The Problem with the Trans Child, Part 2 of 3

Youth gender medicine causes harm

This three part series on gender medicine for youth is inspired by conversations between myself and real-life friends. See part 1 of the series here.

In part 1, I showed that gender medicine—which typically includes puberty blockers, hormone injections and surgeries—is unnecessary, as it confers no proven benefit. We could stop there. But these interventions are worse than unnecessary; they’re harmful. Let’s look at the piles of evidence available.

Puberty Blockers

Puberty blockers are typically the first step of transitioning a child. They’re sometimes called a “pause button” that allows the child time to think, and they’re often billed as “safe and reversible.” But is that true?

Puberty blockers have been around a long time. Names for this family of drugs include gonadotropin-releasing hormone agonists (GnRH agonists or GnRHA), luteinizing hormone-releasing hormone agonists (LHRH agonists), antiandrogens, androgen suppression therapy, androgen depressive therapy, and the brand name Lupron, among others.

Before gender medicine was a thing, these drugs were used to delay “precocious puberty,” a condition causing premature development of sex characteristics in kids, which can bring social stress and stunt their height. Many among this intended patient population have suffered “irreversible side effects and permanent severely disabling health problems” as a result of these drugs. More on that in a bit.

The use of puberty blockers for gender dysphoria is off-label, meaning these drugs weren’t developed for that condition and haven’t been approved for it—kind of like Ivermectin for Covid.

Here’s another off-label use for these drugs: reducing the libido of pedophiles and sex offenders. Known as “chemical castration,” this treatment has been called “problematic” for “human rights.” Its use in this population is limited to certain clinical settings “due to side-effects.”

Let that soak in: We’re freely prescribing a drug to kids that has been deemed too risky for outpatient sex offenders.

The drug is also prescribed for uterine disorders and cancers in other adults, where its label warns that overuse could cause “serious bone density loss.” Which brings us to the precocious puberty cohort.

I highly recommend reading this article in its entirety, describing “more than 10,000 adverse event reports filed with the FDA” by women who were prescribed Lupron as children. These women, many in their twenties, report bone disorders typically affecting the elderly—including osteoporosis, “cracked vertebra,” “cracked teeth,” and at least one “total hip replacement.” One patient at 30 “had more surgeries than her 79-year-old father” and another “muscle weakness so severe that she could barely lift her arms to wash her hair.” Additional reports mention wheelchair use, chronic pain, “degenerative disc disease,” “jaw-joint dysfunction,” “deteriorating vision,” and seizures.

Lest these reports seem anecdotal, this study confirms the connection between GnRH agonists and osteoporosis. This one confirms a “significant” increase in fracture risk with such treatment, and this one found “relative risk of vertebral and hip fractures increases by 40%-50%.” In one case, a female patient “who started GnRHa at age 12” for gender dysphoria “experienced four broken bones by the age of 16.”

So they’re not that safe. Are they reversible?

In part 1, I showed that most gender dysphoric kids, if left alone, will grow out of their gender confusion—some 80% to 95%. Yet nearly all who are given puberty blockers “proceed to a medical pathway.” Why is that?

Puberty is more than a time of sexual changes in the body. It’s “a sensitive window of neurodevelopment” that ushers in a “magnitude and complexity of changes that occur in brain function and structure.” Not only does blocking puberty negatively impact cognition (with “no evidence” that’s reversible), but many researchers theorize that puberty itself brings the intellectual and sexual maturity required to resolve gender confusion. As the story of Jazz Jennings illustrates, children on puberty blockers fall behind their peers developmentally and socially as well as physically, leaving them with little in common with boys and girls their age.

Natal boys blocked early will have a “micropenis” and will never achieve orgasm as adults. A Mayo Clinic study, summarized here by journalist Christina Buttons, finds “mild to severe atrophy” in boys’ testicles after taking blockers.

With their “underdeveloped” genitalia and disinterest in dating, is it any wonder they fail to move beyond an immature understanding of their sexual identity?

And what about their future? Medically-induced sexual dysfunction limits their choice of partners and robs them of the physical intimacy that facilitates bonding and long-lasting relationships.

Hormone Treatment

Like puberty blockers, the use of hormone replacement therapy (HRT) for gender issues is off-label. The risks of HRT are well known and documented on medical information sites everywhere, including gender-affirming care sites, with cross-sex use posing additional risk.

Depending on birth sex and hormone combination, side effects implicated include increased risk of certain cancers, blood clots, gallstones, Alzheimer’s, ulcerative colitis, stroke, cardiovascular disease and thrombosis. Sexual dysfunction, sex organ atrophy, and infertility are major concerns, especially with long-term use or in conjunction with other treatments.

Substacker Helena describes experiencing what was essentially “roid rage” when she went on testosterone at the age of eighteen: "Something that before would have made me mostly sad, or even frustrated, made every cell in my body overflow with rage. The anger was also of a different quality than the kind of anger I experienced before… While I was on testosterone, the anger demanded to be externalized. I felt like my body would explode if I couldn’t hit or throw something, and this scared me.”

Trans man Buck Angel, who was an early “guinea pig” for female-to-male transition, discovered the hard way that “estrogen is what makes a vagina function properly.”

“Testosterone had atrophied my reproductive system,” writes Buck, who collapsed one day with a 101-degree fever and was rushed to the hospital to learn that “atrophy [had] fused my uterus and my cervix together, along with my ovaries and everything else, creating an infection that burst and became septic.”

Surgeries

While it’s more common for kids to receive puberty blockers and hormones, gender-affirming surgeries are performed on minors. The World Professional Association for Transgender Health (WPATH) recently removed age minimums for gender affirmation surgeries (previously set at age 15) from its Standards of Care, apparently under political pressure from U.S. Minister of Health (and trans person) Rachel Levine. At the footnote are several studies that examine gender surgeries in minors.¹

Additionally, gender surgeries are normalized as an eventual endpoint for socially-transitioned kids, especially in conjunction with puberty blockers, and as we saw in part 1, early interventions increase the likelihood of later surgery.

Below I discuss several specific gender-related surgeries.

Mastectomy

Double mastectomy is the gender-related surgery most frequently performed on minors. The procedure is “distinctly different in regard to anatomy, goals, and execution” from basic mastectomy, often entailing chest sculpting and nipple repositioning for a more masculine-appearing result.

This study found a 12% complication rate, though they called that “rare.” This one found an 18% complication rate with 11% of patients requiring additional surgeries. Undesirable outcomes include “scarring, contour deformities,” and undesirable “nipple appearance.” Complications include hematoma, infection, nipple necrosis—that’s tissue death—and loss of the nipples.

Phalloplasty

This female-to-male surgery begins with removing large swaths of skin from the forearms or legs with which to build a flaccid “penis.” The urethra is re-routed through the constructed phallus, though that often fails to achieve the desired result—which is to allow the patient to pee while standing up. Penetrative sex isn’t possible, except with a technique allowing the insertion an external “erectile prosthesis” (which can puncture all the way through the skin if used too ambitiously).

This surgery has the worst complication rates of any gender surgery—a whopping 75.6% according to this systematic review of available studies. Complications include numbness, pain and infection (sometimes requiring “incision and drainage”) in both the skin graft site and genital area, and much worse—like kidney disease. Fistulas, which are breaches in the flesh between two orifices resulting in the leakage of urine or feces, occur in 22% to 75% of patients. Other complications include UTIs, urethral strictures, long-term catheterization, and tissue death (sometimes requiring “debridement” or “secondary correction”).

Vaginoplasty

This male-to-female surgery splits and inverts the penis to create a facsimile of a vagina (called a neovagina). “Rates of complications following penile inversion vaginoplasty range from 20% to 70%.

Ironically, this surgery presents fewer complications for those adult males who received no prior gender treatment as children, so that abundant “raw material” (read: adult-sized penis flesh) will be available with which to sculpt new genitals.

When performed on individuals whose puberty was blocked (and thus have only a micropenis), this surgery requires the augmentation of extra tissue outside the genitals. This tissue is typically taken from the colon, the intestine or the peritoneal lining, which is a membrane that lines the inside of the abdomen and protects the internal organs.

Colonic and intestinal vaginoplasty complications include “foul smell” (from the colon tissue), “prolapse of neovagina, adenocarcinoma of neovagina, diversion colitis, and ulcerative colitis.” With all types of vaginoplasty, complications include “fistulas, vaginal and urethral stenosis and strictures, tissue necrosis, and prolapse,” as well as “rectal or urethral injury” and “separation of the surgical incision.”

Jazz Jennings, whose surgery was augmented by peritoneal lining, suffered that last complication, as well as three revision surgeries in addition to the initial vaginoplasty.

Specific Cases

Stories abound on X, TikTok, and Reddit of botched mastectomies and genital surgeries performed in the name of gender affirming care. A Reddit group for “detransitioners,” or people who regret transition and wish to return to their natal sex, has 55,000 members and growing. While these stories constitute only anecdotal evidence, our hearts should break for any kid whose healthy body was compromised for a “treatment” we know doesn’t work.

This female-to-male patient has undergone a phalloplasty as well as 11 total revision surgeries, but still must use a colostomy bag.

This famous male-born detransitioner (with 66k X followers) was left with a numb crotch (“You could stab me with a knife and I wouldn't know”), a narrow vaginal cavity that “only seem[s] to pick up pain, rather than pleasure,” and urinary difficulties.

This female-born patient shares a horror show of photographs of her botched mastectomy as well as her difficulties getting proper care for infection, finding someone to perform a revision, and getting insurance to cover the complications.²

There are many other transition regretters and detransitioners who speak on this topic, including Scott Newgent, Shapeshifter and more. I’ll update this article to include their platforms at a later time.

In part 1, I dispelled the myth that kids who don’t transition are at greater risk for suicide. Here I’ll list a few whose deaths resulted from transition itself.

In the original Dutch study credited for setting our standards for gender-affirming care (such as they are—see part 3), one youth died as a direct result of a complex colonic vaginoplasty after puberty blockade.

This female-born transitioner, who felt like a “monster” after a surgically-created penis showed “symptoms of rejection,” suffered “unbearable psychological suffering” and opted to die by euthanasia.

This young female-born patient, who looks ill in a final tiktok post, died of a stroke after suffering blood clots, kidney disease, sepsis, a heart attack, a brain bleed and more all stemming from a botched phalloplasty.

This 23-year old male-born patient took his own life after a vaginoplasty left intestines spilling from his neovagina. He left his suicide note in a Yelp review of the doctors who botched his surgery then refused him follow-up care.

1. “A 2017 study of 20 WPATH-affiliated surgeons in the US reported slightly more than half had performed vaginoplasty in minors,” Standards of Care for the Health of Transgender and Gender Diverse People, Version 8, Coleman et al, link

“The Komodo analysis of insurance claims found 56 genital surgeries among patients ages 13 to 17 with a prior gender dysphoria diagnosis from 2019 to 2021”; “At least 776 mastectomies were performed in the United States on patients ages 13 to 17”; “This tally does not include procedures that were paid for out of pocket.” Number of transgender children seeking treatment surges in U.S., Robin Respaut and Chad Terhune, link

“Of the 209 patients who underwent surgery, the median age at referral was 16 years (range 12-17),” Gender-Affirming Mastectomy Trends and Surgical Outcomes in Adolescents, Tang et al, link

Age Is Just a Number: WPATH-Affiliated Surgeons' Experiences and Attitudes Toward Vaginoplasty in Transgender Females under 18 Years of Age in the United States, Milrod et al, link

Chest Reconstruction and Chest Dysphoria in Transmasculine Minors and Young Adults, Olson-Kennedy et al, link

Prevalence of Gender-Affirming Surgical Procedures Among Minors and Adults in the US, Dannie Dai et al, link

Gender-affirming hormones and surgery in transgender children and adolescents, Mahfouda et al, link

2. Hat tip to Exulansic for most of the research on specific cases cited here.