Hundreds of pediatric gender clinics have proliferated across the country in recent years to meet growing patient demand – not medical necessity – of trans-identified youth.
It is an unfortunate reality that market demands, rather than sensible science, can be powerful drivers of the medical industry, often to the detriment of the patient. Sometimes the result is benign, and patients may simply end up with ineffectual treatment.
But sometimes consumer demand results in the creation of a new infrastructure to support the proliferation of drugs that are anything but benign, like the expansion of pain clinics to meet the demand of opioid users — an epidemic that claimed nearly 1 million lives.
It’s happened throughout history — a novel diagnosis emerges in the public periphery, followed by a surge of self-reported cases, and then clinics begin to propagate to meet the new patient demand.
Is “gender dysphoria” following a similar pattern? A decade ago, gender clinics were few and far between. But in recent years, as gender dysphoria diagnoses have become de rigueur for mentally distressed children and adolescents, over 400 gender clinics have sprung up in North America. The “gender-affirmation” model is the current standard of care deployed by pediatric gender clinics across the country. It effectively puts children in the driver’s seat to dictate the terms of their own sex change, and has allowed clinics to distribute puberty blockers, cross-sex hormones and gender-related surgeries without rigorous mental health assessments.
Medical professionals are encouraged to “affirm” a child’s chosen sex identity, despite current evidence indicating that roughly 60–90% of children who identify as transgender, but do not socially or medically transition, will no longer identify as transgender in adulthood.
Pain clinics dispensing opioids were once thought to be legitimate and necessary while operating under the medically-accepted guise of “pain management.” After people caught on to their illegal conduct, approximately 600 pain clinics were shut down, and given the stigmatized nickname “pill mills” to denote the cavalier way they dispensed dangerous narcotics to addicted patients.
What opioid prescriptions for moderate pain and pediatric medical transition have in common is that they both lack legitimate medical necessity, yet have been permitted to function without proper patient assessments or safeguarding.
Explosive increases in patient numbers were largely ignored, negative outcomes and critics were initially dismissed, and protocols were uncritically adopted and given the stamp of approval by the medical establishment, despite the ethical concerns and the fact there were no long-term studies to support their use.
Prescribing more opioids became equated with being compassionate. Opioids were marketed by pharmaceutical companies as safe and nonaddictive. In the same vein, medical transition is often seen as the compassionate response to children with gender dysphoria, and portrayed as safe and consequence-free.
The director of the pediatric gender clinic at Boston Children’s Hospital made the startling admission that puberty blockers are handed out to children “like candy” to a “skyrocketing” number of new patients, despite the fact that they are known to cause infertility and are not approved for their off-label use by the FDA. A new study of nationwide hospital databases found that at least 1,130 adolescents between 2016 and 2019 received “gender-affirming” chest surgeries in the U.S.
In the beginning of the opioid epidemic, those first suffering and showing signs of addiction were dismissed, and the ever-increasing danger was ignored. Similarly, detransitioners and medical professionals who have begun to sound the alarm on fast-tracking children into medical transition are shouted down and verbally abused.
Purdue Pharma, the manufacturer of OxyContin, used a statistic in their marketing that was successful at getting doctors to ignore addiction concerns and prescribe the deadly narcotic. “The rate of addiction is less than 1%,” was plastered all over their advertisements and in their sales pitches, despite the fact that this number was not derived from any study, but a four sentence letter in a medical journal.
Trans rights activists also rely on a 1% statistic to dismiss the negative experiences of “outliers” and any criticisms of pediatric “gender-affirming” care. They often claim that “the rate of transition regret is 1%,” despite the fact that this number is pulled from a study of transition regret in adults, rather than the new cohort that people are most concerned about: adolescents with rapid-onset gender dysphoria (ROGD).
Proponents of “gender-affirming” care have worked hard to portray it as “lifesaving medical treatment” and “suicide prevention” on the basis of the “affirm-or-suicide” myth, a debunked narrative that claims trans-identified minors are more likely to commit suicide if they are denied “gender affirming” medical treatments.
According to the affirmation model, “gender identity” is subjective and determined by the individual – it is to be believed, not questioned, and treated with prescription medicine. Jacqueline Cleggett, an infamous pill mill clinician who pleaded guilty to conspiracy to dispense and distribute controlled substances, said the same of her pain patients when interviewed in the Netflix docuseries The Pharmacist. “Pain is subjective and determined by the patient,” said Cleggett, who prescribed over 180,000 OxyContin pills in one year. “Your pain is what you say it is.”
To make matters worse, both opioid prescriptions and transition services have been doled out without any medical exam or testing. In most cases, pill mill clinicians didn’t conduct thorough background history on patients, they just prescribed drugs. It was discovered that Dr. Cleggett did not examine her patients before prescribing them painkillers, and treated as many as 76 patients per day, according to the DEA investigation.
Many young women who formerly identified as transgender have come forward detailing the accelerated process of obtaining gender transition services and the clinicians who neglected to assess their mental health.
Helena Kirschner writes about receiving testosterone from Planned Parenthood during her first visit, without blood work or a mental health referral.
Cat Cattinson said she obtained a prescription for testosterone after a 30-minute phone call with Planned Parenthood.
KC Miller received a double mastectomy just 6 months after beginning testosterone on her 17th birthday.
Camielle Kiefel received authorization for a double mastectomy surgery after two zoom calls, one an hour and the other 45 minutes, without conducting any mental health assessment. Kiefel is suing the clinics that facilitated her hasty double mastectomy surgery.
Chloe Cole is also suing the medical providers who prescribed her testosterone and puberty blockers at 13 and performed a double mastectomy on her at 15. More detransitioners come forward every day with nearly identical stories of being fast-tracked into medical transition.
At least 47 Children’s Hospitals in the US have pivoted to not just treating “transgender” children, but have opened up their services to kids who merely reject sex-based stereotypes. Gone are the days when clinicians required a diagnosis of persistent gender dysphoria stemming from childhood, now “gender nonconforming,” “gender creative,” and “gender expansive” kids will do. This is similar to how opioid prescriptions expanded from their original use in treating only severe pain to increasingly moderate forms of pain.
In addition to Children’s Hospitals, Planned Parenthood began providing gender transition services in 2017. An investigation by The Federalist found that more than a third of its offices, 239 clinics in more than 40 states, provide hormones to teens age 16 and older (with parental consent). Planned Parenthood guarantees that patients can receive hormones without an evaluation of their mental health and in most cases can expect same-day prescriptions.
While the incentive for financial gain behind the opioid epidemic was much more straightforward, the gender affirmation movement has various motivations by various parties.
Purdue Pharma, the manufacturer of Oxycontin, has generated more than $35 billion in revenue since bringing it to market in 1996, at the cost of thousands of human lives.
“Gender-affirming” care also has a steep price tag associated with it. America’s sex reassignment surgery market size was US $1.9 billion in 2021, according to market analyst Grand View Research. It is expected to grow at a rate of about 11% annually, reaching about $6 billion in 2030.
“Gender affirming” care has brought in business for hospitals, including Vanderbilt University Medical Center (VUMC). Earlier this year a leaked video of a doctor from the Nashville hospital referred to transgender surgeries as “huge money makers,” bringing in tens of thousands of dollars in revenue to the hospital per patient, including follow up visits.
After 2015, when gay marriage was legalized nationwide, civil rights and gay rights organizations who would have otherwise had to shutter their doors, pivoted to championing “trans rights” to retain donors and secure funding. For many trans activists who do not directly profit from “gender-affirming” care, there is emotional validation.
The pharmaceutical industry is largely to blame for the opioid epidemic, but the national catastrophe that struck the US could not have taken place without doctors prescribing the opioids and the medical bodies and academic journals endorsing them. The medical establishment uncritically adopted many of the pharmaceutical companies’ marketeering ploys, against their better judgment. Doctors who prescribed dangerous narcotics to their patients said they were just following medical guidance, just as doctors who facilitate pediatric medical transition are doing now.
The opioid epidemic couldn’t have taken off without the help and failure of the Food and Drug Administration (FDA) with a special label they gave to OxyContin as a “non-addictive opioid,” despite all evidence to the contrary.
“Gender-affirming” care has also been rubber-stamped by ideologically captured US-based medical organizations, despite the lack of evidence to support its use and departure from growing international consensus.
None of the U.S.-based organizations that endorse “gender-affirming” care have done systematic reviews of the evidence, while arguably more “progressive” European countries like Sweden, Finland, and England have. After reviewing the evidence for the use of puberty blockers and cross-sex hormones in treating pediatric gender dysphoria, health authorities in all three countries have decided to abandon the “gender-affirming” model, finding the costs outweigh the benefits.
The state of Florida additionally conducted a systematic evidence review and approved a rule last month prohibiting minors from receiving gender transition surgeries, puberty blockers, and cross-sex hormones, making it the first ban in the country instituted by a state medical board.
Like opioid consumers, the detransitioners who sought medical transition were looking for an escape from their emotional pain, but were given a treatment that caused them additional harm. The opioid epidemic ended in lawsuits, and it is likely that the gender affirmation movement will too.