Will you let your child go under the surgeon's knife for gender change?

When Chloe Cole was an impressionable 13-year-old, she began taking puberty blockers and cross-sex hormones – a set of drugs that delay natural biological changes. Two years later, surgeons removed her breasts in a double mastectomy. Only one doctor warned her about the potential adverse consequences of the surgery. She regrets not heeding that advice.

Chloe suffered from gender dysphoria, a medical condition in which people don’t associate with their biological sex. But experts say children with the disorder often grow out of their gender-related anxiety. Often, they are victims of confusion borne out of other reasons like depression and self-esteem issues.

Cole, now 18, is one of many girls who have ‘detransitioned’, saying their decision to transition into a boy by taking gender-altering drugs and surgeries was wrong.

Cole wants to be a mother one day, but she might never be able to breastfeed.

“Something beautiful and uniquely female was taken away from me forever. I was perfectly healthy before that,” she said in an interview. “I was just a kid.”

These girls, their parents and medical practitioners in many countries are raising concerns about complicated and unproven medical interventions administered to minors.

The controversial gender-change therapies have come under the spotlight at a time when there’s a push by concerned parents against the normalisation of homosexual relationship discussions in primary schools.

In the US, UK and other so-called advanced economies, children are frequently encouraged to choose their own ‘pronouns’, which in some cases has created confusion in their minds, experts say.

How did we end up here?

In the past two decades, the idea of ‘gender-affirming care’ has become pervasive among the international medical establishment. It basically says that if a boy or a girl is confused about his or her gender, he or she can opt for medical intervention, which can involve surgeries.

The problem is that the patients are too young to foresee the consequences of their decision, and doctors do not provide sufficient warnings before the ‘treatments’ start.

“If you are 15-16-year-old and having a mastectomy, you are not really at the age where you are thinking about having a baby sometime in the future. You don’t know what the future holds,” says Dr Karleen Gribble, who works at the School of Nursing and Midwifery at Western Sydney University.

“Fifteen years down the track, you have a baby, and you don’t have breasts, then you can’t do anything about it because it’s a kind of final decision. There is no going back.”

Lately, health institutions where children with gender dysphoria are referred to have come under scrutiny.

In February, a former employee of The Washington University Transgender Center at St. Louis Children’s Hospital turned a whistleblower when she wrote a scathing article, detailing how minors were hurriedly put on irreversible medical procedures without proper counselling, warnings or investigation.

Children with psychiatric issues such as post-traumatic stress disorder (PTSD) and bipolar disorder were being diagnosed with gender dysphoria and advised to go under the surgeon’s knife, Jamie Reed wrote in the article for The Free Press.

“Some weeks, it felt as though almost our entire caseload was nothing but disturbed young people.”

Social contagion

A few years back, most of the cases being handled by the so-called transition clinics involved boys. Since 2015, the number of girls seeking medical intervention has increased rapidly.

In the US, gender dysphoria diagnosis jumped three times to 40,000 cases in 2021 compared to four years ago. A National Health Services (NHS) study in the UK found that ten years ago, there were under 250 referrals, most of them boys. In 2021 there were more than 5,000. And two-thirds of them were girls.

Since the phenomenon is relatively recent, no thorough research is available to decipher the exact causes behind the surge in the number of girls showing up at transition centres.

But anecdotal evidence based on interviews with parents suggests that social media has a role to play. Adolescent girls often see gender dysphoria as a coping mechanism against issues such as unhappiness with their physical appearance.

The proliferation of trans-related content on social media and unverified and often romanticised transition stories on TikTok are also playing a part in shaping the decision of minor girls.

Experts say the biggest problem lies with the lack of research into the long-term consequences of gender-change therapies.

A low bar

In the UK and other so-called developed countries, the route to gender transition usually works something like this: a school-going girl tells her parents she wants to change her name and her appearance, is taken to see a psychiatrist who, after one or two visits refers the kid to an endocrinologist who in turn puts the child on medicines.

Bicalutamide, a drug used on cancer patients, is given to boys as a puberty blocker. The drug changes their appearance, making them more effeminate.

Testosterone given to girls deepens their voice and results in the growth of facial hair.

If parents protest, doctors are known to scare them that their child is vulnerable to suicide if not allowed to proceed.

Gribble of Western Sydney University says the rules and regulations overseeing medical intervention, such as the guidelines of the World Professional Association of Transgender Health, are unreliable.

“Like they don’t even say that double mastectomy is going to impact breastfeeding,” she says.

While doing research for her own paper, which chronicled the regret of a woman who had her breasts removed, Gribble was “shocked” to find that there’s little evidence of any benefit for the girls who took medicines or opted for the surgery.

“Some of the journals are allowing papers to be published that make very strong claims that are not backed by evidence. That is a very concerning thing.”

One ‘research paper’ made a definitive conclusion on the satisfaction of minor girls who had their breasts surgically removed - by asking for their response three months after the surgeries, she says.

“You can’t make those claims. Those were only three months after the surgery. It’s a child who is 14 or maybe 15. In 5 or 10 years, they might have a baby, and how would they feel about it? I think this is what is so concerning. The quality of research is really poor.”