Physicians and Healthcare Professionals in Support of Georgia's Vulnerable Child Protection Act

Physicians and Healthcare Professionals Petition Supporting the Vulnerable Child Protection Act

We the undersigned physicians and mental health practitioners strongly support Georgia’s Vulnerable Child Protection Act (VCPA). Because the interventions prohibited by VCPA are physically harmful to minors and actually mask underlying psychological pathologies that must be resolved to achieve the best patient outcomes, their use on minors should be prohibited.   

1. VCPA would appropriately prohibit administering GnRH agonists to suppress normal puberty (“puberty blockers”). Such use is not approved by the FDA and can arrest bone growth, decrease bone density, prevent the sex-dependent development of the adolescent brain, and impede psychosocial development.[i] Other long-term consequences are as yet unknown.   
2. Suppression of normal puberty is not reversible.[ii] The drugs create a disease state which freezes the child’s physical/psychosocial development and disrupts the delicate synchronization of multiple systems that naturally develop during puberty – musculoskeletal, endocrine, neuropsychiatric, reproductive. Further, a child who is given puberty blockers almost always pursues the irreversible path of cross-sex hormones and perhaps surgery.[iii]   
3. VCPA would appropriately prohibit administering to minors high doses of cross-sex hormones, which can result in an increased risk of heart attack and death, increased risk of thromboembolism (deadly blood clots), infertility, loss of bone density with future risk of osteoporosis and fractures, sexual dysfunction, abnormal brain development, and development or worsening of psychiatric illness.[iv]   
4. A child who is administered puberty blockers followed by cross-sex hormones will become permanently sterile.[v]   
5. VCPA would appropriately prohibit performing on minors genital surgeries and mastectomies, the risks of which include chronic pain, scarring, infection, problems with wound healing, abdominal adhesions, bowel strictures, and obstructions, bladder injury, urinary strictures and fistulas, chronic and lifelong maintenance, [vi] and death.    
6. These genital surgeries sterilize the child and create permanent sexual dysfunction.   
7. The interventions prohibited by VCPA have not been shown to decrease suicidal ideation in this patient population and may even increase psychological distress.[vii] A truly suicidal child needs intense psychiatric treatment by competent professionals, not cosmetic procedures that mask the underlying issues.   
8. Endorsement of these horrific practices from certain medical societies and advocacy groups is motivated by political and financial considerations, not patient welfare.

The ancient foundation of medical practice begins with this: “First, do no harm.” As physicians, we are disturbed that so many practitioners, in apparent pursuit of political, financial, or other agendas, have jettisoned their vows and their principles. We urge the Georgia legislature to protect innocent children and families from these schemes by enacting VCPA.

[1] Giovanardi, Guido. (2017). Buying time or arresting development? The dilemma of administering hormone blockers in trans children and adolescents. Porto Biomedical Journal. 10.1016/j.pbj.2017.06.001; Laidlaw MK, Van Meter QL, Hruz PW, Van Mol A, Malone WJ. "Letter to the Editor: 'Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline'".  J Clin Endocrinol Metab, March 2019, 104(3):686–687.  doi: 10.1210/jc.2018-01925; Paul W. Hruz, Lawrence S. Meyer, & Paul R. McHugh, Growing Pains: Problems with Puberty Suppression in Treating Gender Dysphoria, The New Atlantis (2017), https://www.thenewatlantis.com/docLib/20170619_TNA52HruzMayerMcHugh.pdf. [1] Michael K. Laidlaw, “The Pediatric Endocrine Society’s Statement on Puberty Blockers Isn’t Just Deceptive. It’s Dangerous,” Public Discourse (Jan. 13, 2020), https://www.thepublicdiscourse.com/2020/01/59422/ [1] A.L. de Vries et al., Pubertal Suppression in Adolescents with Gender Identity Disorder: A Prospective Follow-up Study, National Institutes of Health (Aug. 2011), https://www.ncbi.nlm.nih.gov/pubmed/20646177. [1] De Vries ALC, Steensma TD, Doreleijers TAH, Cohen-Kettenis, PT. Puberty suppression in adolescents with gender identity disorder: a prospective follow-up study. J Sex Med. 2011;8:2276-2283; Haiyan Zhu, Xuejie Zhu, Lihong Zheng, Xiaoli Hu, LuZhe Sun, and Xueqiong Zhu1. "The role of the androgen receptor in ovarian cancer carcinogenesis and its clinical implications." Oncotarget. 2017 Apr 25; 8(17): 29395–29405.  doi: 10.18632/oncotarget.12561; Dizon DS, Tejada-Berges T, Koelliker S, Steinhoff M, Granai CO. "Ovarian cancer associated with testosterone supplementation in a female-to-male transsexual patient." Gynecol Obstet Invest. 2006;62(4):226-8. Epub 2006 Jun 23; Centers for Medicare & Medicaid Services, August 30, 2016, Decision Memo for Gender Dysphoria and Gender Reassignment Surgery (CAG-00446N), https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=282; https://blogs.bmj.com/bmjebmspotlight/2019/02/25/gender-affirming-hormone-in-children-and-adolescents-evidence-review/.   [1] Priyanka Boghani, “When Transgender Kids Transition, Medical Risks Are Both Known and Unknown,” PBS Frontline (June 6, 2015), https://www.pbs.org/wgbh/frontline/article/when-transgender-kids-transition-medical-risks-are-both-known-and-unknown/. [1] “Gender Affirming Surgeries and Complications,” Emergency Medicine Residents Association, https://www.emra.org/books/transgender-care-guide/surgeries-and-complications/; “Feminizing Surgery,” Mayo Clinic, https://www.mayoclinic.org/tests-procedures/feminizing-surgery/about/pac-20385102. [1] Dhejne C, Lichtenstein P, Boman M, Johansson ALV, Långström N, Landén M (2011) Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden. PLoS ONE 6(2): e16885. https://doi.org/10.1371/journal.pone.0016885