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Duke Health, UNC Health and ECU Health rebutted claims that the systems provide transition care to toddlers.
In statements, both ECU Health and UNC Health said that it is not an indication of gender dysphoria when children play with toys that are stereotypically associated with the opposite gender.
The standards of care for gender diverse youth that are accepted by many major medical organizations recommend social transition only for children who haven’t reached puberty.
The social media post features an eye-catching graphic that displays the logos of three health care systems prominently, just below a blue, pink and white banner reminiscent of the transgender pride flag.
"Ages for starting gender transitions," the banner read, claiming that transition-related medical care at Duke Health begins at age 2. At UNC Health and ECU Health, two other North Carolina-based health care systems, the graphic claimed transition-related medical care began at 3 and 4 years old, respectively.
"Three medical schools in North Carolina are diagnosing TODDLERS who play with stereotypically opposite gender toys as having GENDER DYSPHORIA and are beginning to transition them!!" read the caption on the May 7 Instagram post. "So if a 2 year old girl is playing with trucks and a 2 year old boy is playing with Barbie’s- they can begin transitioning to the opposite gender."
(Screenshot from Instagram.)
This post was flagged as part of Facebook’s efforts to combat false news and misinformation on its News Feed. (Read more about our partnership with Meta, which owns Facebook and Instagram.)
The post is inaccurate. In statements provided to PolitiFact, Duke Health, UNC Health and ECU Health denied claims that they were providing transition-related gender-affirming medical interventions to toddlers.
It appears that the Instagram claim, which we also found on Twitter, originated from a blog post on Education First Alliance, a website that says it helps conservative candidates "dedicated to the pro-American, pro-parent ideals of the education reform movement." We found no evidence to support its claims that the health systems were providing medication or surgical transition care to toddlers. Education First Alliance did not respond to PolitiFact’s request for comment.
Gender-affirming care is an individualized approach to health care that centers, encourages and supports a person’s gender identity. It is more than just transition-related medical treatments or surgery, according to the World Professional Association for Transgender Health’s standards of care.
Pediatric gender-affirming care might involve general family counseling, allowing children to wear whatever clothes they like or encouraging the use of the name and pronouns that align with the children’s gender identity.
ECU Health Public Relations Director Jason Lowry said the health care system does not offer puberty blockers and offers hormone therapy only after puberty, in limited cases, under guidelines that include extensive mental health evaluations and consent from parents or guardians. ECU Health doesn’t offer gender-affirming surgery to minors, he said.
"On its own, a child playing with a toy associated with the opposite gender would not be an indication of gender dysphoria," Lowry said. "Some common indications of gender dysphoria can include signs like distress, anxiety and depression and are usually seen in older children and adults."
Gender-affirming primary care includes mental health care services for that reason, he said.
In a statement, UNC Health said claims that it provides transition care to toddlers were false. It also said gender dysphoria has nothing to do with the toys toddlers choose.
At parents’ requests, supportive psychiatric services — such as treatment for depression — are provided to children as young as 7 years old, UNC Health said. Puberty blockers can be part of treatment near the onset of puberty and hormones can be used as treatment after puberty.
Duke Health told PolitiFact it has provided evidence-based gender care to adolescents and adults for years and said claims about toddlers beginning transition care were false. Patients, their families and their providers make age-appropriate care decisions that adhere to national and international guidelines, it said.
"Under these professional guidelines and in accordance with accepted medical standards, hormone therapies are explicitly not provided to children prior to puberty and gender-affirming surgeries are, except in exceedingly rare circumstances, only performed after age 18," read a statement provided by Duke Health media relations director Sarah Avery.
The World Professional Association for Transgender Health’s standards of care support these approaches. Prepubescent children, which would include toddlers, are ineligible for medical interventions, per the standards. This means any recommended transition care would focus on psychological and social support.
For children, the standards of care recommend that:
Parents, caregivers and health care providers support children who want to be acknowledged as the gender that matches their gender identity and support children continuing to explore their gender through prepubescent years, regardless of social transition;
Health care professionals discuss possible benefits and risks of social transition with families who are considering it;
Health care professionals provide information about potential gender-affirming medical interventions to gender diverse children and their families as the child approaches puberty. The standards mention discussing treatments’ effects on future fertility and options for fertility preservation.
None of the recommendations call for using puberty blockers, hormone therapies or gender-affirming transition surgeries on toddlers or prepubescent children.
An Instagram post claimed that three health care systems in North Carolina were diagnosing toddlers with gender dysphoria and starting to transition them for playing with stereotypically opposite-gender toys.
Duke Health, UNC Health and ECU Health said claims that they provide transition care to toddlers were false. Standards of care for gender diverse youth that are accepted by most major medical organizations recommend social transition only for children who haven’t reached puberty. Additionally, the toys children play with do not signal gender dysphoria.
We rate these claims False.
PolitiFact, Is all gender-affirming care for children ‘experimental’? Experts say no, Jan. 17, 2023
World Professional Association for Transgender Health, WPATH Standards of care for the health of transgender and gender diverse people version 8, Sept. 15, 2022
Education First Alliance, Transgender toddlers treated at Duke, UNC, and ECU, May 1, 2023
Tweet, May 4, 2023
The Carolina Journal, Duke Health emerges as Southern hub for youth gender transition, May 9, 2023
Charlotte Observer, What it means to be transgender: Answers to five key questions, May 9, 2016
Newsweek, Fury at gender transition for toddlers prompts denial from medical schools, May 5, 2023
American Civil Liberties Union, Hecox v Little - Adkins Declaration, April 27, 2020
Human Rights Campaign, Supporting and caring for transgender children, accessed May 9, 2023
UNC School of Medicine, UNC Psychiatry Gender Equity and Wellness Initiative, archived April 17, 2023
Emailed statement from Jason Lowry, director of public relations for ECU Health, May 8, 2023
Statement provided by Duke Health media relations director Sarah Avery, May 8, 2023
Statement from UNC Health, May 8, 2023
YouTube, Gender-affirming care in NC - media briefing, Feb. 8, 2023
UNC School of Medicine Psychiatry, UNC Psychiatry Gender Equity and Wellness Initiative, archived Sept. 21, 2022
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