaction and bounces back to the initial set point of life satisfaction after some years.”

Darlene McCormick Sanchez contributed to this report.