Gender-affirming care for kids has gone too far, says ‘detransitioned’ teen

Chloe Cole (again, no relation to this Cole) told a story of gender transition and regret at the University of Iowa on Oct. 16, a synopsis of which I shared in this column last Sunday. It’s a true story — her own — about a pubescent girl with anxiety and depression showing signs of being on the autism spectrum, led by the health care professionals to whom she turned for psychiatric treatment down a path of gender transition that wreaked havoc on her body with puberty blockers, testosterone therapy, and the surgical amputation of her breasts at age 16.

Some people don’t want you to hear accounts of gender transition regret like Cole’s. Many see nothing wrong with you being prevented from hearing them — or punished if you do. On the night of Cole’s speech, protesters turned out in force, many likely some of the same losers who blocked traffic when conservative commentator Matt Walsh spoke on campus last semester, causing motorists unable to escape the crowd (including Yours Truly) to feel unsafe. (Yes, I called them “losers.” My contact info is below.)

Reacting to Cole, protesters pulled the same stunts they did the night Walsh spoke: chanting obscenities, blocking doors to the building where Cole was speaking, et cetera. I got wise this time — protesters couldn’t block my car if I didn’t leave until after they did — and stood by at a safe distance, watching other terrified drivers have their vehicles surrounded by incensed lunatics. And I felt bad for them.

Naysayers aren’t limited to Iowa City’s finest little agitators. Plenty of decent, civilized people believe that those with stories like Cole’s should be denied an outlet to tell them. The contention seems to be that even if a story of regret is true, sharing it “causes harm to trans people.” How? By “spreading hate” for one, even though leftists are very good at defining even the slightest hesitation to praise gender nonconformity as “hate.” Also? Because stories of regret can be used by policymakers motivated by transphobia and literally nothing else such as genuine concern to justify laws and policies prohibiting gender-affirming care in kids.

But Cole is adamant: Gender-bending hormones and invasive surgical procedures cause harm to transgender kids. She contends that those treatments should never, ever be used on a child.

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Advocates of childhood gender transition argue that medical and surgical treatment is extremely uncommon in children under 18, and used only after long-term, comprehensive assessment of a minor patient. Their understanding is that medical treatment such as puberty blockers and “gender-affirming” hormones are only given when a minor patient has persistently identified with their stated gender for a long period of time; surgical treatment is only done in rare situations of extreme gender dysphoria.

With every fiber of my being, I want them to be correct; for medical and surgical transitioning of minors to be as rare as they state. But other detransitioners are starting to speak out and share experiences similar to Cole’s, suggesting that medicalization of trans kids is not as rare as some think … or hope.

They’re speaking to whoever will listen. 21-year-old Luka Hein told former CNN personality Chris Cuomo, now, on NewsNation that the first step in her transition from female to male was surgery to amputate her breasts at the age of 16. She began hormone therapy only after the surgery.

Represented by some of the same attorneys as Cole, Hein is suing her health care providers at the University of Nebraska Medical Center alleging negligence on the part of her care team, which she says followed a course of treatment that did not even meet standards recommended by the pro-affirmation World Professional Association for Transgender Health (WPATH.)

Hein has transitioned back to living as a female in a body that has sustained heart damage, bone and joint pain and reproductive dysfunction. “At this point, there’s no really going all the way back,” she told NewsNation in a voice that still sounded distinctly male. “And I don’t know what to do.”

More are seeking justice through legal channels. Last week, 20-year-old female Isabelle Ayala filed suit against her physicians in her former home state of Rhode Island, alleging fraud and medical malpractice among other claims. Ayala’s physician, Dr. Jason Rafferty, to whom she was introduced during an inpatient stay stemming from a suicide attempt, is accused of prescribing testosterone to Ayala at the age of 14 and increasing its dosage to as much as 4 times the amount to which her parents had consented, all while she reported increasing feelings of anxiety and depression.

From a very young age, Ayala had exhibited signs of severe mental health issues including bipolar disorder, of which her family had a history. She also had post-traumatic stress from being sexually assaulted around age seven.

She had not exhibited signs of gender dysphoria or a desire to be a boy until she started using social media at the age of 11, where she was introduced to the “concept of being ‘trans.’” Her suit alleges that Dr. Rafferty and other local providers ignored her complicated mental health and the pain stemming from her young past. A note in her patient file made by Dr. Rafferty almost a year after he began treating her stated that she had “no history of trauma.”

Ayala’s detransition began after she moved out of state and stopped seeing her physicians in Rhode Island. Her suit contends that on the day before she moved to Florida, Dr. Rafferty wrote her one last prescription for testosterone with an abundance of refills but never followed up to ensure that she was being adequately monitored.

As the distance grew between Ayala and her Rhode Island physicians, she decided to quit taking testosterone “cold-turkey” and quickly grew out of her gender dysphoria. She now attributes her previous gender identity issues to childhood trauma and other mental health ailments and regrets transitioning. She now deals with significant complications from the use of hormones, including vaginal atrophy.

Ayala’s suit is the first to name the American Academy of Pediatrics as a defendant. To the ire of many of its rank-and-file members who questioned the lack of long-term studies to support it, the AAP adopted a policy statement in 2018 — written by the same Dr. Rafferty who treated Ayala — which endorsed the Gender-Affirming Care Model as the only recommended course of treatment for “TGD” (transgender and gender diverse) children.

The AAP’s gender care policy statement describes puberty blockers such as leuprolide (which was prescribed to Cole) as “reversible.” But a footnote acknowledges that their effects on fertility are unknown. Additionally, over 10,000 adverse event reports have been filed with the FDA by adult women who took leuprolide as children, mostly for its approved purposes. The reports detail complications of chronic pain and fractures from severe osteopenia - thinning bones.

The AAP statement also does not define or recommend protocols for gender-affirming surgeries in minor children. Though it states that surgical treatment is typically reserved for adults, it stipulates that a child’s eligibility is determined on a “case-by-case basis.” It also listed “surgical affirmation” as a key component of gender affirmation for transgender children and recommends that insurance plans cover, “when indicated, surgical gender-affirming interventions.”

Other countries with advanced health systems are scaling back their gender-affirming care programs. Britain’s National Health Service completely shut down its Tavistock gender clinic after an independent review concluded that little if any reliable research exists to justify the medicalized route of gender care or disprove its potential to cause irreversible harm. Yet the AAP renewed its pro-affirmation policy statement this year.

Bizarrely, the AAP gender care policy statement implies that Dr. Rafferty is the sole physician to draft, review, revise, and approve its manuscript, seemingly bypassing the organization’s typical collaborative process of developing a policy position, which includes multiple rounds review by peer physicians and board leadership. The statement notes that Dr. Rafferty “agrees to be accountable for all aspects of the work.”

This is some pretty eyebrow-raising stuff, here. But set aside the professional consensus (or lack thereof) for a moment. Set aside the studies, the lawsuits and the offense you take to the snotty conservative writing another anti-whatever screed, and just consider these treatments increasingly accepted as part of gender-affirming health care for what they actually entail.

These treatments entail surgery to completely remove the breasts of a physically healthy 15-year-old girl. Prescribing gonadotropic hormones to children for use that has never been approved by the FDA. Dispensing testosterone to a teenage girl that could suppress or destroy her fertility.

They entail giving children as young as 13 a form containing a list of procedures to choose from if they desire surgery in the future, including a hysterectomy, an oophorectomy, and an orchiectomy — removal of one’s uterus, one’s ovaries, and one’s testicles; and metoidioplasty, phalloplasty, and vaginoplasty — plastic surgery to alter one’s genitals to mimic those of the opposite sex.

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They’re treatments performed on healthy, non-diseased bodies, altering the body to conform to what is felt in the psyche. They’re the bodies of children who cannot fully understand the implications, let alone consent to them. Yet some believe that the sharing of experiences like Cole’s is too harmful to a transgender child to be tolerated.

If our need and our desire to affirm gender-nonconforming children is powerful enough to stop us from speaking out against such horrific treatments, then we need to re-evaluate what affirmation should actually look like.

Cole has an important story to share. Others like her are coming forward with their own accounts. The detransitioners are ready to talk. Are you ready to listen?

Comments: 319-398-8266; althea.cole@thegazette.com