A growing number of doctors, patients, and whistleblowers are beginning to question the medical establishment’s recommendations for children with gender dysphoria.

This week, the American Academy of Pediatrics (AAP) is holding its annual leadership conference at its headquarters in Itasca, Illinois. One issue that won’t be on the formal agenda but will be on the minds of many members is how to treat gender dysphoria in children. AAP, along with most of America’s medical establishment, endorses the approach of the World Professional Association of Transgender Health (WPATH). This transgender advocacy group recommends that doctors irreversibly alter a child’s physical appearance to appear as a different gender through hormones and surgeries. But two transgender-identifying doctors in WPATH caution that teenage patients are receiving “sloppy care.” And there is dissent in AAP’s own ranks as to the legitimacy of this practice. As many countries around the world turn to safer, non-invasive “watchful waiting” and psychotherapy to treat gender-confused kids instead of defaulting to hormones and surgeries, America is rapidly becoming an outlier.

Gender dysphoria is a mental disorder that creates incongruence between one’s internal sense of gender and the reality of the sexed body. But unlike with anorexia, AAP’s recommended treatment does not focus on resolving the mind-body incongruence through counseling. Instead, doctors at “gender clinics” try to make a person’s body resemble their self-perception, disordered though it may be.

This isn’t the first time this has happened. Back in the twentieth century, another radical ideology captured the scientific and medical establishment. Eugenicists persuaded doctors to sterilize 70,000 Americans, who were disproportionately women and minorities. Medical schools taught eugenics. Wealthy tycoons funded the practice. And three presidents (Theodore Roosevelt, Franklin Delano Roosevelt, and Woodrow Wilson) lent their political support. The support for eugenics also existed on a systemic level: The American Neurological Association endorsed forced sterilization of people with schizophrenia, manic depression, epilepsy, and Down syndrome, and the American Medical Association relied on the research of a wealthy eugenics advocate for its contraceptive testing. Eventually, the premise of eugenics, genetic inheritance, was debunked and discredited by scientific evidence. But for three decades, doctors participated in one of the greatest ethical scandals of the last century.

But, in a tragic echo of this dark moment from America’s past, some U.S. courts are now greenlighting a course of irreversible treatment for confused, vulnerable youth that would potentially render them sterile, often with a raft of lifelong medical complications and mental health challenges. Fortunately, a contingent of courageous doctors is working to stop history from repeating itself. These doctors have repeatedly tried to introduce resolutions in the AAP calling for systematic evidence reviews, the gold standard in medicine. AAP leadership has ignored them even though one resolution questioning support for gender transition garnered 80% support from those who voted.

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