On the disaster of transgender medicine

Benjamin Ryan, one of the top reporters covering the field, explains how doctors became advocates - and the backlash that followed.

Note: For three-plus years, Benjamin Ryan has offered readers top-notch investigative reporting on transgender pediatric medicine — or what might more accurately be called the trans pediatric medical industry.

Ben has published investigations and scoops documenting the field’s recklessness, including an investigation with Compact magazine based on conference videos from a top trans medical organization.

Ben has proven himself fearless and fair. If he has one flaw, it is that he is so knowledgeable about transgender medicine he sometimes loses himself in its details.

So after the Supreme Court’s ruling supporting the rights of biological girls to compete in sports without facing transgender athletes, I asked Ben if he could offer Unreported Truths readers an overview of the current debate around trans issues. Keep it at the 50,000-foot level, I said!

His response follows. I don’t necessarily agree with every word, but I hope you find it as interesting as I did. You can find Hazard Ratio, his Substack, here!

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(By Benjamin Ryan)

American doctors charged with caring for the vulnerable — and often troubled — young people who identify as transgender have catastrophically failed them.

Through an overzealous campaign to promote medicalized gender transitions for adolescents, they have permitted progressive identity politics to overwhelm common sense and caution.

Gradually, then all at once, they triggered a backlash — from cynical right-wing politicians who seized upon a new culture-war wedge issue, as well as justifiably concerned parents — that has toppled much of their medical field in the United States.

Last year, the Supreme Court’s conservative supermajority effectively blessed state bans of gender-transition treatments for minors. And last month, the court affirmed state laws barring athletes born male from girls’ and women’s sports.

These rulings dovetailed with public opinion that has moved against the rigid demands of the transgender advocacy movement.

But the battles over the explosion of transgender identification among adolescents have come at a devastating cost, especially for one tiny group of youths.

These people start expressing a cross-sex identity as young children and will likely hold a transgender identity for life. Absent medical transition, they may suffer from permanent gender-related distress. They have been known as the “true transsexuals,” destined to identify as the opposite sex throughout their lives.

They’ve been forgotten in this fight. They shouldn’t be.

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(William “Lia” Thomas, whose Division I collegiate swimming championship in the women’s 500-yard freestyle in March 2022 helped spark a backlash against trans athletes in women’s sports.)

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Liberals and conservatives each deserve blame for approaching this complex issue with anything but the deft hand it required.

The left cooked up a civil rights movement that shut down dissent and made a litmus test of supporting radical, irreversible and often unethical medical interventions to troubled adolescents. The right responded with brute force.

Amid the rubble of this political collision are dashed hopes that researchers might determine how best to treat the gender-related distress some young people genuinely face. The existing research is of poor quality, which is especially concerning given the serious and unique risk of harm these medical interventions pose.

But the American leaders in this medical field are too concerned with being seen as white-knight saviors of vulnerable youth to conduct rigorous research and to report it honestly and promptly if those findings show concerning results.

Partly in response to these blunders, conservatives have done everything they can to dismantle the nation’s research apparatus — and robbed the public of potential scientific findings that might better guide the care of young people who are often mentally ill and are frequently autistic as well.

But the pipeline of adolescents coming into a transgender identity hasn’t simply dried up. These distressed young people are headed for a blockade erected by statehouse Republicans and the Trump administration. And conservatives have offered them no solutions.

The left’s contribution to this sociopolitical tragedy has remained underexamined, given the liberal bias of the legacy media. In a better world, media outlets would investigate and atone for their own failure to have covered this complex subject with the dispassionate circumspection it demands.

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The current crisis had its origins in a clinic in the Netherlands.

In the 1990s, Dutch researchers launched a strict, cautious protocol to address the question that had long haunted adult transgender people: What if I could have gone through the opposite-sex puberty? The Dutch recruited a small cohort of youth who exhibited gender-related distress starting at a young age.

If these youth were “consistent, insistent and persistent” in their cross-sex identity, they could begin puberty blockers, later transition to cross-sex hormones and ultimately undergo gender-transition surgery. The study participants had to demonstrate stable mental health and have families supporting their transition.

The Dutch researchers’ findings, published in the early 2010s, were hardly grounded in high-quality science. They didn’t even have a control group. Still, they unleashed a new medical field — pediatric gender medicine — across the Western world.

Then American medical providers took this narrow protocol and went hog wild. They tossed aside rigorous psychosocial assessments and instead prioritized access. By 2018, it became Boston Children’s Hospital’s policy, for example, to provide minors seeking gender-transition drugs with only a two-hour appointment with a psychologist to determine whether to refer the child to a medication specialist.

The nation’s first medical-malpractice trial waged by a detransitioner — a person who medically transitioned and then reverted to identifying as their birth sex — heard testimony in January from a 22-year-old plaintiff who, as a seriously unstable 16-year-old girl, underwent a gender-transition mastectomy after publicly identifying as transgender for less than a year.

Such practices should shock anyone who wishes the best for all children struggling not just with their gender but with identity confusion writ large during the daunting social media era.

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(Ahh, social media fads. The Benadryl TikTok challenge is, well, to take a lot of Benadryl. And, yes, teens actually do this. Some, anyway.)

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The swift expansion of this new medical field coincided with the onset of what psychologist Jonathan Haidt has witheringly dubbed the “phone-based childhood.” Beginning around 2012, tweens and adolescents gained access to an algorithm-based virtual world in which to question and cultivate their senses of self.

As any parent who has had children in a progressive private school can attest, it was during this period that clusters of friends — biological girls in particular — suddenly started professing cross-sex identities.

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But the leaders of pediatric gender medicine refused to consider whether adopting a transgender identity might sometimes be a socially-formed coping mechanism to deal with the anxieties wrought by Tumblr, Instagram and TikTok.

To such doctors, these were transgender children, bar none. And as the American Academy of Pediatrics wrote in a foundational, practically spiritual, and astonishingly flawed 2018 policy statement on the so-called gender-affirming care method, transgender kids know their gender as well as anyone.

Buttressed by that philosophy, a niche medical field designed for a tiny population of young people exploded. Scores of pediatric gender clinics opened their doors to aid transitions in kids not even old enough to drive.

Supply appeared to create its own demand.

By 2023, over 3 percent of teenagers reported identifying as transgender and over 1 in 250 natal girls were taking testosterone by age 17 in super-liberal Oregon. The World Professional Association for Transgender Health, or WPATH, an influential, quasi-activist-medical group, professed the following year that the majority of transgender adolescents should undergo medical transitions.

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(Testosterone shots: Not just for MMA fighters anymore!)

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The leaders in this field, social-justice warriors to the core, rarely acknowledged that online trends could have encouraged this groundswell. In WPATH’s conferences, dissent or debate about this novel field remained shockingly absent, as I discovered from watching recordings I obtained of over 100 such conference sessions.

The imposed silence about this seismic cultural shift among adolescents extended to other scientists, concerned parents, journalists, and politicians.

Dr. Lisa Littman, a researcher who sought to study what in 2018 she dubbed “rapid-onset gender dysphoria,” was shunned. Reporters like Jesse Singal who dared write even circumspectly about pediatric gender medicine were defamed and banished.

Parents could have child protective services called on them if they resisted their children’s demands for a medicalized gender transition. Democratic politicians were pilloried if, like Representative Seth Moulton of Massachusetts, they questioned how communities should respond to the proliferation of youth identifying as transgender in schools and sports.

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Exerting thought control is not a healthy way for scientists and society alike to explore how best to care for troubled children.

Nor, often, is the blunt instrument of the law.

In the wake of gay marriage’s Supreme Court win in 2015, and amid rising support for gay rights, conservatives pivoted to leveraging transgender issues as a political wedge issue. Republicans saw pediatric gender medicine’s recklessness and were all too happy to express their horror at it with a show of authoritarian force. Starting in 2021, conservatives blanketed over half the states with bans of these practices, which the Supreme Court solidified in 2025.

Some youths will be saved from harmful and unnecessary medical interventions as a result — though many, primed by gender-medicine advocates to believe such treatments were vital to their health, will endure protracted suffering from the letdown.

A smaller group could pay an especially heavy price.

It is at least arguable that a select population of youths are best served by medically transitioning in early adolescence — namely, those “true transsexuals” who would have qualified under the original Dutch protocol.

But few people in gender medicine are even trying to discern those children from others for whom the risks of medical intervention, including infertility and the loss of healthy body parts, dwarf likely benefits. Many leading voices in this field want to end assessments entirely. They believe that whatever a kid says should go, and that questioning such impulses is stigmatizing and harmful.

This leaves the average person to wonder: Have you ever met a teenager?

Had pediatric gender medicine remained as cautious as the Dutch had first established it to be, it’s possible these medical practices would have kept operating quietly in the shadows. But the leaders in this movement egregiously overplayed their hands — and provided so much fodder for anxious parents and the field’s enemies on the right they effectively robbed the tiny minority of youth who truly might have benefitted from these interventions of a chance to receive them quietly in private.

That’s an American tragedy, and it’s still unfolding.

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Benjamin Ryan is a veteran health and science journalist who covers pediatric gender medicine on his Substack, Hazard Ratio.