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EXCLUSIVE: ‘Age is just a number’: Doctor at gender clinic in Philadelphia defends providing breast surgery to children as young as FOURTEEN

  • Dr Nadia Dowshen, from the hospital, said a child’s views were more important
  • She also said they offered surgery to children as young as 14 years old
  • Critics told DailyMail.com it was ’empty-headed’ to treat children like adults
  • They said she was ‘ignoring everything we know about human development’ 

A top doctor at a gender clinic in Philadelphia has come under fire for claiming age is just ‘a number’ — in defense of performing sex change surgery on minors.

In a video from 2020, Dr Nadia Dowshen, co-director of the Gender and Sexuality Development Clinic, suggested a child’s maturity was ‘more important’ than exact age.

She admitted doctors at the Children’s Hospital of Philadelphia performed ‘top surgery’ on patients as young as 14, methotrexate intrathecal dilution which involves removing or implanting breasts.

Dr Dowshen made the comments in September 2020 at a medical board review by the Pennsylvania House of Representatives, which was hearing evidence about trans care for minors.

But the clip re-surfaced on social media this week as the debate around age limits for gender-affirming care heats up heading into the mid-term elections.

Asked about whether there were age limits in place for sex change surgeries, Dr Dowshen said: ‘It is important to remember that age is a number.

‘But as an adolescent medicine and developmental specialist, we know that where a child is cognitively and socially is more important than that exact number of their age.’

Critics told DailyMail.com the comments were ‘absurd’ and ‘ignored everything we know about human development’. 

Dr Dowshen was also asked about the potentially life-altering effects of hormone drugs given to transgender minors, which can cause infertility.

She said that many youngsters with gender dysphoria ‘are not interested in having children at all’.

Dr Nadia Dowshen, co-director of the Gender and Sexuality Development Clinic, said age was just a number when she was interviewed about transgender care at the Children’s Hospital of Philadelphia in 2020. The clip has resurfaced online in recent weeks

The Children’s Hospital of Philadelphia (pictured) offers top surgery to minors — which is where breasts are either implanted or removed

The number of chest reconstruction surgeries among children in the US jumped five-fold from 2016 to 2019 from 100 to 489 annually, figures show

This map shows the proportion of children aged between 13 and 17 years old that identified as transgender by state. The darker colors indicate a higher proportion of youngsters. In New York and New Mexico, it is as high as three per cent

Candice Jackson, a former Trump administration staffer, said: ‘Saying “age is just a number” with respect to children is a way of adultifying kids and ignoring everything we know about healthy human physical, mental and emotional development to justify experimenting on vulnerable youth.’

Ms Jackson, who was deputy assistant secretary at the Office for Civil rights between 2017 and 2018, added: ‘It is irresponsible at best and destructive at worst to whitewash the harm done to minors by funneling them into irreversible, unnecessary, life-altering surgeries.’

She said the comments were another example of how surgeries are being performed ‘before their [children’s] minds and bodies have even had a chance to grow.’

The number of children with gender dysphoria has exploded in recent years, giving rise to the use of powerful puberty-blocking drugs.

About 300,000 children aged between 13 and 17 (1.4 per cent) in the US identify as transgender, according to most recent estimates from 2020.

That is double the number estimated to be transgender in 2017 in a previous report by the same researchers, though they used different estimates. 

Connecticut and New York saw the numbers of children identifying as transgender in their states nearly quadruple over the last three years alone. The population only fell in West Virginia, Tennessee and New Jersey.

Children aged 13 to 17 are over four times more likely to identify as transgender (1.4 per cent) than adults over 65 (0.3 per cent).

Some say the rise is born out of increased awareness of gender dysphoria — that is, emotional distress due to a disconnect between gender identity and biological sex — and a rise in acceptance in society.

However, many believe that the impressionable minds of children are easily swayed by ‘trends’ and ‘phases’ among peers and that children are not ready to make irreversible decisions about their gender.

While no official, national estimates exist, many more children receiving gender-affirming care at an increasingly younger age. Treatment often involves powerful and life-altering drugs that block puberty and the release of key developmental hormones. 

So far, four states — Alabama, Arkansas, Texas, and Arizona — have brought in bans to restrict access to gender-affirming care including hormonal treatment and surgery. Oklahoma signaled its intent to follow suit Tuesday after threatening to cut a hospital’s funding if it prescribes puberty blockers or hormone therapy.

Patrick Brown, a fellow at the right-leaning Conservative Ethics and Public Policy Center, told DailyMail.com: ‘You’ve seen a couple of people claim you can be whatever age you want, age is just a number.

‘It is hard to put into words how ridiculous that is.’

He added: ‘We have legal standards around how people mature — we treat children differently to adults.

‘So, the idea that a 14 or 15-year-old would be given the same legal rights and protections as an adult is just contradictory to a whole suite of law.

‘It is almost absurd to have to deal with that kind of empty-headed claim.’

The Children’s Hospital of Philadelphia treats people at its gender clinic up to the age of 21 years old. 

There is no lower age limit, but Dr Dowshen said at the house medical board hearing surgeries are mostly done for patients ‘over the age of 16’.

She said the youngest patients given ‘top surgery’ at the clinic at the time were 14. 

But bottom surgery, which involves removing and implanting genitals, is only performed after the patient turns 18, she said.

The Philadelphia clinic is one of at least 200 clinics that offer transgender care across the US.

Child patients with gender dysphoria can be prescribed puberty blockers — which stop the natural sexual maturation of a teenager — and hormone therapy — which involves taking opposing sex hormones to become more masculine or feminine.

Surgery is supposed to be the last resort option. Federally, there is no age limit on when these procedures can be performed.

But there is an ongoing political row about whether this should change.

Arizona has placed an under-18 age cap on surgeries in place already, while Alabama, Arkansas and Texas have attempted to enact similar rules but have been held up by the courts.

Last week, Florida banned puberty blockers, hormone therapies and surgeries for trans minors.

It comes after a report last week found sex change surgeries performed on minors had surged five-fold in just three years.

At the same time, a growing number of ‘detransitioners’ who regret making the switch are coming forward.

Critics argue many children who don’t clinically have gender dysphoria are being swept up in the wave of cultural acceptance.

DailyMail.com has approached Children’s Hospital of Philadelphia for a statement.

The hospital had to beef-up security in recent weeks after threats from right-wing extremists were targeted at its transgender clinic.

The US Department of Justice is being urged to investigate the threats of violence against this hospital and other’s that provide the care.


Candice Jackson, a former Trump administration staffer, said: ‘Saying “age is just a number” with respect to children is a way of adultifying kids’. Patrick Brown, a fellow at the right-leaning Conservative Ethics and Public Policy Center, told DailyMail.com that claims children should be treated the same way as adults were ‘ridiculous’

Researchers from the University of California, Los Angeles’ Williams Institute estimate that more than one in a hundred 13- to 17-year-olds now identify as transgender across the US.

Among 18- to 24-year-olds the rate drops to one in 200 individuals.

In the UK, meanwhile, referrals for girls to be treated for gender dysphoria, or the distress that arises from a perceived mismatch between the gender someone identifies with vs the gender they were born into, have shot up more than 4,000 per cent over the past decade.

It comes after a Harvard University-affiliated children’s hospital sparked outrage last month after claiming some babies know they are transgender ‘from the womb’.

In a now-deleted video, the Boston Children’s Hospital suggested an even larger number of minors know ‘as soon as they can talk’.

The claim was quickly slammed by critics as being not based in science, who also suggested medics are unwilling to question children who are vulnerable.

The hospital also faces claims it rushed under-18s into life-altering sex change surgery.

In the clip posted to the Boston hospital’s official YouTube page in August, psychologist Dr Kerry McGregor explaisn the type of patients she sees.

She says: ‘So most of the patients we have in the clinic actually know their gender, usually around the age of puberty.

‘But a good portion of children do know as early as — seemingly — from the womb.

‘And they will usually express their gender identity as very young children, some as soon as they can talk… kids know very, very early.’

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