Gender-affirming care for transgender kids will backfire: experts

When her biological daughter Alex* came out as transgender at the age of 12, Anna* offered her support instantly — but she also had concerns. The New York City-based mom knew her child also suffered from autism, severe depression and self-harm, and hoped that any psychologist exploring a transition with her child would consider all those conditions as part of the treatment.

Instead, she says her child was offered puberty blockers after a 10-minute evaluation at “the best possible clinic” for transgender care in New York. “My child’s autism was completely overlooked,” Anna told The Post.

Although Anna needed to give consent for Alex to start the puberty blocker treatment (which she denied), she said she and her husband felt pressured to give her the hormones. “From the first moment we told her counselor that our child said she was trans, they told us the standard of care is to affirm. That was it. No questions. I thought we have to trust the science, we have to trust the medical professionals. But I now know they have little understanding of what’s truly going on,” she said.

London’s Tavistock Centre has treated thousands of patients with gender dysphoria over the past two decades with an “affirmative” approach that many staffers have described as “unquestioning” and “pressured.”REUTERS

In the three years since Alex has identified as transgender, the teen has been hospitalized multiple times for mental health reasons and has attempted suicide once. Now Anna worries that therapists sent her family down the wrong path.

“There was no real exploration as to what does it mean to be trans,” Anna said. “What does she mean she feels like a boy? Why do you think you’re not a girl? Tell me more. How does that feel? How do you know? And what does that mean to you? There was no exploration of that.”

A report by Dr. Hillary Cass (above) said a surge in new patients and long waitlists caused Tavistock to rush patient care, while failing to fully collect data on treatment outcomes. A report by Dr. Hillary Cass (above) said a surge in new patients and long waitlists caused Tavistock to rush patient care, while failing to fully collect data on treatment outcomes. rcpch

Many parents of children with gender dysphoria feel just like Anna right now, being told they must support their kids’ transitions at all costs. In June, President Biden promised to ensure access to gender-affirmative care for all American trans youths via executive order. But that same approach was recently called into question in the UK, where the country’s only clinic treating trans minors is closing next year following a damning report.

In July, Britain’s National Health Service announced plans to shutter the Gender Identity and Development Service (GIDS) at the Tavistock clinic in London, where thousands of young patients have been treated since 1989. According to an independent report, patients found that their full range of mental-health issues were “sometimes overlooked” and staffers felt under pressure to adopt an “unquestioning affirmative approach.”

A “significant increase of referrals” — from 138 in 2010 to 2,383 in 2020 — and a two-year waitlist also incentivized GIDS staffers to rush children through their transitions, according to the report by Dr. Hillary Cass. GIDS also failed to collect data about the treatments offered at the clinic or their long-term outcomes, Cass wrote.

Following her detransiition, Bell sued Tavistock for failing to properly address the root causes of her mental health conditions.Following her detransiition, Bell sued Tavistock for failing to properly address the root causes of her mental health conditions.Paul Cooper/Shutterstock

One young patient, Keira Bell, a biological female who medically transitioned to a male at GIDS, went so far as to sue the clinic, writing in a post, “The consequences of what happened to me have been profound: possible infertility, loss of my breasts and inability to breastfeed, atrophied genitals, a permanently changed voice, facial hair. When I was seen at the Tavistock clinic, I had so many issues that it was comforting to think I really had only one that needed solving: I was a male in a female body. But it was the job of the professionals to consider all my co-morbidities, not just to affirm my naïve hope that everything could be solved with hormones and surgery.”

GIDS is now scheduled to close in spring of 2023, and the NHS will shift its gender identity services to smaller regional centers better equipped to treat patients holistically, as recommended by the report.

Bell, before and after her transition from female to male. She says the medical treatment she received at Tavistock left her physically scarred and potentially infertile. Bell, before and after her transition from female to male. She said the medical treatment she received at Tavistock left her physically scarred and potentially infertile.

Former Tavistock executive Marcus Evans told The Post he feels “vindicated” by Cass’ report.

Evans was Clinical Director of Adult and Adolescent Services at the Tavistock and Portman NHS Trust, which oversees GIDS, but stepped down from his role on the Board of Governors in 2019 after he grew concerned about children being rushed through medical transitions.

“There is no research that justifies our current approaches. We’re in the dark, and we’ve just been putting children on a medical conveyor belt,” he said. “It’s as if the whole Trust has gone off into the area of political activism, and Hilary Cass is pulling it back. It’s absolutely extraordinary.”

Former Tavistock director Marcus Evans — who left the clinic over fears of rushed treatment — applauded Dr. Cass’ findings, calling her efforts “absolutely extraordinary.”Former Tavistock director Marcus Evans — who left the clinic over fears of rushed treatment — applauded Dr. Cass’ findings, calling her efforts “absolutely extraordinary.”courtesy of Marcus Evans

Britain is just one European country pumping the brakes on medicalizing transgender youth. In March, France’s National Academy of Medicine advised caution on gender affirming care for young people. In February, Sweden — a progressive country previously on the cutting edge of providing medical services to transgender youth — also reversed course. The Swedish National Board of Health and Welfare updated its guidelines for treating trans youth, scaling back the use of puberty blockers and cross-sex hormones, saying there hasn’t been enough research on their efficacy or side effects.

But, here in the United States, the affirming care model is still embraced with open arms.

In January, the American Academy of Pediatrics (AAP) doubled down on its 2018 policy advocating gender affirming care for minors, including the use of puberty blockers and cross-sex hormones. According to the AAP, “youth who identify as TGD (transgender and gender diverse) [should] have access to comprehensive, gender-affirming and developmentally appropriate health care.”

Chloe Cole is another outspoken detransitioner who is currently campaigning in Florida for a new law barring Medicaid funds from being used for transitions like the one she experienced. Chloe Cole is another outspoken detransitioner who is currently campaigning in Florida for a new law barring Medicaid funds from being used for transitions like the one she experienced. courtesy of Chloe Cole

Two months later, a group of five pediatricians signed a letter calling on the AAP to reconsider these guidelines. “We want our children to be affirmed as whole human beings,” the authors wrote. “And we want them to be treated with evidence-based interventions which ensure that benefits outweigh the risks.” But, so far, their calls for greater moderation have fallen on deaf ears.

Dr. Erica Anderson, a clinical psychologist specializing in gender, sexuality and identity, agrees the affirmative care model has gotten out of control. A transgender woman herself, Anderson advocates an exploratory, methodical approach that emphasizes a full mental health evaluation prior to any medical intervention.

Brian Wagoner as Brianna before he returned to his biological gender following years of estrogen treatments to live as a woman. “Transition made all of my problems worse,” he said. Brian Wagoner as Brianna before he returned to his biological gender following years of estrogen treatments to live as a woman. “Transition made all of my problems worse,” he said.

Brian Wagoner, here in a recent photo near the Hollywood Reservoir, says the financial incentives around gender-reassignment are huge; Brian Wagoner, here in a recent photo near the Hollywood Reservoir, said the financial incentives around gender-reassignment are huge. “Doctors see dollar signs.”Roger Kisby

“[Exploratory care] has been the standard of care in the United States but in some circles is being ignored, much to my chagrin,” she told The Post. “Many parents contact me . . . and rather than getting a full comprehensive individualized psychosocial evaluation, they are told, ‘Here’s the pathway to hormones.’ ”

“We’re trapped in this deep blue state where affirmation is the only legal option.”

Mom Anna, whose daughter has been hospitalized for mental-health reasons and attempted suicide after being offered puberty blockers at 12.

While parental consent is required before trans youths under 18 undergo a medical transition, many moms and dads feel pressured into treatment. And Anderson worries that kids are being hurt by this swift affirmative care approach, both in the US and at GIDS.

“In the haste to treat these kids, they’ve taken some shortcuts, and those shortcuts aren’t going to look good in the long run. I think we’re going to have an increased number of kids who don’t do well transitioning on medicine and ultimately detransition.”

Already, young American detransitioners are speaking out.

Dr Erica Anderson, who is herself transgender, believes medical professionals have overreached when it comes to affirmative care for gender dysphoria. “They’ve taken some shortcuts,” she said. Dr Erica Anderson, who is herself transgender, believes medical professionals have overreached when it comes to affirmative care for gender dysphoria. “They’ve taken some shortcuts,” she said. Twitter

In July, Brian Wagoner, 31, told The Post how he decided to return to his biological gender after years of living as a woman on estrogen treatment. “Transition made all my problems worse,” he said. “There’s a lot of money to be made by doctors here. They see the dollar signs, and in the end, money talks.” And Chloe Cole, who had a double mastectomy to live as a man before detransitioning back to a woman, is campaigning for a Florida rule that will block Medicaid funds from paying for medical interventions in cases like hers.

“I really didn’t understand all of the ramifications of any of the medical decisions that I was making,” Cole, now 17, said at a recent hearing. “I was unknowingly physically cutting off my true self from my body, irreversibly and painfully.”

Complicating matters in New York and other blue states are laws that make all kinds of “conversion” therapy illegal — including any attempt to change a person’s gender identity. The vagueness of the law has put some therapists in limbo, worried that questioning their patients’ feelings about gender dysphoria could jeopardize their careers or even open them to legal action.

“For some who are afraid of being accused of doing conversion therapy — even though they don’t think they are, and they don’t call it that — these laws could be intimidating,” Anderson said.

This legal ambiguity has also left parents like Anna feeling left out of their own children’s transitions. “The government, the schools, and the president are all talking about affirmation all the time and trying to drive a wedge between children and their parents,” Anna said. “I really feel like we’re trapped in this deep blue state where affirmation is the only legal option for care.”

Cole, who underwent a double-mastectomy, a decision she now calls During her transition, Cole underwent a double-mastectomy, a decision she now calls “painful and irreversible….I really didn’t understand all of the ramifications,” she said. courtesy of Chloe Cole

For anything to change, Evans said the transgender treatment industry must stop its “political culture and reestablish a clinical culture in which people can challenge and discuss and look at things from different points of view.”

Anderson agrees. “I actually think it’s gender affirming to do exploratory therapy,” she said. “It’s just what therapists do. ‘Tell me more, I want to understand and explore all the factors that might be related.’”

Until we can establish such a culture, Anna takes heart from the news about Europe’s more moderate approach.

“It gives me a tremendous amount of hope,” said Anna, who added that her child is finally in a better place with improved overall mental health. “As more and more of these stories of vulnerable young people who feel betrayed by the care they got come out, it will be impossible to ignore.”

* Names have been changed to protect the identities of these sources.