In a world full of changing societal norms, industries and sciences are constantly evolving. The medical field is not immune to this. One consistent ideal every doctor abides by is “Do no harm.” But what happens when “harm” could be considered subjective?

The American Academy of Pediatrics released a policy statement on Sept. 17 regarding the care of LGBTQ children, called “Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents”. Gender-diverse is a term describing all the different gender labels that are used today, and care for these types of children may entail practices that could be considered harmful.

“Gender affirming care should not change anything in the doctor’s office but rather provide more positive interactions for children, adolescents and young adults with the health care system,” Chair for the Committee on Adolescence for the AAP Dr. Cora Breuner said.

Transgender children face many difficulties, and often lack the mental health resources to cope with gender dysphoria, the powerful sense of disconnection from one’s assigned sex. Some people believe that gender dysphoria should be treated as a mental illness and that doctors and parents should not encourage transgender children to identify as such. But the AAP’s statement was created in hopes of easing this stress and ensuring sufficient resources for these youth, doctors said.

“I think [the statement] will normalize things for students who are or have experienced this. If we attach the stigma of a mental health condition to gender dysphoria, it would seem to be piling on to the mountain of social and emotional problems students may already be facing,” LT’s PRISM club founder Vikki Reid said.

A controversial practice in the medical care of LGBTQ children is pubertal suppression. Pubertal suppression is the introduction of hormone-blockers, essentially “pausing” puberty, according to the Lurie Children’s Hospital of Chicago. Some doctors think this is dangerous, along with gender reassignment surgery. This includes a group of about 500 physicians who have separated from the AAP in favor of practicing medicine that more closely adheres to their socially conservative views, called the American College of Pediatrics, or ACPeds.

“We have all taken an oath to ‘First do no harm,’” Executive Director of ACPeds, Michelle Cretella, MD, and President Quentin Van Meter, MD, said in reaction to such practices. “There are many physicians and mental health professionals who know that so-called transgender pediatrics is dangerous propaganda that will permanently scar countless children both physically and mentally. We must not comply.”

Since surgical treatments and hormone blocking can lead to irreversible results in children who are still forming their identities, some professionals believe that the statement is premature and more research should be undertaken before doctors obey it, ACPeds doctors said.

“There is no rigorous science to demonstrate that transgender belief is any different from other disordered beliefs such as anorexia nervosa,” Cretella and Van Meter said. “There is no rigorous science to prove anyone is born destined to become anorexic and there is no rigorous science to prove anyone is born destined to be trans-identified.

Despite such opposing views, the AAP stands by its statement.

“In general, we have received outstanding, excellent responses and support,” Breuner said.

How a doctor must decide what to do when a young female patient says “I’m a boy” is guided by these organizations. Pediatricians must make the right choice: the stakes are high.