It’s difficult these days to escape the transgender front of the culture war. Detransitioners — those who identified as transgender and underwent social and medical transitions only to reverse course later — are the latest group the left is accusing the right of deploying, while the right says we ought to take them as a warning.  

The right, it appears, is learning the lesson articulated by Andrew Breitbart —  “politics is downstream from culture.” Conservatives are boycotting Bud Light, Miller Lite, and now Target over the companies’ “woke” advertising and products they say are “grooming” kids to be transgender. A pro-Trump rapper’s song calling for a boycott of Target — the chorus is “Target, yeah they’re targeting kids” — hit number one in late May on Apple’s iTunes sales chart, Newsweek reported, beating out Taylor Swift.

Every week it seems another sport is contending with how to accommodate transgender women. The outrage over drag shows is reaching a fever pitch. San Francisco named its first “Drag Laureate.” The Dodgers invited, then disinvited, then reinvited a controversial drag performance troupe that satirizes Catholicism. The largest LGBTQ organization in America, Human Rights Campaign, declared its first national state of emergency. And Pride month is just getting underway.

While many, primarily on the left, warn that the rhetoric around LGBTQ issues is turning increasingly homophobic and transphobic — and in some corners it is — the panic on the right is at heart about children and the rapid increase in the number of minors identifying as transgender. The videos inside Target stores that went viral were the ones pointing out “tuck friendly” swimsuits — made for adults — reportedly near the children’s section. Parents are scared.

The number of American children who received a diagnosis of gender dysphoria tripled between 2017 and 2021. The number of minors taking puberty blockers and hormones more than doubled in the same five-year period. While the percent of transgender adults has remained steady over time at 0.5 percent, according to a 2022 study by the Williams Institute, a think tank that studies sexuality and gender identity in law, the percentage of minors identifying as transgender is now nearly triple that  — 1.4 percent.

THE POLITICS OF CARE

As more detransitioners come out publicly with their stories, the political fight over how to care for transgender-identified minors and whether a strictly affirming model is the right approach is intensifying. Some 20 Republican-led states have passed bans or restrictions on “gender affirming care” for minors. Governor Abbot of Texas declared last year that helping a child medically transition is child abuse and could prompt a Child Protective Services investigation.

Democratic-run states, meanwhile, are passing “refuge” laws to allow minors to travel to those states to get gender affirming care like puberty blockers, hormones, and surgeries. California is considering legislation that would make “affirming” a child’s gender weigh favorably in parental custody disputes, as well as another bill that would require foster parents to affirm a child’s gender identity. 

Democrats say that the rise in youth identifying as transgender is the result of a more accepting society and that in the past these children would have suffered in silence. Even questioning the efficacy of this care is called “transphobic.”

“Like everything in America, it’s become polarized. The left has pushed one point of view, and because the right is pushing back, the left doubles down, and the right pushes harder,” a psychotherapist who works with gender questioning patients and detransitioners, Dr. Joseph Burgo, tells the Sun. “It shouldn’t be a political decision, it should be about protecting children, what’s best for them.”

Dr. Burgo supports bans on surgeries, puberty blockers, and hormones for minors — a decision, he says, he didn’t come to lightly as a lifelong Democrat. As a vice director at Genspect, an organization that advocates for “a wider range of treatment options” than just the affirmation model, Dr. Burgo is an outlier in his field, at least publicly.

The American Academy of Pediatrics and the American Medical Association support “gender affirming” care for minors. The guidelines published by the World Professional Association for Transgender Care are considered by many practitioners to be the gold standard for transgender medical care and include the use of puberty blockers, hormones and, after the age of 16, double mastectomies.

“The biology in your brain that tells you what sex you are is part of sexual reproduction and is a phenomenon,” the executive director of the Mount Sinai Center for Transgender Medicine and Surgery, Dr. Joshua Safer, tells the Sun. “Even if we didn’t recognize it in the past, it’s there, and for most people it’s coded the same way as the genitals that we saw when they were born, but for some people it’s not. And so gender affirming care is simply recognizing all of that.”

Yet the WPATH guidelines call for more comprehensive assessments of minors than many gender clinics in America provide in practice. Longer periods of assessment and caution before medicalizing are often perceived as “gatekeeping” or even “conversion therapy.”

MAJOR DECISIONS FOR MINORS

The Sun spoke with a mother of a transgender teenager who says her child was given a prescription for testosterone patches at their second visit to a New York City gender clinic. Her transgender son, born female, received a letter from his attention deficit disorder therapist saying that he has gender dysphoria and that was enough to start the hormones. 

While the mother thinks her son is getting good care and is “100 percent supportive” of him, she says she was dismayed he wouldn’t freeze his eggs first in case he later wants to have children. “He said 100 percent that he never wanted to have kids,” she tells the Sun.

It’s easy to find similar stories online of young persons getting prescriptions for cross-sex hormones with little psychological assessment from gender specialists. There are also YouTube videos coaching young people about what to say to get these prescriptions more easily.

“I have no problem with adults doing what they want to their bodies,” Dr. Burgo says. “But I do think we need to protect adolescents from making choices that will affect the rest of their lives. … Why do we have laws that prohibit adolescents from getting tattoos? Because kids do impulsive things and they might regret them later.”

The personification of this regret are detransitioners, though regret is not always the reason a person decides to stop hormones and other treatments and return to their natal sex or some other identity on the spectrum like nonbinary. A survey done in 2021 of 100 detransitioners found that reasons for detransition varied, with 49 percent saying they had concerns about medical complications from their transition, 23 percent saying they experienced discrimination, another 23 percent said they realized they were just gay, and 38 percent saying they realized their gender dysphoria was caused by something else like trauma, an eating disorder, or another mental health condition. A majority of respondents said they didn’t think they got adequate medical evaluations before proceeding with transition.

DETRANSITIONERS SPEAK OUT

The visibility of detransitioners is a controversy itself. There are now several with substantial followings on Twitter and TikTok who are speaking out. One of the most high-profile child detransitioners, Chloe Cole, was the subject of an unflattering New York Times article recently about her advocacy work with Republicans to help pass bans on gender affirming care for minors. The Times dismissed detransitioners as rare and their influence in Republican politics “striking,” if not dangerous.

“I’m often accused of trying to get rid of transgender people. And I’m even told sometimes that I’m at the forefront of a genocide,” Ms. Cole tells the Sun. “I don’t want there to be any more detransitioners. I don’t want anybody to regret their transitions. I want people who happily go through transition and are satisfied with the results.”

Ms. Cole describes herself as a textbook case of regret and inadequate screening before being medically transitioned as a child. She says she was a tomboy and “had some body image issues,” as well as undiagnosed autism, when she discovered transgenderism online at age 12. She says it had never occurred to her before then that she might have been born in the wrong gendered body, but the feelings described in online posts from transgender persons matched her own as an insecure adolescent.

Ms. Cole started dressing as a boy, changed her name, and began using male pronouns. At age 13, she started taking puberty blockers and then testosterone. At age 15, she underwent a double mastectomy — called “top surgery” — only to realize she regretted it less than a year later.

“I discovered that I wanted to become a mother one day, but I was on this path that might take away my ability to conceive children naturally,” Ms. Cole says. “And now that my breasts are gone, I’ll never have that special experience of bonding with my child and feeding them naturally.”

Now 18 years old, Ms. Cole says she is suffering from medical complications from her transition: that she may be infertile, and that she is experiencing “sexual dysfunction.” One of the potential side effects of taking puberty blockers and then cross-sex hormones is the inability to orgasm, according to WPATH president, Marci Bowers, speaking about natal males. Critics of medicalized gender care for minors point out that children who are not sexually active are incapable of consenting to never having an orgasm. Bone density loss is another side effect of puberty blockers. 

Ms. Cole doesn’t blame her parents, saying they were “duped” as much as she was. “They were told it was a life-or-death situation for their own daughter, that if you don’t allow your kid to transition then she’s going to kill herself,” Ms. Cole says. “It’s either you’re going to have a dead daughter or a live son.”

Ms. Cole is now suing her healthcare provider, Kaiser Permanente, as well as her surgeon and other doctors. Dr. Burgo says lawsuits like this are going to become more common in the coming years, and that he knows of several lawsuits in the planning stages now.

The Sun contacted Kaiser Permanente for comment but did not hear back. Kaiser told Sinclair Broadcasting’s National Desk that it “provides patient-centered gender-affirming care that is consistent with the standards of medical care and excellence.” 

“The care decisions always rest with the patient and their parents, and, in every case, we respect the patients’ and their families’ informed decisions about their personal health,” Kaiser added.

IS DETRANSITION RARE?

“I think that, unfortunately, what’s going to happen is we’re just going to see more and more collateral damage as the detransitioners come forward, and there’s going to be a lot of them,” Dr. Burgo says. He hopes some big settlement awards will prompt insurance carriers and doctors to rethink the gender affirming model for youth.

As heartbreaking as Ms. Cole’s story is, the question is whether hers is an isolated one from a rare cohort of child detransitioners or whether she is a harbinger of things to come. How common are detransitioners? And are a few high-profile ones like Ms. Cole hijacking the debate, as the Times suggests, hurting other transgender children by sowing seeds of doubt about their medical care and pushing for outright bans on it?

There are no large-scale, long-term studies that track persons who medically transitioned as minors to determine how many reversed course as they aged into adulthood. The studies that do exist show wide ranges for detransition, from as low as 2 percent to as high as 25 percent. The discrepancy in the data underscores the shortcomings of these studies and the fact that many researchers and medical providers in the field have been unwilling to talk about or study detransition because it is seen as harmful to transgender medical care.

“People are terrified to do this research,” a clinical psychologist who treats transgender youth and is a co-author of WPATH’s Standards of Care, Dr. Laura Edwards-Leeper, said in an interview. She supports affirming care for minors, but thinks the silence on detransition is troubling. “We cannot carry on in this field that involves permanently changing young people’s bodies if we don’t fully understand what we’re doing and learn from those we fail.”

The most commonly cited figure from transgender rights activists is that only 2 percent of minors who medically transition later detransition. This statistic is based on a 2022 study from the Netherlands of nationwide prescription registry data that shows, of 720 minors who started with puberty blockers and then went on to take cross-sex hormones, 98 percent continued with hormone treatment four years later.

While this would suggest detransition is rare, adolescents in the Netherlands go through lengthy assessment processes of a year on average before medically transitioning. That’s often not the case in America. The study also only tracked pharmaceutical data for four years, while other studies show the average time to detransition is between four and eight and a half years after transitioning. This time period is the basis for Dr. Burgo’s claim that there will be a tsunami of detransitioners in the coming years.

The two percent figure also undermines the common argument that puberty blockers are just “hitting pause” to give a child time to assess. Aside from the health risks of the blockers, the study suggests that once a person starts the medicalized transition journey, they are unlikely to turn back.

“It’s very hard to admit that you might have made a mistake that damaged your own future and your body,” Dr. Burgo says. “The trans community, which is extremely supportive of anybody who identifies as trans, is toxic — if you walk it back, if you decide it was a mistake, they’ll reject you.”

Ms. Cole says she experienced that rejection. “I had some pretty harsh treatment from the transgender community. There were a lot of people harassing me, bullying me,” she says. “This was a group of people I thought loved me. I thought I loved them. And I didn’t expect that just by stopping my transition and talking about it that they would see this as some sort of betrayal.”

Dr. Safer counters that seeing 98 percent of patients go on to cross-sex hormones is a sign that clinicians are “not casting a broad enough net. That is, you’re giving [puberty blockers] to just the most extreme kids, who are the most insistent” of their gender dysphoria. “And if we did a better job of giving the opportunity for puberty blockers to more kids who are exploring, we would then find more of those kids, in fact, not to be interested in going on to sex hormones,” he says.

CONFLICTING NUMBERS

Other studies suggest detransition is not quite so rare. A 2022 study that examined U.S. Military Healthcare System pharmacy records between 2009 and 2018, found that 25.6 percent of minors prescribed cross-sex hormones later discontinued their use. If a quarter of childhood transitioners later detransition, this indicates there are real problems with the way transgender youth are assessed before starting hormones.

This study, too, has its flaws, and researchers acknowledge as much. The main one is that it doesn’t account for patients who stopped getting hormones from the military healthcare system but may still be getting them from another healthcare system, like at college. Other studies show rates of detransition in between 2 and 25 percent, though there are issues with these as well, particularly with the number of participants who dropped out.

“The problem with the data is the follow up is so poor,” Dr. Burgo says. “Nobody knows for sure because they don’t track these people. They’re lost to aftercare. The people who detransition often do not want to go back to their original care providers. … They don’t want to go public. They’re not like Chloe Cole.”

While Ms. Cole and Dr. Burgo support bans on medical transitions for minors, there are many in the center and dissident left who don’t support these bans but say we should be talking more about detransitioners nonetheless. They say if we don’t acknowledge that regret happens then we won’t get transgender medical care for minors right.

“We strongly oppose efforts, in state legislatures and elsewhere, to target trans children and their families and pass laws restricting treatment options for gender dysphoria,” a transgender man and detransitioner researcher at York University, Kinnon MacKinnon, and co-author Daniela Valdes, wrote in the Atlantic. “But trans-rights advocates and mainstream-media outlets should stop downplaying the reality of detransition, lest readers and viewers conclude that it’s a negligible issue. It’s not.”

“I personally think that there are transgender kids,” a writer and podcaster who covers the topic, Meghan Daum, tells the Sun. Yet she says “you have a huge cohort of kids who are really not transgender but they’re saying they are. And the parents are going to increasingly have to face the fact that something else is going on.”

Ms. Daum points to studies that show a significant portion of minors diagnosed with gender dysphoria have co-occurring issues like autism, eating disorders, anxiety, depression, and cutting. She also mentions the theory of “rapid onset gender dysphoria,” a term coined by Dr. Lisa Littman, who studied cohorts of young, mainly natal females, who suddenly come out as transgender with no history as dysphoria as children.

Dr. Littman’s 2018 study is highly controversial — activists attacked it and forced a correction on her research paper that did little but expound on its methodology. The paper suggests, from surveys of parents, that internet and peer group influence may explain the rapid rise in young persons identifying as transgender. Natal females now make up two-thirds of this group.

“The idea that kids are brainwashing themselves into having a different gender identity is too extreme,” Dr. Safer counters. 

TOWARDS A DÉTENTE?

The New York mother who spoke with the Sun about her transgender son had never heard of “rapid onset gender dysphoria.” Her child was the first among his friends to come out as transgender, but she says a large proportion of these friends now identify as transgender, nonbinary, or LGBTQ in some way. “I think there might be something to that,” she says of the social contagion theory, “but I hate to, for it to be used in the right wing way to fuel their argument.”

This mother is part of a liberal downtown New York City art scene and has plenty of lesbian, gay, and transgender friends. She says her child was always uncomfortable with his body and dressed as animals when he was younger — a sign to her that there was something amiss. She says she thinks he is getting good care, but she concedes the whole journey has been difficult. Her son is turning 18 this month and is scheduled for a double mastectomy in July.

“I’m worried about the top surgery,” she tells the Sun. Yet she says he can always get breast reconstruction later, as she did after she had breast cancer. 

“I love that we’re living in the bubble in New York, because here, everyone’s like, ‘you’re such a good mom. Your son’s so lucky,’” she says. “Everything has shown me that I made the right decision. You know, he’s happy and thriving and comfortable and doing nothing wrong. That’s how I see it.”

The issue of transgender medical care for minors is so fraught because parents like this are just trying to navigate the system, often with limited information, and to do what they think is best for their children. This mother’s child may have genuine gender dysphoria and benefit from transition. For Chloe Cole, transitioning was a terrible mistake that will impact the rest of her life.

Several countries in Europe are now rethinking how they treat transgender minors. Britain’s National Health Service announced Friday it is banning the use of puberty blockers except in clinical trials. The county’s sole clinic for medically transitioning minors is closing, after seeing a 4,000 percent increase in the number of children seeking treatment for gender dysphoria, a third of them on the autism spectrum. Sweden, Norway, Finland, and France have also issued stricter guidance on when to prescribe puberty blockers and cross-sex hormones to minors.

Ms. Daum says much of the hesitancy in America to talk about the problems with transgender medical care for minors is due to the legacy of the religious right and homophobia. Nobody wants to be called a bigot, particularly on the left. “They’re just thinking of this as Gay Rights 2.0,” she says, “when in fact it’s an entirely different thing.”

“I don’t think there’s any reasonable person in this debate at all that has said anything other than transgender people deserve the full complement of rights as much as anybody else does,” Ms. Daum says. “But there’s a difference between granting people their rights and facilitating young people — children and teenagers — into irreversible medical transitions based on very little evidence and no exploratory therapy.”

Dr. Burgo agrees. “It’s hard to have a civil conversation,” he says.

The only way to improve how we treat transgender-identified children and teenagers is through open dialog and studying detransitioners and what this care gets wrong. The Pride Wars are intensifying. With no good data, outrage is fueled by feelings. That won’t lead to a détente.