An Ob/Gyn's Report on “The Dangers of ‘Gender Affirming Care’ for Minors” (Part 1)

the FTC throws down the gauntlet before American organized medicine

One week ago, on July 9, the Federal Trade Commission held an extraordinary workshop (link: https://www.ftc.gov/media/dangers-gender-affirming-care-minors) at which they announced they were planning to investigate a number of mainstream medical organizations – the World Professional Association for Transgender Health, the American Academy of Pediatrics, the Endocrine Society, and the American Psychiatric Association were all named – for consumer fraud. I have never seen anything like it, and I hope never to again.

For seven hours, the FTC made a compelling case that by investigating these medical associations was in its purview – that they had published guidelines on youth gender medicine based on flimsy evidence, while assuring patients and their parents that the evidence was sound.

The unlikely coalition gathered in the auditorium included adult gays and lesbians who saw themselves in gender nonconforming youth; former employees at youth gender clinics who had become disturbed by what they saw; former youth gender clinic patients and their parents; many attorneys; physicians; and psychologists.

From a medical perspective, the workshop gave us the opportunity to hear from quite a few young people who have suffered ill effects from medical or surgical treatments they were administered as minors, who once identified as transgender but no longer do. They identify as detransitioners. Most doctors have been insulated from hearing their stories. Most doctors still think these stories are very rare. Unfortunately, at this point we know they are not.

I wish we lived in a different world, where the medical associations had treated the topic of gender medicine with the same rigor and demand for high-quality evidence that they insist on for the other medical conditions that their members treat every day. I wish that the nearest the FTC came to my field was chasing down the false claims of hokey diet pills. I have been a dedicated volunteer for my own medical organization, the ACOG, and I know the people who run it are good and devoted clinicians who want the best for their patients. I truly do not know how it came to this.

But without further ado, I present to you my notes on this very long and grimly fascinating day.

Introduction

Senior policy advisor John Schweppe kicked off the meeting by noting the diversity of the assembled coalition: “We have Republicans, Democrats, conservatives -- even feminists!” EVEN FEMINISTS, if you can imagine, were in that auditorium in Washington, DC.

Then the FTC Chairman, Andrew Ferguson, gave some fairly partisan opening remarks. The Biden administration was absolutely raked over the coals over the course of the day, and deservedly so, at least on this issue.

Chairman Ferguson made his case that the field of gender medicine was in his purview, since, “Congress has entrusted me with protecting citizens from deceptive acts and practices.” He argues that a pattern of deceptive practices in the field would unfold over the course of the day. Specifically, troubled and desperate young adolescents, without longstanding gender dysphoria, but with recent life trauma and associated mental health issues, found themselves questioning their gender and referred to gender clinics. There, allegedly, they and their parents were told that medical and surgical transition would be healing, and that not proceeding with medical transition would be risky and perhaps fatal. However, the treatment they received harmed instead of helped them.

Ferguson argues that parents believe they are getting “objective, evidence-based guidance,” when they are not. They are given an ostensible choice between agreeing to medical gender transition and the likely suicide of their child. “Would you rather have a dead son or a live daughter?” they are asked. Yet, the ACLU’s attorney arguing a recent case before the Supreme Court, Chase Strangio, admitted that, “There is no evidence in the studies that this treatment reduces completed suicide.”

Although the FTC does not regulate the practice of medicine, “The FTC mandate is to protect vulnerable people from deceptive claims about health and cures.” Ferguson argues the FTC has brought enforcement actions against false and misleading health claims, for example people selling herbs and spices to cure cancer, or, just last year, a company selling unproven stem cell therapy. He notes not everyone who undergoes gender affirming care will experience loss and regret. However, everybody has the right to be informed about the risks of these procedures.

The first panel: parents and survivors

The panels start out with a bang, with four heart-wrenching stories of young people’s care gone very wrong.

Simon Amaya Price: This incredibly sweet young man. His testimony was devastating. At 14, he was in crisis. He was at a new high school, the victim of merciless homophobic bullying, and sexually assaulted by an older boy. His parents took him to a therapist affiliated with Boston Children’s. He states that, between information he learned at school and “obsessive googling” he came to believe he was a transgender girl. He relates his therapist immediately and unquestioningly agreed with him and encouraged him to, secretly from his parents, attend a transgender support group. At 15, he shared his new gender identity with his pediatrician, who referred him to the gender clinic. However, his father was a career statistician who undertook his own analysis of the evidence behind pediatric gender medicine and found it lacking. When his father refused to take him, the pediatrician asked the father in front of Simon if he would rather have a dead son or live daughter.

“People are saying this,” Simon said, referring to the live versus dead trope. “I’m one of the lucky ones. I only socially transitioned… I didn’t lose any body parts… I was lied to by medical professionals. I was told that changing my name, my pronouns, taking hormones, going under surgeries, would fix me… I wish my doctors would have asked about the history of sexual assault, years of homophobic bullying, being called the F-slur… I wish they would have told me I was born in the right body and perfect just the way I was. Nobody told me that except for my dad… We cannot expect every parent to be a trained statistician, and that is why we are here today.”

Gareth Amaya Price (Simon’s dad): Gareth adds that Simon had undiagnosed autism and that puberty was traumatic for him. When Simon said he was really a girl, Gareth, the statistician, embarked on weeks of research. When he was told to take Simon to GEMS, the Boston Children’s youth gender clinic, he says, “I already knew what is public knowledge now, that GEMS universally agreed that kids were the wrong gender and only gave a cursory assessment before recommending medical intervention.” He was fearful the therapist would call CPS to recommend Simon be taken away from him and felt he had to “walk on eggshells.” Both Simon and Gareth became emotional recalling these events. He calls the “dead son or living daughter” rhetoric “emotional blackmail.” He took Simon to a private pay facility that addressed his depression and anxiety. Gareth says that he cannot name the facility because “treating a transgender child in any way other than affirmation is illegal in Massachusetts.” Simon no longer has gender dysphoria.

Claire Abernathy – Again, this young lady is tremendously brave for telling her story, which, again, is devastating. “I am a detransitioner,” she begins. A week after she turned 14, she was started on testosterone at the youth gender clinic of \ Cook Children’s Hospital in Texas. Six months later, again, at 14, she underwent a double mastectomy. She became tearful: “I was sold a product – medical transition – and told it would fix my distress and save my life. If I didn’t do this, I would probably end up dead. They didn’t tell me taking cross-sex hormones at 14 years old could leave me with pelvic floor dysfunction and urinary incontinence,” which she has at the age of 20. She says she tried to warn others, leaving honest reviews on his website describing her regret and complications, but they were deleted. She says she was targeted publicly for speaking out about her regret. “Anyone who asks questions is called hateful,” she says. She says every week she hears from more young men and women like her, people who were convinced as kids or teens that the only way to survive is to “become a lifelong medical patient.” “We watch helplessly as the same professionals and clinics keep selling the same product to the next generation of vulnerable kids while silencing those of us who speak out,” she says. She is open to the idea that transition may benefit some kids, but she says the consumer deserves the whole truth, including all the risks and alternatives, and to speak out without being censored. She trusted the adults at 14 that were supposed to protect her. They sold her a dream that turned out to be a nightmare. “Please hold these providers and pharmaceutical companies to the same standards as any other industry,” she says

Elvira Syed – Ms. Syed is the mother of Ilene, who she lost to suicide at age 18. Of all the wrenching stories I heard, hers is the most horrific. Ilene was an exceptional young woman. She won a full scholarship to college but struggled with anxiety, depression, ASD, and trauma after she lost her father to cancer at a young age. Ms. Syed states that she “spent too much time online” during the pandemic and “cycled through some LGBTQ labels and declared she was transgender” in high school. She saw a therapist, who immediately affirmed her identity, with “no attempt to delve into trauma.”

Ilene went to college as a minor and cut off her mother. She met a transgender pastor at the Metropolitan Community Church in Hartford, CT, who filed a complaint against Ms. Syed with the Department of Children and Families for refusing to accept Ilene’s transgender identity. The complaint was successful, and Ms. Syed lost all access to Ilene. Ilene sought therapy at an LGBTQ clinic in Hartford. Her therapist, who was also transgender, continued to affirm her and told her that Ms. Syed was “unsafe” for Ilene to be around due to not affirming Ilene’s gender identity. Although the therapist documented self harm, suicidal ideation, autism, and dissociation, he recommended Ilene start testosterone and referred her to the endocrinology clinic. There, she saw an APRN who started her on testosterone and referred her for a mastectomy.

Nine months after the initial therapy appointment, Ilene died by suicide. She was not found in her dorm room until 4 days after her death. Ms. Syed reports the cause of death was an overdose of Benadryl.

Kayla Lovdahl - Kayla notes she has only recently started using her real name; she has told her story previously but has used a pseudonym due to retaliation. “I am a survivor of gender medicine, or detransitioner,” she says. She was prescribed Lupron and testosterone at age 12 and underwent bilateral mastectomy one month after her 13th birthday. She says, “I had undiagnosed autism and unaddressed childhood sexual trauma. I was scared to become a woman. I was getting unwanted male attention. I learned about transgenderism at 11.” When Kayla brought the idea of being transgender to her therapist, she says the therapist immediately affirmed her and referred her to Kaiser Oakland’s youth gender clinic. “Nobody seemed to wonder why I suddenly identified as transgender,” she says. At her first appointment, she received testosterone and referral for mastectomy, which she underwent. She says it was called “top surgery,” which she did not understand at age 12. She was told she would never be able to “chest feed” and would lose chest sensation, but now she describes “nerve pain, extreme slicing sensation, electrical zaps, and itchiness” of her chest. As her skin is numb, sometimes she scratches until she bleeds.

She continued to take testosterone from ages 12 to 17. She catalogues the permanent effects: her voice is permanently lowered; she has an Adam’s apple; she can’t raise her voice for prolonged periods due to vocal chord changes. “I can’t scream if I am in danger, and I only stand 4’ 11”, she says. Still has facial hair, genital atrophy, urinary issues, fatty liver, weight gain, and chronic joint pain. She says her psychiatric issues worsened on testosterone. “I was never offered an off ramp,” she says. She tapered off her hormones herself at age 18.

Doctors are prevented from hearing detransitioners’ stories.

At this point, I would like to skip ahead to an afternoon panel that featured more detransitioners, because seeing all their stories together in one place is incredibly powerful. I believe that the majority of physicians do not realize that detransition is a real, fairly common phenomenon. A commonly cited statistic of a 1% rate of transition is taken from decades-old studies of transitioning adults. None of these gender clinics have tracked their young patients longitudinally, and nobody has any idea how common this experience is. In general, liberal-leaning reporters and news organizations have been hounded and harassed for reporting on these individuals’ existence, so it is understandable their experiences have not been well described outside of explicitly conservative media outlets.

Detransitioned youth from afternoon panel of patients and families

Prisha Mosley – Prisha states she is a 27 yo detransitioner, mother, and victim of medical fraud and abuse. “My doctors lied to me,” she says explicity. She struggled with mental illness, panic attacks, depression, and bipolar personality disorder. She experienced sexual assault and states she feared being a woman. “I learned about trans online on Tumblr.” In her mind, as she engaged in self harmed and hated her body, a transgender identity made sense. She was referred to endocrinology for testosterone at 16. In her words, “As soon as I said the word trans, all medical ethics went out the window. I was led to believe I had a male brain trapped in a female body, and this would lead to my death by suicide.” Her therapist asked her parents if they would rather have a dead daughter or a living son.

On testosterone, she had worsened mental health, ovarian cysts, and pelvic pain that she was told was due to male puberty. She continues to have vaginal atrophy. “I was told I needed to remove my breasts to treat my mental health,” she said. Although she was told she “may have trouble breast feeding,” her chest is “surgically sealed shut.” She had terrible pain from residual breast tissue after childbirth. She believes her doctors tricked her using euphemisms like “top surgery” and “pseudoscience like the ‘genderbread man.’” She says she cannot say child’s name because she is getting threats to her children for testifying today.

Soren Aldaco – Soren, now 23, was 11 when she transitioned socially and was “chronically online.” She thought maybe she was born in the wrong body. She was uncomfortable with her body in puberty, which in retrospect she feels is normal. At age 15, she met her biological father for first time, which was a significant emotional event. At a support group in the Dallas-Fort Worth area, she met an ARNP with an adult transgender child who, Soren states, “was giving hormones to anyone who wanted after one appointment.” Soren began taking testosterone and anastrazole. Soren experienced vaginal atrophy, joint pain, dizzinesss, and headaches on this regimen. She sought out removal of her breasts, as she hoped this would help her distress. She saw a therapist with a trans ex-spouse to obtain a referral letter for surgery, which she states was “totally fraudulent” and claimed she had lived as a man for 12 years. She had complications from her surgery breast surgery and reports her surgical clinic offered her $400 to sign an NDA about her experience, which she did not do. Since stopping testosterone, she has gone from taking 14 medications to just 2.

More to come

I will continue to report on the panels and speakers from this extraordinary day, but I think this article is long enough for now. I would really like for my fellow physicians to realize that these patients exist, and they deserve to be helped and listened to, not swept under the rug. I am honestly under the impression that most physicians believe detransitioners are incredibly rare and largely exist in the minds of right-wing conspiracy theorists. I hope that putting down the words of these brave young people who have been through so much makes them more real. I have tried to represent their testimony as accurately as possible.

Part 2 is here.

Part 3 is here.