Transitioning Back to Sanity

Ed. Note: This column involves a subject that is graphic in nature and may be upsetting to some. Readers are duly warned.

As soon as he returned to the Oval Office this January, Donald Trump unleashed a flurry of executive orders. He signed a whopping 37 in the first week of his second term — a historic clip. Some were righteous (e.g., restoring the Hyde Amendment, which prevents federal funding or promotion of abortion), others ridiculous (e.g., renaming the Gulf of Mexico to the Gulf of America). Among the former, one executive order is particularly worthy of our attention. Titled “Protecting Children from Chemical and Surgical Mutilation” (henceforth PCCSM), it addresses what I’ve termed transanity (see my column “Transanity Is Taking Over. How Will the Church Respond?” Jan.-Feb. 2024), or the rapid — and reckless — rise of gender ideology.

Gender ideologists believe that gender (male or female) is “assigned at birth” by parents, a doctor, or both, and that a person can “transition” from one gender to another with the aid of hormone therapy and surgeries. These ideologues command a multifaceted and massively successful movement, one that has altered the contours of education, entertainment, language, athletics, politics, and medicine. And it’s a money machine. As of 2022, the U.S. sex-reassignment-surgery market size was estimated at $2.1 billion, with an expected compound annual growth rate of 11.25 percent. Pharmaceutical giants, healthcare providers, insurance companies — they all stand to profit from the proliferation of what’s euphemistically labeled gender-affirming care.

One of the fastest areas of growth in this movement is so-called gender-affirming care for minors (henceforth GACM). A decade ago, there were only a handful of gender clinics for children in North America; as of today, there are over 400. In these clinics, and in hospitals across the nation (including nearly 150 Catholic hospitals), medical professionals have been “maiming and sterilizing a growing number of impressionable children under the radical and false claim that adults can change a child’s sex through a series of irreversible medical interventions,” PCCSM states. When an adult pushes a child down the path of transition, that child will need gender-related therapies for the rest of his life. Studies show that well over 90 percent of children who start puberty blockers (the long-term effects of which are still unknown) progress to cross-sex hormones. Some then advance to radical surgeries that often have serious complications and require — you guessed it — more medical interventions. Each child who suffers from gender dysphoria (or what was known as gender-identity disorder until the ideologues made inroads into the American Psychiatric Association just over a decade ago) is a potential cash cow.

In declaring that henceforth it is “the policy of the United States that it will not fund, sponsor, promote, assist, or support the so-called ‘transition’ of a child from one sex to another, and it will rigorously enforce all laws that prohibit or limit these destructive and life-altering procedures,” PCCSM threatens to cut off a major source of income for powerful — and powerfully greedy — groups. PCCSM instructs all institutions receiving federal grants to desist from performing “chemical and surgical mutilation of children,” and all federal insurance policies to remove such procedures from coverage.

Given what’s at stake, it was inevitable that the proponents, practitioners, and profiteers of GACM would push back against PCCSM — and push back hard. So, it came as no shock when, this February, the ACLU (of course) filed a complaint in federal court, suing the State Department, the secretary of state, the president, and the United States of America. PFLAG, the nation’s largest pro-LGBTQ+ organization, and GLMA, the country’s largest organization of LGBTQ+ medical professionals and their allies, are also plaintiffs in the case. In response to the suit, Judge Brendan Hurson, a Biden appointee (of course), issued a temporary restraining order blocking enforcement of PCCSM.

By then, however, multiple hospitals across the country (including most Catholic hospitals) had paused their GACM practices, including prescribing puberty blockers and performing sex-reassignment surgeries.

Even before Trump signed PCCSM, the tide was beginning to turn. As of November, 26 states had enacted laws or policies limiting GACM, some of which carry heavy penalties for infractions. In Idaho, a physician who provides GACM could face up to ten years in prison. In Florida, parents who allow GACM could lose custody of their child. In Missouri, patients who change their minds after consenting to GACM can sue their doctors for up to $1.5 million in damages.

The political and legal battles over GACM will surely be intense. As we watch them unfold, we would do well to ask: How did we get here?

PCCSM offers a clue. “The blatant harm done to children by chemical and surgical mutilation cloaks itself in medical necessity,” it says, “spurred by guidance from the World Professional Association for Transgender Health (WPATH), which lacks scientific integrity.”

What is WPATH? It is, essentially, an international clearinghouse for gender-related medical care (care, in this case, being a duplicitous term). WPATH bills itself as an “interdisciplinary professional and educational organization devoted to transgender health.” It was founded in 1979 by John Money, a controversial “sexologist” at Johns Hopkins University who believed people are born without a gender, and a person’s “gender identity” is determined mostly by social influence. He also claimed that pedophilia is just another “sexual orientation” (a term he is credited with coining), like heterosexuality and homosexuality, and should be “accepted for its etymological meaning, which is simply the love of children.”

Money is most well known for his role in the infamous “Reimer twin” case. The Reimers were a Canadian family who welcomed twin boys in 1965. During his circumcision, one twin’s penis was accidentally severed. His parents sought Money’s advice, and Money recommended the 22-month-old undergo an experimental surgery that would allow him to live as a “girl.” His parents consented, and the boy’s testes were removed and a “vulva” constructed in their place. His parents then gave him a girl’s name, put him on estrogen so he would grow breasts, and raised him as their daughter, encouraging him to engage in typical female pursuits, such as wearing dresses, playing with dolls, and socializing with girls.

Money theorized that the boy would assume the gender identity with which he was raised rather than that of his biological sex. Money’s treatment included having the twins, as young as six years old, perform “sexual rehearsal play” by stripping naked, inspecting each other’s genitals, and simulating intercourse. Money sometimes photographed these sessions. He published extensively on the case in the 1970s, offering it as proof of his theory that gender is primarily learned. He claimed that the transgendered twin behaved like a girl and didn’t demonstrate any of the boyish mannerisms of his brother.

But the twin never felt like a girl. He sensed that he was really a boy living as a girl. Throughout adolescence he suffered gender dysphoria, depression, and suicidal ideation. As a teen he discovered what had been done to him, and he decided to live as a boy. He underwent testosterone treatment and had surgeries to remove his breasts and reconstruct a penis. Yet, even as an adult, he suffered psychological and emotional problems — due to Money’s experiments and his childhood trauma. He struggled with unemployment and marital difficulties. Finally, at age 38, he committed suicide. Two years earlier, his twin brother had died of a drug overdose.

Money’s theories were largely debunked once the Reimer twins’ true story was revealed in the late 1990s. Yet his theories live on in WPATH’s Standards of Care. And these guidelines for the treatment of gender-dysphoric individuals have been adopted by numerous medical organizations, including the American Academy of Pediatrics, which recommends puberty blockers, cross-sex hormones, and even sex-reassignment surgery for adolescent children.

The Trump administration’s PCCSM rightly calls WPATH’s Standards of Care “junk science” and demands that “all policies that rely on WPATH guidance” be rescinded or amended.

As with the tragic case of the Reimer twins, we can’t answer the question of how we got here without shifting our focus from the macro view of ideology and politics (and the money trail it discloses) to the micro view of the people whose bodies and futures have been altered — often irreparably — by the junk science WPATH and others sell.

For that we may turn to The Detransition Diaries (Ignatius, 2024) by Jennifer Lahl and Kallie Fell, both of whom are nurses and officers in the nonprofit Center for Bioethics and Culture. Their book examines the human cost of what they call “activist-driven medicine” by recounting the experiences of seven gender-dysphoric individuals who “believed the lie they were told by peers, teachers, and medical professionals that they could be their ‘true’ selves by medically and surgically altering their bodies to match the opposite sex.” As adolescent girls are disproportionately affected by the trans movement, five of the seven individuals whose stories Lahl and Fell tell are women. The authors glean from their personal tales “three interwoven yet distinct themes” that together help pull gender-dysphoric girls into the sway of the trans movement:

1. peer contagion (often spread via social media)

2. untreated mental-health concerns and related trauma (including sexual abuse)

3. fear of being female (based on perceived limits of being a female in a male-dominated society)

Take the case of “Helena.” A typical girly-girl (she liked dressing up and playing with Barbie dolls as a child), Helena lost her primary caregiver at a young age, and she suffered the emotional struggles that often entails. By 13 she was depressed, had developed an eating disorder, and was engaging in self-harm. She avoided socializing, preferring to spend most of her time online, particularly on Tumblr. At 14 Helena encountered an online peer group heavily influenced by a “social justice ideology” defined by a hierarchical notion of oppression and privilege: the more “oppressed” a person is, the more her opinion counts, whereas a “privileged” person has no right to an opinion. Helena felt this dynamic personally when at first she identified herself to the group as a “straight white girl.” She felt compelled constantly to apologize for her inborn “privilege.” At 15, when she declared she had changed her pronouns from “she/her” to “they/them,” she immediately received better treatment from the group — she was now one of the “oppressed.” Buoyed by such approval, Helena soon took to calling herself “nonbinary” and a “demi-girl” (close to, but not quite, a girl). By 17 she was describing herself as a boy, displaying masculine mannerisms, and assuming outwardly masculine features — cutting her hair and wearing boys’ clothing. Thus began the first phase, her “social transition.”

Another aspect of Helena’s life online contributed to her confused sense of self: She was only 10 when she was first exposed to pornography online. Though it disturbed her initially, the online peer groups she engaged with in her teens were openly pro-porn. In another example of their hierarchical thinking, they put a premium on “kinkiness,” holding violent pornographic fantasies in highest esteem. Those who demurred were branded “antifeminist,” and Helena felt compelled to feign interest and excitement, despite her reservations about being on the receiving end of sexually charged violence for someone else’s erotic pleasure. But she didn’t want to risk alienation from the only group to which she felt she belonged. Transitioning to male seemed a way to mitigate this problem.

Meanwhile, at school, none of the staff, teachers, or counselors reached out to Helena when she was clearly struggling with her mental health. But once she declared her intent to transition, “they all wanted to bend over backwards to help me be trans,” she said.

As her parents didn’t approve of her transition, Helena made an appointment with Planned Parenthood as soon as she turned 18 to inquire about testosterone treatment. The appointment lasted about an hour, and she talked for 20 minutes to a social worker, after which she was determined to be a “perfect” candidate. She also discussed future chest and facial-masculinization surgeries to complete her transition. A nurse practitioner asked her what dosage of testosterone Helena wanted. “The highest we can go,” she answered. She received a prescription for 100 milligrams per week at that first, brief visit to Planned Parenthood. Thus began her “medical transition.”

After a few weeks on testosterone, Helena began experiencing intense flashes of anger. She struggled to control her emotions, and her wild fury made her feel like she was “possessed.” In an attempt to quell her frequent outbursts, she resumed her self-harm, for which she eventually ended up in the hospital. Yet no one there connected her radical personality changes to her testosterone use. The antidepressants and antipsychotics they prescribed her didn’t help. “My life just became a total disaster,” she recounts. “I wasn’t functioning at all. I wasn’t holding down a job. I wasn’t going to school…. I felt like a monster.”

Helena had expected the treatment to help her become her “authentic self.” Instead, she had become profoundly dysfunctional and unhappy. After 17 months of agony, she decided to discontinue testosterone and stop presenting herself as a male. At last, her “detransition” had begun. Luckily for her, she never got those surgeries she had been planning.

Helena’s counterparts “Grace” and “Chloe” weren’t so lucky. They both underwent “top surgeries” (double mastectomies; Chloe at age 15) before realizing they’d been duped into making a terrible mistake. Grace’s insurance provider covered the removal of her healthy breasts but refuses to cover reconstructive surgery. As for Chloe, she came to the realization that “no matter what I did to myself, I would always be a woman.” She decided to go public about her detransition — first on social media, then in print and on podcasts, and eventually at state legislative hearings — and, she says, the intense backlash she’s received from the trans community has been “cruel,” “hateful,” and often “threatening.” Even those who were once her friends have tried to silence her.

Another detransitioner, “Rachel,” like Helena, had no surgeries, only testosterone treatment — but for five and half years. During that time she experienced loss of muscle mass, chronic skin issues, jaundice, kidney and liver failure, blood in her urine, endometriosis, vaginal atrophy, and three mini-strokes. Now in her late 20s and off testosterone, her estrogen levels are that of a menopausal woman. She will need to take supplemental estrogen for the rest of her life. As soon as she began sharing the story of her detransition (though not in so public a manner as Chloe), Rachel met with much animosity from the trans community, even from former friends, who’ve smeared her as a “traitor,” a “transphobe,” and a “TERF” (trans-erasing radical feminist). She’s even received death threats.

Detransitioners deserve not ostracization, threats, or scorn but sympathy, comfort, and support — as do those who are not inclined to detransition. They, too, have been sold a false bill of goods.

Now that she is older, Helena wonders why so many adults fail to grasp that adolescents are emotionally and intellectually unprepared to make permanent, life-changing decisions. Have they forgotten what it’s like to be a teenager? How could the physicians, therapists, and school personnel who pushed her (and so many others like her) down the path to transitioning lack a basic understanding of the adolescent experience? It seems that a misguided sense of “compassion” coupled with aggressive activism has displaced the common sense of too many adults. Lahl and Fell ask how we can hold them responsible for the harm they’ve inflicted on vulnerable young people. The states of Idaho, Florida, and Missouri have provided an answer.

Let us pray that PCCSM is the turning point marking the transition away from what it calls a “terrible trend” and a “shameful stain on our nation’s history.” The future of our citizenry, no less than our national sanity, depends on it.

“Gender ideology directly repudiates reality…. Gender ideology rejects any human experience that conflicts with its own flawed premises; it’s the imperialism of bad science on steroids…. For American culture…the body is now little more than animated modeling clay.” — Archbishop Charles Chaput, Strangers in a Strange Land

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