The aggressive promotion of gender ideology has coincided with a sharp rise in children identifying as transgender. As with the eugenics movement of a century ago, doctors are subjecting these young and vulnerable children to harmful drugs and irreversible surgeries that can leave them permanently sterilized.
Researchers attribute the new phenomenon of rapid-onset gender dysphoria largely to social contagion. In England, the number of girls identifying as transgender skyrocketed by 4,400 percent in a 10-year period. In Denmark, the number of children referred to the centralized gender service also exploded, climbing from 97 in 2016 to 352 in 2022, of whom 70 percent were female. Between 2017 and 2021, American youth receiving a diagnosis of gender dysphoria nearly tripled in just five years, according to one study.
The medical transition of children has become a highly profitable growth industry. In 15 years, the number of U.S. gender clinics has gone from zero to more than 100. Doctors have performed double mastectomies on girls as young as 13. Oregon and California are allowing doctors to perform both mastectomies and genital surgeries on 15-year-olds without parental consent. Doctors administer puberty blockers for “off-label” use at the first noticeable sign of puberty. Companies have little incentive to seek FDA approval for these drugs; one of the major pharmaceutical companies said it “has no plans to seek regulatory approval.”
But former patients who have survived pediatric medical transition—and regret it—are beginning to speak up. These individuals have become comfortable with their sex (as male or female) and are holding their doctors to account. Many of them have described how doctors rushed them toward medical transition, ignored comorbidities, and made explosive and unsupported claims about how it would make them less suicidal.
Minor Patients’ Inability to Be Informed
Detransitioners who underwent harmful hormonal and surgical interventions as minors have sued on the grounds that they were incapable of giving informed consent. In England, for example, doctors prescribed puberty blockers to Keira Bell at 16 and testosterone a year later. They performed a double mastectomy on her when she was only 20. Bell’s lawyers filed suit against the gender clinic on the grounds that, at 16, she could not understand the long-term consequences of puberty blockers and, therefore, could not give informed consent. Bell also suffered from depression and grew up in a home with alcoholism and mental illness. But instead of exploring her complex childhood and mental health issues, doctors proceeded immediately toward medical transition.
In California, Chloe Cole’s doctors prescribed her puberty blockers at 13, started her on testosterone one month later, and performed a double mastectomy of her healthy breasts when she was only 15. She also struggled with mental health issues and was the victim of sexual assault. But doctors did not recommend psychiatric exploration of her comorbidities and trauma before subjecting her to powerful drugs and irreversible surgery with lifelong consequences.
In North Carolina, doctors prescribed testosterone to Prisha Mosley and performed a double mastectomy when she was only 17. She had been sexually assaulted at age 14, became pregnant, and miscarried her child. In the same year, she began identifying as a male and also developed obsessive-compulsive disorder. She also suffered from borderline personality disorder, depression, anxiety, and anorexia. Despite her long history of mental health issues (which included cutting, suicidal ideation, and hospital stays), doctors encouraged her to reject her biological sex and undergo experimental hormonal and surgical protocols in an effort to appear more male. Mosley points out, “Liposuction is not a treatment for anorexia, but surgery is a treatment for gender dysphoria.”
Many states limit the ability of minors to consent to their own medical treatment. As psychiatrist Stephen B. Levine writes, there are times “when informed consent cannot inform the patient.” In addition to youth limiting their capacity, mental and emotional disabilities compromise their judgment. Informed “consent” cannot be given if a patient’s cognitive abilities are impaired by age or disability.
Clinicians bear responsibility for taking into consideration whether a young person is competent to comprehend the implications of medical interventions. Doctors told Mosley that she was “actually a boy,” and that she would develop male genitalia as a result of taking hormones. They encouraged her to believe that drugs and surgeries would cure her gender dysphoria. At the same time, however, counselors documented her mental and emotional decline. Mosley clearly could not comprehend the risks and irreversible harms of these interventions on her body. Her attorneys have filed a medical malpractice lawsuit against both the counselors and doctors who encouraged and performed the procedures.
Doctors’ Failure to Inform
In addition to their own inability to give informed consent, detransitioners and their parents claim that their doctors withheld critical information. To make an informed decision, a patient or their parents or guardians must be told all the risks and alternatives of medical transition. Cole’s lawsuit alleges that her doctors failed to disclose the risks of puberty blockers and cross-sex hormones and did not mention long-term, controlled follow-up studies of people who medically transitioned. Her lawsuit states that doctors told her parents she would be more likely to commit suicide if she didn’t undergo medical transition, even though she never had suicidal thoughts.
Doctors also failed to tell her that her gender dysphoria would likely resolve as an adult without hormones or surgery. Studies consistently show that the majority of pre-pubescent kids become comfortable with their bodies if doctors don’t subject them to social or medical transition. Even the Endocrine Society acknowledged in its 2017 guidelines that up to 85 percent of children who struggle with gender distress will later desist from identifying as transgender.
Mosley’s lawsuit says her doctors did not tell her about the permanent nature of surgical removal of her breasts and the inability to nurse children. They also did not offer alternatives to testosterone, which permanently changed her voice and caused chronic pain in her shoulders, neck, and impairment of sexual function.
Whistleblowers within the medical community confirm these experiences. They have participated in the medical transition of children as young as eight with hormone therapy, failed to obtain parents’ informed consent before doing so, and shown indifference to their patients’ adverse outcomes. Jamie Reed, a former case manager at the Washington University Transgender Center at St. Louis Children’s Hospital, says she was not allowed to schedule gender-dysphoric children for non-invasive psychological care. Instead, she was required to schedule them with doctors who would immediately start them on puberty blockers and cross-sex hormones. Reed says she saw “shocking injuries” to these children and that the public was “not told the truth.”
Isabelle Ayala, a 21-year-old female detransitioner, is now suing the American Academy of Pediatrics for having issued a 2018 policy statement on the necessity of providing “affirmative care” to youth who express distress about their sex. This lawsuit, which also names Ayala’s doctors, is among the first to take on the medical industry at the level of its professional organization and to address the systemic nature of the problem.
State Lawmakers Are Restricting Gender Transition Procedures
Today, in light of medicine’s failure to self-regulate, state lawmakers are acting to rein in the threat to children created by gender ideology. More than 20 states placed statutory limits on pediatric gender transition. One of those states, Florida, enacted a rule that makes the standard of care non-invasive counseling and psychotherapy. Like European public authorities, it conducted a systematic review of the evidence. It also concluded that hormonal and surgical interventions are “experimental” and could cause sterilization. The transgender movement is challenging Florida’s rule and a number of new laws in other states.
Courts have heard opposition to these restrictions from the medical establishment, the Biden Administration, and elite universities like Yale School of Medicine and Yale Law School. Many judges have deferred to the “experts,” relying on the eminence of the World Professional Association for Transgender Health (WPATH) and the medical establishment rather than weighing the evidence independently. One federal district judge in Tennessee called the WPATH and Endocrine Society guidelines “widely accepted.” These courts also cite the endorsements of the AMA, the AAP, and the APA as evidence that treating the mental disorder of gender dysphoria through hormones and surgeries is the “prevailing” standard of care. Such deference to the “experts” reflects the high stakes nature of these debates within the scientific community—and the high cost of suppressing internal debate.
However, the U.S. Court of Appeals for the 11th Circuit upheld Alabama’s legislation protecting minors from harmful and unnecessary medical procedures. In doing so, the court stated that “decisions applying the fundamental parental right in the context of medical decision-making do not establish that parents have a derivative fundamental right to obtain a particular medical treatment for their children as long as a critical mass of medical professionals approve.”
Americans have been blindsided by a new ideology, backed by a powerful network of political and financial interests, that has persuaded America’s medical elites to experiment on children. In testimony before Congress, Chloe Cole urged lawmakers to stop “one of the biggest medical scandals” in American history.
But the eminence of experts means nothing if their recommendations ultimately prove to be unscientific and harmful. Yet there are hopeful signs that the cloud of gender ideology is beginning to lift—even more quickly than the cloud of eugenics. The horrific cost of this ideology is becoming more visible. Courageous doctors, detransitioners, and whistleblowers are speaking up and bringing legal pressures to bear. More parents are asserting their rights and protecting their children from indoctrination. Lawmakers and courts are intervening. When they succeed, they will be remembered for bringing an end to one of history’s great injustices against the vulnerable.
Emilie Kao is senior counsel and vice president of advocacy strategy for Alliance Defending Freedom.
