Enforcer
The Trump administration is tightening the screws on the US industry that markets paediatric medical transition
In the US, the Trump administration’s campaign to restrict paediatric medical transition is unfolding rapidly on multiple fronts. The retreat of gender clinics even in Democratic-voting states has been reported with obvious dismay by The New York Times. Typical coverage in liberal media outlets makes much of the distress of young people deprived of “trans healthcare,” with little sense there might be any reason for this, beyond crass political targeting.
However, it’s noteworthy that Children’s Hospital Los Angeles, which has just shut down the country’s biggest gender clinic, cited as one factor the sobering 400-page review of the (very weak) evidence base issued in May by the US Department of Health and Human Services. In keeping with the clear policy aim of President Trump’s January 28 executive order against gender medicine for minors, his administration has stepped up to enforcement mode.—BL
Frontline action
Moment of truth | The US Federal Trade Commission (FTC) has launched an inquiry into consumer fraud in the gender medicalisation of minors, including failure to disclose material risks, and false or unsubstantiated claims about the benefits or effectiveness of puberty blockers, cross-sex hormones and trans surgery. The 60-day period for public comment, which includes provision for anonymous complaints, follows a historic workshop in Washington DC on paediatric medical transition, which brought together FTC officials, doctors, medical ethicists, whistleblowers, detransitioners and parents.
The FTC’s July 28 request for public comment is “a quiet but seismic move,” according to the LGB Courage Coalition, whose executive director is the gender clinic whistleblower Jamie Reed. “For the first time, a federal agency is asking whether ‘gender-affirming care’ is consumer fraud,” the coalition says in a post.
At the July 9 workshop, child psychiatrist Dr Miriam Grossman said the fraud and deceptive practices dated from the 1960s invention of the concept of “gender identity,” through the misrepresentation of “one tiny Dutch study” as a secure foundation for the widespread adoption of paediatric gender medicine, to the constant refrain that gender-affirming care enjoys expert consensus, when in truth it entails “the silencing of opposition.”
Detransitioners Prisha Mosley and Claire Abernathy have reprised their workshop testimony here. One mother, Elvira Syed, told attendees of losing her exceptional but struggling 18-year-old daughter, Ilene, “to gender ideology and to a system that failed her at every step.” Video of the almost 8-hour workshop is available.
Subpoenas | Also at the workshop, Department of Justice (DOJ) chief of staff Chad Mizelle outlined several avenues of civil and criminal investigation. These involved the pursuit of gender clinics and hospitals for false statements and fraudulent billing, but also new scrutiny of non-profit organisations and medical associations “that have provided false, deceptive or scientifically dubious assertions about transition-related medical interventions, allegedly as cover for the clinics and the hospitals to be able to do what they’re doing.” Mr Mizelle said “nearly 20” subpoenas had been issued to gender clinics, and subpoenas had also been sent to pharmaceutical manufacturers “for possible violations of drug marketing laws and the Food, Drug and Cosmetic Act.”
On July 28, it was revealed that Boston Children’s Hospital, the first specialist gender clinic in the US to import the Dutch protocol of paediatric medical transition, was among the institutions subpoenaed by the DOJ. The hospital used to advertise its sizeable team of Harvard University-credentialed gender surgeons available to operate on adolescents and young adults. Back in that more sanguine era, public broadcaster WBUR in 2018 ran with the celebratory headline “Boston Children’s Hospital Constructs Penis For Transgender Man—A First In [Massachusetts].”
Video: A documentary by journalist Jennifer Block and filmmaker Eric Vaughan explains that unease about youth gender medicine is not about politics, but evidence—or rather the lack of it
Closed for business
Clinics in retreat | The White House has welcomed the closure of the largest US paediatric gender clinic, at Children’s Hospital Los Angeles (CHLA), and the suspension or cessation of gender medicalisation of patients under age 19 at some 20 facilities and health networks across the country. January’s Trump executive order had declared it was now “the policy of the US 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.”
In a June email to CHLA staff, hospital executives cited federal initiatives that “strongly signal this 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 initiatives highlighted by CHLA executives were an April memo from US Attorney-General Pam Bondi targeting paediatric medical transition as potentially felonious “female genital mutilation”, the Gender Dysphoria Report issued by the US Department of Health and Human Services, and the FBI going public to seek tips about surgical “mutilation” of minors “under the guise of gender-affirming care.”
CHLA, Boston Children’s Hospital and Children’s Hospital Colorado are under investigation for “alleged child mutilation,” according to National Review. (CHLA’s high-profile gender clinic director, Dr Johanna Olson-Kennedy, reportedly said last year that the discouraging results of a national puberty blocker study had been held back lest they be “weaponised” by opponents of gender-affirming care. She also faces a lawsuit from a detransitioner, Kaya Clementine Breen.)
A hospital linked to Yale University—home to paediatrician Dr Meredithe McNamara and her “white paper” suggesting the 2024 Cass review was no reason to pull back on gender medicine—announced on July 23 an end to puberty blockers and cross-sex hormones for patients under 19.
On July 30, in settling a wider dispute with the US government, Brown University undertook to “not perform gender-reassignment surgery or prescribe puberty blockers or hormones to any minor child for the purpose of aligning the child’s appearance with an identity that differs from his or her sex.” Brown’s president Christina Paxson said the university would “refer affected students who seek care from Student Health Services or the University Pharmacy to area specialists.”
Brown said the settlement restoring federal research funding left intact the university’s values of “academic freedom and freedom of expression.” Its leadership had arguably buckled to trans-activist pressure after publication of the 2018 “rapid-onset gender dysphoria” paper by Dr Lisa Littman, then-assistant professor of the practice of behavioral and social sciences at Brown. During the controversy, the university insisted academic freedom and inclusion were not mutually exclusive, stating it was “proud to be among the first universities to include medical care for gender reassignment in its student health plan, and that our medical school is a leader in education on care for transgender individuals.”
Brown’s medical school is home to Clinical Assistant Professor Jason Rafferty, principal author of the American Academy of Pediatrics’ 2018 “affirmation-only” policy statement, which was the subject of a withering and unrebutted “fact check” by researcher and clinical psychologist Dr James Cantor.
In its July 22 news report, The New York Times noted that funding threats and subpoenas issued by the Trump administration were advancing its policy “in some of the most heavily Democratic places in the country.” The large California-based health service Kaiser Permanente—which is being sued by two detransitioners, Chloe Cole and Layla Jane—has announced a pause to under-19 trans surgery from August 29.
The US government is pulling several levers in its attempt to squeeze paediatric medical transition. “In May, nine leading children’s hospitals across the country received letters from the Centers for Medicare and Medicaid Services, demanding data on revenue from pediatric gender treatments and the rates of regret among patients,” The New York Times reported on July 10.
Video: Professor Paul McHugh, one of America’s most distinguished psychiatrists, applies a sharp, historical perspective to today’s gender confusion
Opportunity cost
Discipline of the dollar | The purse-strings threat of President Trump’s executive order, which has been the subject of court injunctions, is to be enforced with a new rule on eligibility for federal funds, National Review reported on July 17.
“The Department of Health and Human Services will soon begin the rule-making process to prohibit the federal government from directly funding sex-trait modifications for minors [that is, paediatric medical transition] through Medicaid and the Children’s Health Insurance Program (CHIP),” the magazine said.
“The White House is in ‘the final stage of review for a new rule that would make it a condition of hospitals participating in Medicare or Medicaid that they not provide sex trait modifications to minors,’ according to an administration official. The prohibition will apply to hospitals that provide puberty blockers, cross-sex hormones, and gender-transition surgeries to minors.” (This is intended to have the same effect as a thwarted legislative provision championed by Texas Republican Dan Crenshaw.)
The Trump administration official told National Review: “We are actively combing through all federal grants that go to the hospitals that still provide these procedures (surgeries, hormones, and puberty blockers) to kids, and sorting through what funding could be cut without jeopardizing the health and safety of other patients and critical research needs. We are identifying what cuts can be made consistent with ongoing injunctions and what cuts can be made immediately after the injunction is lifted.”
New ways to sue | A bill was introduced on July 22 to the US House of Representatives in order to create a federal tort for people harmed by gender medicalisation as minors. This is the House variant of a bill with the same title—the Jamie Reed Protecting Our Kids from Child Abuse Act—introduced to the Senate by Republican Josh Hawley in January. It would afford a private right of action against gender clinics and practitioners.
The Oregon Health and Science University Gender Clinic is a leading promoter of the medicalized, ideologically affirming approach to childhood and adolescent gender distress—and it operates in my adopted hometown of Portland. That’s why I’ve focused my attention here. With federal oversight or reform of such clinics long overdue, for now we’re left to scrutinize the public-facing materials ourselves.
One revealing feature of the clinic’s website is the curated set of promotional images, which seem more aligned with identity politics branding than with the delivery of evidence-based, ethically grounded health care. If gender identity is supposed to be an internal sense rather than a performance, the visual messaging raises a fair question: why is it so often about visibility?
Follow this link to see where the OHSU Gender Clinic markets itself to "Parents, Children and Teens." Can find the clinic's informed consent form? https://www.ohsu.edu/transgender-health/transgender-health-program-parents-children-and-teens
On that page, OHSU promotes its version of gender ideology—content that resembles indoctrination more than medicine. I have provided parenthetical notes that supply context and cautions that any responsible informed consent process ought to include.
GENDER IDENTITY IN CHILDREN AND TEENS
IN CHILDREN
Gender awareness: Children usually develop some sense of their gender by age 2 to 4.
(The concept of "gender" is contested: critics argue it is a socially constructed set of stereotypes rather than an innate identity. The claim that toddlers "sense" an internal gender relies on circular reasoning—children associate themselves with certain behaviors or preferences, and these are then used to retroactively assign them an identity. Biological sex is a definable characteristic; "gender" remains fluid and context-dependent.)
It’s common — and normal — for young children to want to look, talk and act like someone of a different gender.
(This is true and typically represents imaginative play or nonconformity, not an identity. The text fails to mention that most gender nonconforming children grow up to be gay or lesbian, not transgender—a critical omission.)
For many, this doesn’t last beyond puberty.
(Accurate but downplayed: multiple studies show that the majority of children with cross-gender identification or behavior desist and instead identify as same-sex attracted adults. This fact is often omitted or minimized in affirming models of care.)
Gender identity: Children are varying ages when they recognize that their gender identity is different from the one they were assigned at birth.
(“Assigned at birth” is an ideological euphemism. In almost all cases, sex is observed and recorded based on anatomy—it is not arbitrarily “assigned.” Also, the notion of a fixed, internal "gender identity" emerging in early childhood lacks robust empirical validation and is based on subjective reports.)
Many are as young as 3 or 4.
(Claims of gender identity at age 3 or 4 are highly disputed. Young children lack the cognitive maturity to understand abstract identity concepts. Their statements often reflect social influences or preferences, not stable identities.)
Others may not have this awareness until puberty or later.
(This is true, but again the framing presumes a stable, innate gender identity awaiting discovery, a position that remains scientifically unproven.)
Gender expression: There’s no typical way in which children express gender diversity.
(This statement is vague and blurs the distinction between personality, behavior, and identity. Not all forms of nonconformity imply a different identity. This framing encourages pathologizing or reifying atypical behavior.)
Some, seeking to please their family or fit in at school, may not express it at all.
(This suggests that unexpressed gender diversity is common, which is speculative and may encourage clinicians or parents to interpret ordinary behavior through an ideological lens.)
Gender dysphoria: Gender dysphoria refers to the discomfort some young people feel about their gender identity not matching the gender they were assigned at birth.
(Again, “assigned at birth” is ideologically charged and misleading—biological sex is observed, not imposed. This framing promotes the idea that a subjective identity can override objective sex, which is a matter of ongoing ethical and scientific debate.)
It often emerges or becomes apparent in kindergarten or first grade, when expectations to conform to gender roles increase.
(This is speculative and sociologically framed. It implies that dysphoria is socially induced, which raises the question of why identity-based interventions are prescribed rather than addressing the child’s distress or environment.)
Children often become distressed about not being able to wear the clothes they wear at home, for example.
(Distress over clothing restrictions may reflect parental or social rigidity more than an internal gender identity. The example is simplistic and potentially misleading.)
IN TEENS
Gender dysphoria: Some teens become aware of their gender identity or choose to express it at puberty.
(This conflates awareness, identity, and expression. It also avoids discussion of the rapid rise in adolescent-onset dysphoria among natal females, which some researchers link to social contagion or underlying psychological issues such as trauma, autism, or depression.)
The sex traits that develop in puberty — such as chest development, body hair or voice changes — can intensify or lead to gender dysphoria.
(“Chest development” is a euphemism for breast development and obscures the reality of what causes distress for many natal females. This vagueness may facilitate medical intervention without informed clarity. Also, the framing suggests a one-way causal link between puberty and dysphoria, ignoring the complex biopsychosocial context.)
Gender dysphoria in teens is highly likely to last into adulthood.
(This is a contested claim. While some studies on clinically referred youth—especially those who begin medical transition—report persistence, these samples are subject to selection bias. Other research suggests that many cases of adolescent-onset gender dysphoria, particularly among natal females, may be transient. Moreover, longitudinal studies from earlier cohorts indicate that the majority of gender-dysphoric teens—especially those who are not socially or medically transitioned—will desist and go on to identify as gay or lesbian. Critics argue that early affirmation and medicalization can derail normal psychosexual development, locking in a transgender identity that might otherwise have resolved into same-sex attraction.)
Emotional issues: Gender dysphoria can worsen emotional issues that often come with puberty, such as anxiety and depression.
(This is plausible, but it implies that dysphoria is the root cause of emotional distress rather than a symptom. Many teens who identify as trans have preexisting mental health issues. The direction of causality is unclear.)
Teens with gender dysphoria are twice as likely to have suicidal thoughts as other teens, research shows.
(This figure has been widely cited but is disputed. It often comes from surveys of self-selected samples or cross-sectional studies that cannot determine causality. Suicidality is elevated in many marginalized or distressed populations, not just those with gender dysphoria. Importantly, the text omits that no robust evidence shows medical transition reduces suicide risk long-term.)
At last. Oh to have a sensible government in this country. One that protects children from activists.