The American Academy of Medical Ethics (AAME) affirms the historic understanding of humankind as consisting of two sexes, male and female. The AAME has concerns about recent usage of the term “gender” to emphasize an identity other than one’s biological sex, that is, a sense of self based on subjective feelings or desires of identifying more strongly with the opposite sex or with some combination of male and female.
The AAME affirms the obligation of healthcare professionals to care for patients struggling with gender identity with sensitivity and compassion. The AAME holds that attempts to alter gender surgically or hormonally for psychological indications, however, are medically inappropriate.
Accordingly, the AAME opposes medical assistance with gender transition on the following grounds.
Sex is an objective biological fact that is determined genetically at conception by the allocation of X and Y chromosomes to one’s genome, immutable throughout one’s lifetime, and not a social construct arbitrarily assigned at birth or changed at will.
The AAME recognizes that gender identity issues are complex, and inclination to identify with the opposite gender may have biological, familial, and social origins that are not of the making of particular individuals. In contrast to the current culture, the AAME believes that finding one’s identity within one’s biological sex will result in a healthier and fulfilled life. The AAME believes, moreover, that social movements which contend that gender is decided by choice are mistaken in defining gender, not by nature, but according to desire. Authentic personal identity consists in social gender expression that is congruent with one’s natural biological sex. The AAME is concerned that efforts to compel healthcare professionals to affirm transgender ideology, provide medical legitimization for transgender psychology, or cooperate with requests for medical or surgical sex reassignment threaten professional integrity.
Among individuals who identify as transgender, use cross-sex hormones, and undergo sex reassignment surgery, there is well-documented increased incidence of depression, anxiety, suicidal ideation, substance abuse and risky sexual behaviors. Patients’ gender altering and sexual encounter choices are among the factors relevant to these health disparities in transgender patients as compared to the general population. Hormones prescribed to a previously biologically health child for the purpose of blocking puberty inhibit normal growth and fertility. Continuation of cross-sex hormones, such as estrogen and testosterone, during adolescence is associated with increased health risks including, but not limited to, high blood pressure, blood clots, stroke, and some types of cancer.
Medicine rests on science and should not be held captive to desires or demands that contradict biological reality. Sex reassignment operations are physically harmful because they disregard normal human anatomy and function. Normal anatomy is not a disease; dissatisfaction with natural anatomical and genetic sexual makeup is not a condition that can be successfully remedied medically or surgically. The purpose of medicine is to heal the sick, not to collaborate with psychosocial disorders.