Abigail Shrier: How the Gender Fever Finally Broke
Loving, naive parents believed medical science was above politics and beyond question. Now, with the stroke of a pen, a destructive ideology has been eliminated.
When the history of 21st-century gender mania is written, it should include this signal entry: In 2020, a website called GoFundMe, usually a place to find disaster-relief appeals and charities for starving children, contained more than 30,000 urgent appeals from young women seeking to remove their perfectly healthy breasts.
Another entry, from June 2020: The New England Journal of Medicine, America’s platinum medical publication, published a piece explaining that biological sex is actually “assigned at birth” by a doctor—and not a verifiable fact, based on our gametes, stamped into every one of our cells. In fact, biological sex ought to be deleted from our birth certificates—the authors claimed—because a person’s biological sex serves “no clinical utility.” Breaking news to gynecologists.
Public schools began asking elementary kids whether they might like to identify as “genderqueer” or “nonbinary.” Any dissent from this gender movement was met with suppression. The American Civil Liberties Union’s most prominent lawyer, Chase Strangio, announced his intention to suppress Irreversible Damage, my book-length investigation into the sudden spike in transgender identification among teen girls. “Stopping the circulation of this book and these ideas is 100% a hill I will die on,” he tweeted. Weeks later, Amazon deleted Ryan Anderson’s book criticizing the transgender medical industry.
I could go on. But as of January 28, 2025, I don’t have to.
On that day, President Donald Trump signed an executive order announcing that the federal government would no longer “fund, sponsor, promote, assist, or support the so-called ‘transition’ of a child from one sex to another,” and that it would “rigorously enforce all laws that prohibit or limit these destructive and life-altering procedures.”
To the practitioners and promoters and numberless devotees of pediatric “gender affirming care”—a euphemism for the vast apparatus pushing junk science on vulnerable children and confused families—it came as a much-needed slap in the face.
If it seems odd that the spell of pediatric gender medicine should have been ended by politicians and not physicians, consider that in America, politics is how it began. Specifically, it began with Obamacare.
Section 1557 of the Affordable Care Act, President Barack Obama’s signature legislation incentivizing and coercing private insurers to offer their products on a government exchange, prohibited those companies from discriminating on the basis of sex. And in May 2016, six years after the bill’s enactment, the Obama administration’s Department of Health and Human Services added this fateful qualification: Discrimination on the basis of “sex” was to include discrimination on the basis of “gender identity.”
“Obama effectively wrote into law, through healthcare, that gender identity is a protected class,” healthcare executive and gender-medicine researcher Zhenya Abbruzzese told me. And that opened a huge new source of funding for these treatments. “Because once these insurers feel like they have to cover it, that’s it. You have just turned on the engine,” Abbruzzese said.
If an insurer covers testosterone to treat a man who was deficient, then, according to gender ideology’s cracked logic, the insurer would also need to cover testosterone for a woman identifying as a man. If a procedure to remove a man’s unwanted breast tissue was covered, then a similar procedure for a woman identifying as a man must also be covered. Denying those claims could subject insurers to federal enforcement action.
To mandate coverage for gender treatments, activists “snuck in gender identity without Congress ever voting for it,” Abbruzzese told me. Transgender rights groups filed lawsuits, to test whether judges agreed: Suddenly, a “woman” was anyone who claimed to be one, as far as provision of healthcare was concerned. Luxury cosmetic treatments became available even to minors covered by their parents’ insurance—at fire-sale prices.
While gonadotropin-releasing hormone agonists (“puberty blockers”) have never received FDA approval to treat gender dysphoria in youth, doctors could prescribe them “off-label” as long as they had reason to believe they would be helpful to patients. Everywhere physicians looked, activists and medical accrediting organizations (increasingly, one and the same) and every news outlet of legacy media assured them, as if with one voice, that these were “lifesaving” treatments.
The World Professional Association for Transgender Health (WPATH), an activist organization styled as a medical one, issued guidelines used as the “standards of care” by all major insurers and Medicaid to justify the provision of, and reimbursement for, gender transition services. WPATH represented their guidelines as evidence-based. Court-ordered discovery in a 2022 lawsuit filed by the Department of Justice to overturn Alabama’s ban on gender treatments for minors revealed that WPATH’s guidelines lacked solid evidentiary basis, but also that WPATH leadership knew it.
The organization suppressed publication of systematic reviews of puberty blockers, cross-sex hormones, and surgeries undertaken by Johns Hopkins University. That research would almost certainly have revealed, as so many systematic reviews have now done, that while the risk of sterility, cardiac event, osteoporosis, and bone fracture were high, any alleged mental health benefits of the WPATH-approved puberty blockers-to-cross sex hormones protocol remained unproven.
But the Biden administration pressed onward, suing any state that enacted bans on medical transition for minors. Assistant Secretary for Health Rachel Levine, a transgender adult, successfully pressured WPATH to drop minimum age requirements for gender medical treatments and surgeries in its September 2022 standards of care. Again and again, President Joe Biden and Vice President Kamala Harris used the bully pulpit to assure “transgender Americans . . . especially the young people” that “your president has your back,” as Biden declared in an April 2021 address to Congress.
In 2022, the Department of Health and Human Services published a fact sheet claiming that gender affirming treatments for youth were “crucial to overall health and well-being.” Any physician or therapist who might otherwise have been tempted to discourage trans-identified youth from immediate and irreversible medical transition sat up and took note.
The Obama and Biden administrations worked in tandem with activist organizations. Federal funds poured into tainted research. Gender physician Johanna Olson-Kennedy received nearly $10 million from the National Institutes of Health to study the effects of puberty blockers and cross-sex hormones on gender-confused adolescents ages 11 and up. (She later lowered the age to 8.) Olson-Kennedy and a team of colleagues recruited hundreds of transgender-identified minors. They gave one cohort of the children cross-sex hormones and another puberty blockers—to determine if either treatment produced improvements in mental health. (There was no control group.) After only one year on cross-sex hormones, two of her 315 subjects had committed suicide.
As for her nine-year study on puberty blockers, Olson-Kennedy didn’t like the results so, by her own admission, she shelved them. “She said the findings might fuel the kind of political attacks that have led to the bans of the youth gender treatments in more than 20 states,” according to The New York Times. She told the Times she intends to publish the data, but that getting her work to a place where it wouldn’t be “weaponized” required it to be “clear and concise. And that takes time.”
The public that had funded her research has never had the opportunity to review its results.
Trump’s executive order directs federally funded institutions to stop reliance on WPATH, calling its recommendations “junk science.” Cut off from what Abbruzzese calls WPATH’s “evidence laundering,” insurers will be forced to evaluate the gender medical evidence and issue policies on their own. Systematic reviews and investigations already undertaken in England, Finland, and Sweden indicate it’s not likely they will find the evidence for medically transitioning children to be terribly impressive. Activist researchers into gender medicine might soon see their federal grants dry up.
Every healthcare entity accepting federal dollars (nearly all of them, in Obamacare’s world) risks losing contracts with Medicare and Medicaid if they continue to provide pediatric gender transitions.
This executive order does not abolish pediatric gender medicine. Boutique practices that do not rely on federal funding can still offer “top surgery” to minors, for instance. There will surely be litigation to challenge the reach of Trump’s order.
But that order does break the spell—and the spell was always our biggest problem. Parents who allowed their children to transition are often caricatured as Hollywood eccentrics, the sort who bequeath their estates to teacup Chihuahuas. The parents I spoke to—even those who allowed their children to transition—are nothing like that.
Many are conscientious and loving and afraid, if a little naive. They believed medical science was above politics and beyond question. They had wandered into a Truman Show, an all-consuming simulacrum, designed to convince them to abandon their protective instincts. If the parents still weren’t convinced, therapists coerced them into allowing their daughters to undergo gender transition with this thinly veiled threat: “Would you rather a live son or a dead daughter?”
If it seems, suddenly, that only a fool would fall for this, then it is worth pointing out that millions of us were fools for a while. This social contagion spread far beyond teenage girls. It touched corporate executives who rushed to put pronouns in their profiles, pastors who raised the transgender Pride flag at their churches, and school administrators that actively deceived parents about the new gender identities they had selected for the parents’ children.
A lot of bad actors—pediatricians, surgeons, endocrinologists, therapists, teachers, even clergy—took advantage. No reason to let them off the hook: The science is, and always was, shoddy. When I published Irreversible Damage in 2020 and became, overnight, socially radioactive even among many conservatives, the medical risks were as plain to the experts then as they are today. One only needed to take an interest.
Desperate parents who transitioned their own children during this period, against their better judgment, made an understandable, if devastating, error. Harmonizing one’s views with the powerful reflects the oldest social survival instinct. We are engineered to stay within the herd and get along.
Disagreeable contrarians who resisted gender fever are the real oddballs. Some combination of personality quirk and conviction that occasionally makes us obnoxious employees and intolerable cocktail-party guests also inoculated us against gender madness. There is no reforming us.
But we served a vital function: Together, a ragtag crew of truculent journalists and outcast researchers stopped the entire herd from running off the cliff. None of us ever expected to be welcomed back into the same elite circles that, only recently, had cheered or looked away as a generation of tormented girls took themselves apart.
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