The Terror of Transitioning: "Just as the destructive objective of critical race theory is to divide Americans racially, that of gender ideology is to disrupt the formation of stable families, the building blocks of American life.".

• Author: Shrier, Abigail
• Position: NATIONAL AFFAIRS

IN 2007, the U.S. had one pediatric gender clinic; today there are hundreds. Testosterone readily is available to adolescents from places like Planned Parenthood and Kaiser, often on a first visit--without even a therapist's note.

How did we get to this point? How is it mat we all are supposed to pretend that the only way you can know I am a woman is if I tell you my pronouns? How did we get to an America in which a 13-year-old in the state of Washington can begin "gender affirming" therapy without her parents' consent? How did we get to an America in which a 15-year-old in Oregon can undergo "top surgery"--elective double mastectomy--without her parents' permission? Moreover, what can we do about it?

To understand how we got to this point, it is useful to begin by considering gender dysphoria--the feeling of severe discomfort in a person's biological sex. Gender dysphoria certainly is real. It also is exceedingly rare. It afflicts about 0.01% of the population, most of whom are male.

For nearly 100 years of diagnostic history, gender dysphoria typically began in early childhood, between the ages of two and four, and usually involved a boy who insisted that he was not a boy but a girl. Children afflicted are insistent, consistent, and persistent in the feeling that they are in the wrong body. It is by all accounts excruciating. I have spoken with many transgender adults, most of them biological males, who describe the relentless chafe of a body that feels all wrong.

Historically, this has been the classic presentation of gender dysphoria. When these children were left alone--when no one intervened medically or encouraged what we today call "social transition"--more than 70% of them outgrew their gender dysphoria. Most of those who outgrew it became gay men. Those who did not outgrow it became what used to be known as transsexuals. They did not believe they were women, but they felt most comfortable presenting themselves as females.

Today, however, we do not leave these children alone. Instead, the moment children seem not to be perfectly feminine or perfectly masculine, we label them as "trans kids." Teachers encourage them to reintroduce themselves to their classes with new names and new pronouns. We take them to therapists or doctors, nearly all of whom practice so-called affirmative care--meaning they think it is their job to affirm the diagnosis of gender dysphoria and help the children medically transition.

The typical first step in treatment administered to these kids is puberty blockers, which shut down the part of the pituitary gland that directs the release of hormones catalyzing puberty. The most common of these drugs is Lupron, whose original purpose was the chemical castration of sex offenders. To this day, the Food and Drug Administration never has approved this drug for halting healthy puberty.

One has to wonder why a parent or a doctor would take measures to stop a child's puberty, given that even a child with genuine gender dysphoria most likely would outgrow that condition if left alone. Some argue that it is traumatizing to let children go through the puberty of the sex to which they do not wish to belong but, in many cases, puberty seems to have helped children overcome gender dysphoria. The truth is that there is no satisfying answer, given that scientists have no way of predicting which children will outgrow the dysphoria on their own and which will not.

Proponents of "affirmative care" also argue that allowing puberty to occur is dangerous because suicide rates for trans-identified youth and trans adults are very high. Therefore, they say, we need to start treating children with gender...