Pain, confusion and compassion: How the US has reached a trans ‘tipping point’

The past three years have been painful for transgender-identified young people. 

Republicans have blanketed the nation with bans on gender-transition treatments for minors, often pairing them with restrictions on trans bathroom access and sports participation.

The latter has become of national interest as athletes like Lia Thomas and Riley Gaines battle for each side in public.

These laws have descended many families into crisis and even drove some to flee to bluer states. 

The years to come are expected to bring more turmoil for these vulnerable youths as the walls close in on pediatric gender medicine. 

Most consequentially, the Supreme Court is poised to rule on the constitutionality of Tennessee’s ban on puberty blockers and cross-sex hormones for treating gender-related distress in minors.

Oral arguments are set to begin on December 4 and legal experts expect the state will prevail.

The court’s decision could herald an end to pediatric gender-transition treatment in about two dozen states.

Blue states won’t be able to guarantee refuge, as access to these controversial interventions is expected to narrow even where they remain legal. 

Stakeholders predict that, at a minimum, pediatric gender doctors will become far more cautious as this field is pummeled by lawsuits, subpoenas, and negative research reports. 

These unrelenting forces could all but end pediatric gender-transition treatment nationwide in the years to come.

“Everything is on the line,” Chase Strangio, a trans-rights litigator at the ACLU, acknowledged on a recent podcast.

Speaking with The Post, Paul Garcia-Ryan, executive director of Therapy First, which prioritizes counseling for gender-distressed youths, pointed to Europe as a preview. 

A half-dozen formalized literature reviews have found that the research behind pediatric gender-transition treatment is largely weak and inconclusive.

Given the medications’ risks to adolescents — particularly infertility — national health -authorities in five European nations have sharply restricting access by minors. 

For now, the American field poses a stark contrast, with most leading voices calling for no such restraint.

“What makes this a medical scandal is that individuals and major organizations who promote fast-tracking gender transitions are digging in their heels and calling anyone who disagrees with their approach bigots and transphobes,” said Dr. Lisa Littman, the physician-scientist behind the controversial term “rapid-onset gender dysphoria.” 

“It’s as if their loyalty is to the transition interventions and not to the long-term health and well-being of transgender-identified young people.”

No credible evidence has emerged from Europe of the wave of suicides that many trans activists insisted would result from denying minors these medications.

The only study to directly address whether such interventions are tied to a lower youth suicide death rate actually revealed they were not. 

The finding that such treatment is not “life saving,” as supporters often claim, is but one revelation that could dampen support.

“Many health-care professionals and institutions currently involved in providing endocrine or surgical treatments for youth gender dysphoria will gradually withdraw from these practices,” Garcia-Ryan predicted. “They will do so quietly and without taking responsibility for any wrongdoing, in an effort to avoid public scrutiny, legal risks, or reputational damage.”

Doctors in states without bans have apparently already begun this quiet retreat, according to a new medical-claims-data analysis by the nonprofit Do No Harm. 

In the 26 ban-free states, gender-transition prescriptions to minors were typically resurgent post-COVID. But in all but one, prescriptions fell in 2023, in some cases sharply.

Experts theorize that burgeoning public debate about gender medicine’s risks has likely made parents more wary of consenting to these drugs for their children. 

Additionally, the looming threat of litigation could be leading pediatric gender doctors to become more conservative in their prescribing. 

“At some point the sheer weight of human suffering caused by these mistreatments will force a reckoning,” said Vernadette Broyles, president and general counsel of the Child & Parental Rights Campaign. 

The pendulum toward this reckoning began to accelerate earlier this year, propelled by a torrent of damaging revelations.

Britain’s scathing Cass Review found that the field of youth dysphoria medicine was based on “remarkably weak evidence.”

And the release of internal communications from the World Professional Association for Transgender Health (WPATH), some of it leaked to an activist-journalist and a separate trove subpoenaed by Alabama’s attorney general, has damaged that organization’s credibility.

These records exposed a Biden health official and the American Academy of Pediatrics as each having meddled in WPATH’s revision of its influential trans-care guidelines.

And now Republican state attorneys general appear poised to sue the AAP, suggesting in a recent letter to the organization that its trans-care policy statement violates consumer protection laws. 

This AAP document is a cornerstone of the broad support for pediatric gender-transition treatment by other medical societies. It’s also the basis of a lawsuit waged against the organization by a detransitioner —  someone who medically transitioned and then reverted to their birth sex. Along with potential discovery from that suit, subpoenas from state legal officials could expose damaging internal documents, fracture the AAP’s good standing on this issue, and trigger a domino effect through other medical bodies.

Nearly two dozen detransitioners have filed medical-malpractice and fraud lawsuits against care providers who oversaw their gender-transition treatment when they were minors or young adults. Easily the most famous is Chloe Cole, 20, who is suing health practitioner Kaiser Permanente. If at least a few of these suits win substantial awards or settlements in the years to come, legal experts expect they could drive a litigation feeding frenzy.  

The surge in youth trans identification began a decade ago. And detransitioning is estimated to take five to 10 years. Consequently, many pediatric gender experts expect the number of detransitioners will swell. And even if statutes of limitation block many from suing, a growing chorus of detransitioner reports could increasingly poison public opinion.  

“If trans people think those stories are bad today, we’re going to have 100 times more in five years,” said Brianna Wu, executive director of the progressive political action committee Rebellion PAC.

Time Magazine recently reported that the threat of detransitioner lawsuits had already sent malpractice premiums soaring for some independent gender clinics, quintupling the rate at one Illinois clinic.

Insurance experts told The Post that successful detransitioner litigation might magnify this effect and threaten the financial viability of at least some smaller clinics.

A handful of blue states have already passed laws forbidding malpractice insurers from imposing rate increases tied to pediatric gender care.

And gender clinics housed in large hospitals might be buffered from such financial pressures, because any clinic-driven increase would be a relatively minor overall financial factor. 

However, hospital administrators, wary of reputational damage from lawsuits, could direct pediatric gender doctors to pull back on prescribing.

“There’s going to be a rude awakening,” Erica Anderson, a psychologist who is transgender and the former head of WPATH’s US branch, said in anticipation that university-based pediatric gender clinics will generate bad publicity that will “hit the prestige” of their academic hosts.

“Trustees of hospitals are risk-averse,” she said. “They’re not activists.” 

There remains a woeful paucity of research on the long-term outcomes of people who medically transitioned as minors, including regarding detransitioning. Answers could come from England. But this would require its health authorities receiving data about former pediatric patients that adult gender clinics refused to provide the Cass Review team.

If forthcoming, many expect those findings to prove damning. 

Skeptics and opponents of pediatric gender medicine are already demanding, but not necessarily expecting, accountability for the damage they believe this movement has wrought.

Journalist Andrew Sullivan, who is gay, insists that gay children are being misclassified as trans and harmed by gender-transition treatment. 

“It is probably the greatest mistake that the gay rights movement has ever made,” said Sullivan of the major LGBTQ advocacy nonprofits, such as GLAAD and the Human Rights Campaign, throwing their might behind pediatric gender medicine. “I really don’t know that any of these organizations will ever take responsibility.”

Wu, who is trans, said she faulted trans activists for what she characterized as their heedlessness and radical demands. “Coexistence requires compromise,” she said. “But this set of activists is not willing to give anything up in return and that’s not reasonable.”

And as for the political backlash that now threatens the rights and medical care of adult trans people, Wu said, “The impulse we have to blame everything on the right wing is so convenient. We are walking face-first into a cultural firestorm.”

So what will become of the new generation of gender-distressed children if they’re denied these medications? 

The Post asked Laura Edwards-Leeper, a child psychologist specializing in gender-related distress. She helped import the Dutch pediatric gender-transition treatment model to the United States, in 2007, and coauthored the WPATH guidelines on child and adolescent care. 

Edwards-Leeper said the inaccessibility of gender-transition treatment “will definitely greatly hurt” some youths.

But based on her considerable experience caring for children denied such medications due to a parent’s refusal or a state ban, she predicted not mass suicide, but patience, even resilience.

“There are going to be many other youth who are going to be able to cope with the reality that they’re not able to get the medical care immediately,” she said, “and they’re going to have to wait a few years until they turn 18.”