The End of Youth Gender Transition?

The End of Youth Gender Transition?

Emily Yoffe - 06.18.25 — Sex and Gender - The Free Press

https://www.thefp.com/p/the-end-of-youth-gender-transition

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In a landmark decision, the Supreme Court ruled that states can restrict the ability of minors to get transition treatment. It’s long overdue

In a 6–3 decision handed down today, the Supreme Court of the United States has upheld the ability of the states to ban or restrict so-called “gender-affirming” medical care for minors. This landmark decision will help bring this medical scandal to a deservedly ignominious end.

Since the earliest days of The Free Press, we have been documenting this movement that claimed it was providing lifesaving medical treatments to young people suffering from gender dysphoria—that is, distress at their biological sex. In less than two decades, what was once an extremely rare diagnosis became so common that at least 100 clinics in the U.S. opened to provide medical interventions intended to help children pass as members of the opposite sex.

The number of young people in the West seeking such treatments has exploded. And, in a break with history, in which a small number of boys expressed the desire to change sex, this rise was fueled by adolescent girls, many who had never expressed previous gender distress. In the U.S., between 320,000 and 400,000 minors received a diagnosis of gender dysphoria or related diagnosis between 2017–2023, according to an analysis by the Manhattan Institute. The UK reported a twentyfold increase over a decade.

In its decision in United States v. Skrmetti, the Court concluded that restricting the ability of minors in Tennessee to get medical transition treatment “does not violate equal protection guarantees.” “The ruling effectively establishes a path forward for states to restrict practices their legislatures regard as harmful and inadequately regulated,” said Leor Sapir, a fellow at the Manhattan Institute. “A second-order effect, one can hope, is that the ruling will draw more attention to the flimsy evidence base, lack of reasonable clinical rationale, and ethical problems in the provision of these interventions to minors.”

The ruling comes at a time when the ground is already shifting underneath those advocating such transitions. In recent years, about half the states, generally red ones, have placed restrictions on transitioning minors. A number of clinics have closed as a result.

An early Trump administration act was an executive order declaring the federal government would no longer “fund, sponsor, promote, assist, or support the so-called ‘transition’ of a child from one sex to another,” and that it would “rigorously enforce all laws that prohibit or limit these destructive and life-altering procedures.”

Just last week, one of the country’s largest and most prominent pediatric gender clinics in one of the bluest states, California’s Children’s Hospital Los Angeles, announced that it will shut the doors of its Center for Transyouth Health and Development. According to hospital executives, the decision was the result of “a lengthy and thorough assessment of the increasingly severe impacts of federal administrative actions and proposed policies”—including the “administration’s intent to take swift and decisive action, both criminal and civil, against any entity it views as being in violation of the executive order.” The hospital leaders decided they could no longer risk providing such treatment to its nearly 3,000 patients.

The Court’s ruling is narrow; it says that a state has the right to regulate the practice. States, mostly blue, that still allow youth gender transition aren’t affected. But the decision will likely lend weight to the arguments of people who want to end the practice nationwide. And it will likely help the legal efforts by “detransitioners”—that is, young people who say they were pressured into life-altering treatments they now regret—to get compensation. Surely more such lawsuits will now be filed. Gender transition clinics will likely be under far more scrutiny: This Free Press story describes the cases of two such young women who were given prescriptions for testosterone after about a 30-minute appointment at Planned Parenthood.

The idea that biological sex is not a fixed reality but a social construct took hold so quickly that, seemingly overnight, children in preschool were being instructed they could easily change their sex if they felt they were in “the wrong body.” In June 2020, the prestigious New England Journal of Medicine ran an article championing the idea that when a baby is born we can’t know if the infant will come to “identify” as male or female, so we should only tentatively designate what the child is “assigned at birth.” The authors also said sex designations on birth certificates serve “no clinical utility.” This is only one of many examples of how profoundly this ideology has captured powerful institutions.

Children who express gender distress often suffer from a host of other medical and psychological issues, such as autism, ADHD, depression, or anxiety, or have experienced various traumas. But to the gender doctors in their lucrative new clinics, there was only one answer to such childhood troubles: gender transition. This usually meant medically blocking a child’s normal puberty, then putting that patient on opposite-sex hormones: testosterone for girls, estrogen for boys. Sometimes complicated and painful surgeries were undertaken to try to create new genitals. Thousands of teenage girls, and some not even teenagers, have received double mastectomies, known euphemistically as “top surgery”—a surgical intervention normally reserved to treat breast cancer.

In the U.S., gender-distressed children and their parents were told that without the swift intervention of these radical treatments, the children were likely to commit suicide. It became a cliché for the reluctant parents of girls seeking to transition to be asked by the gender provider, “Would you rather have a live son or a dead daughter?” (And vice versa for parents of boys.)

The clinicians assured parents there was robust evidence underlying their interventions, but this was false. During the oral argument in the case, Chase Strangio, the lawyer for the ACLU, arguing to overturn Tennessee’s ban, was forced to acknowledge to Justice Samuel Alito that “completed suicide, thankfully and admittedly, is rare.”

In her 2020 book, Irreversible Damage: The Transgender Craze Seducing Our Daughters, Free Press contributor Abigail Shrier described in graphic detail the effects of medical and surgical transition treatments on girls—reporting for which she was widely vilified at the time. Jamie Reed, the whistleblower from The Washington University Transgender Center at St. Louis Children’s Hospital, told readers of The Free Press of a healthy 15-year-old boy given a drug off-label, Bicalutamide, used for the treatment of metastatic prostate cancer. Why would a healthy boy be put on such a medication? Because the drug helps block testosterone, and one of its side effects is that it feminizes the male body. The doctor who prescribed it did so in the hope it would help this teenager grow breasts.

The Court’s ruling notwithstanding, the U.S. medical establishment remains firmly behind the practice. Compare that to England, where a rigorous and independent report, the Cass Review, concluded that the evidence for pediatric transition is “remarkably weak.” Finland, Norway, and Sweden are among the other Western nations that have joined the UK in moving away from this treatment.

It is widely observed that the vast majority of young people with gender dysphoria—even those whose distress is “consistent, insistent, and persistent”—when allowed to go through normal puberty, come to accept their biological sex. (And there is no way to identify the very small number of children who will go on to experience lifelong gender distress.) Many of these children turn out to be gay, which is why a rising number of gay adults and gay-rights advocates have become alarmed that the transgender movement is medically transitioning gay kids. They argue that this movement has, intentionally or not, reified homophobic tropes.

When the history of this era is written, historians will have to explain how transgender activists so quickly took over institutions, and were able to so successfully threaten the social and work lives of those who objected.

Critics of the Supreme Court decision will argue that our major medical associations, from the American Academy of Pediatrics, to the American Medical Association, to the Endocrine Society, have all given support to this new branch of medicine. This is true. It is also true that these organizations or similar ones once supported lobotomies and eugenics. Just as that is a source of shame today, it is to be hoped that their vehement support of medically transitioning vulnerable young people will be a source of shame in the future. These medical societies have failed in their most basic duty of care to their patients by embracing a model that has so little evidence and such profound lifetime consequences.

When the history of this era is written, historians will have to explain how transgender activists so quickly took over institutions, and were able to so successfully threaten the social and work lives of those who objected. We are confident that historians will also remember those courageous individuals who, at the risk of professional and personal ruin, did so anyway.