The United States went from having no clinics specializing in pediatric gender care to over 100 in less than two decades. In 2015, these transgender clinics saw a massive patient shift — what was historically a small number of boys with gender dysphoria became outnumbered by teenage girls, according to Jamie Reed.
In 2023, Reed spoke out against what she witnessed as a patient intake coordinator and case manager for The Washington University Transgender Center at St. Louis Children’s Hospital.
When she began in 2018, Reed said there were around 10 calls a month from struggling young girls. When she left in 2022, that number increased to 50, and nearly 70% of new patients overall were girls.
“The girls who came to us had many comorbidities: depression, anxiety, ADHD, eating disorders, obesity. Many were diagnosed with autism, or had autism-like symptoms,” Reed wrote in a story published in 2023 in The Free Press. “When I said the clusters of girls streaming into our service looked as if their gender issues might be a manifestation of social contagion, the doctors said gender identity reflected something innate.”
But what once seemed unquestioned by medical associations and hospital policy is now being contested in Congress and in the courtroom.
A wave of state and federal restrictions, civil lawsuits from detransitioners and sustained activism have reframed pediatric gender practices as a legal and political fight as much as a clinical one — accelerating a shift in who ultimately decides the boundaries of care.
“As both a physician and a legislator, my primary commitment has consistently been the safety and well-being of our children,” Rep. Mike Kennedy, R-Utah, recently said in a statement after becoming co-lead on legislation that would ban all transgender medical interventions for minors nationwide. “We are seeing a disturbing trend where radical ideologies have overtaken evidence-based medicine, causing irreversible and terrible damage to children.”
Institutions like the Washington University Transgender Center have since stopped performing gender-affirming surgeries on minors — but not before the procedures were carried out on many young patients.
“Between 2019 and 2023, there were at least 13,394 gender reassignment procedures on individuals 17.5 years old or younger nationwide, with the youngest 7 years old,” according to The Center Square, “of those, there were 4,160 breast removal procedures and 660 phalloplasty procedures on minors.”
Litigation and legislation as an offense
There are nearly 30 active malpractice cases filed by detransitioners across the country, many of them involving biological girls like Chloe Cole, who felt “grief and regret” following her top surgery.
Cole recently told the Deseret News that detransitioning was profoundly disorienting, involving not only personal loss but a full ideological unraveling. She said it also took years to realize she wasn’t to blame. She’s taking her childhood medical professionals to court in April 2027.
Last month, a New York jury awarded 22-year-old Fox Varian $2 million in damages to be paid by her childhood psychologist and the surgeon who performed her double mastectomy, in a first of its kind ruling.
Charles LiMandri, a partner at LiMandri & Jonna, a California firm involved in multiple detransition lawsuits, including Cole’s upcoming case, told the Deseret News that the complete shutdown of these practices performed on minors will come down to litigation and legislation.
Using the strategy of litigation, civil rights nonprofit Center for American Liberties CEO Mark Trammell said, “uniquely offers a solution that is impervious to the swing of the political pendulum.”
The nonprofit is also on Cole’s legal counsel for her upcoming case.
“If there’s a verdict in her case, it doesn’t matter who’s in the White House or who’s sitting in Sacramento,” Trammell said, “That is going to be immune to the political pressures.”
“I think what could happen is, as lawsuits continue to mount, it becomes more and more difficult for hospitals to continue to engage in this type of abusive behavior on minors,” he added, “and as it becomes more and more expensive and more and more of a liability for them — again with minors — then I think what could happen is they decide, ‘You know what, this isn’t something we’re going to do.’”
Despite many medical institutions ending their gender-affirming surgeries on minors, “there’s not going to be any accountability for the harm they’ve done without these lawsuits,” LiMandri said. The only “big stumbling block is the statute of limitations.”
That’s where recently proposed legislation comes into play.
Kennedy and Rep. Bob Onder’s, R-Mo., bill that would prohibit gender medical interventions for minors nationwide, would also establish “a private right of action for children and the parents of children whose healthy body parts have been damaged by medical professionals practicing or participating in certain interventions.”
Dubbed the Chloe Cole Act, the law would also grant an expanded statute of limitations of either 25 years from the detransitioner’s 18th birthday or within four years after they pay for detransition treatment, whichever date is later.
It gives “these individuals an opportunity to hold their clinics, hospitals and doctors associated with the transitioning care that they’ve received accountable,” Kennedy told the Deseret News. “It’s not that hard with telehealth, as well as with UPS, FedEx, or the Postal Service, for a doctor in San Francisco to provide treatments to a child in Utah or any other state who has passed bans on this, so this federal legislation puts those doctors on notice that these individuals have a right to file a lawsuit for many years after they may have done these things.”
He added that the bill would work collaboratively with the 26 states that already have laws banning these procedures on minors.
Pointing to the Varian case, and the recommendation from the American Society of Plastic Surgeons’ statement last month to delay gender-related surgeries until at least age 19, as well as recent policy reversals in Finland, Sweden and the United Kingdom — countries that were early adopters of pediatric medical transition — Kennedy said it is “like watching a house of cards that’s falling apart on its own.”