Would you rather have a dead daughter or a live son?

A Brief Summary of the Transgender Medical Literature

“Would you rather have a dead daughter or a live son?” This is the question posed to some parents of children struggling with gender dysphoria.  Parents with a daughter who says she wants to be a boy may bring their child to a psychologist or a gender clinic; instead of a thorough evaluation of underlying issues, the immediate and only treatment that is offered is gender transition.  Parents are told that if they do not allow their child to transition to the other sex, their child might kill themselves. But parents are being lied to. Gender transition has not been shown to decrease suicide rates or improve mental health. Gender transition for children and adolescents does more harm than good.

Anyone older than thirty realizes that in the past decade or so, there has been a drastic shift in the percentage of people who struggle with gender dysphoria. Historically, gender incongruence or gender dysphoria (GD) was quite rare, with an incidence of fewer than 5 in 100,000 people.(1) GD historically was found mainly in two very distinct populations. Early-onset GD occurs in very young children, usually boys, who exhibit “gender-atypical” behavior at an early age. If not transitioned, most of these boys will, in time, become comfortable with their birth sex. Late-onset GD, on the other hand, occurs in adults, usually men, who, often after years of living with a wife and children, express a desire to be a woman (e.g., Caitlyn Jenner, Rachel Levine). These men often have a history of cross-dressing and are aroused at seeing themselves dressed as women, a condition termed autogynephilia.

Currently, however, we see not only a surge in the incidence of people identifying as transgender but also a change in the population. In the past decade, there has been a surge in the number of adolescents who express discomfort with their birth sex and want to transition. The majority of these are girls. An estimated 3.3% of adolescents identify as transgender,(2) over 700 times the incidence in the past. Unlike those with early- or late-onset GD who have struggled with gender incongruence for years, these young people often have no history of gender dysphoria and suddenly announce out of the blue that they are transgender, thus the term rapid-onset gender dysphoria (ROGD). ROGD was first identified by Dr. Lisa Littman,(3) and it was described in Abigail Shrier’s book Irreversible Damage.(4)

Not only has there been a change in the population and incidence of GD, but there has also been a change in the treatment of those with these struggles. Historically, the treatment for a young person with GD was not medical and surgical transition but “watchful waiting,” which consisted of time, support, and therapy. Now, however, most major medical organizations endorse a new model of care called gender-affirming care (GAC) in which the young person is affirmed in their desired gender with minimal evaluation. The desire to be another gender is no longer considered a psychiatric disorder; it is accepted as a normal variant, which explains why the terminology was changed from “gender identity disorder” to “gender dysphoria.”(5) In GAC, the healthcare professional is obligated to affirm the patient’s chosen identity with little to no evaluation. The diagnosis is made by the patient, not the physician. Those with GD are more likely to suffer from neurodevelopmental and mental health issues, such as anxiety, depression, history of trauma, history of abuse, and autism, all of which are more common in those who identify as transgender.(6)(7)(8) Yet, rather than exploring these underlying issues, the health care professional offers gender transition as a panacea and sets the young person on the destructive path of medical and surgical transition.

The path of gender transition consists of four possible steps. Those who identify as transgender may proceed through some or all of these steps:

1. Social transition consists of taking on the name, pronouns, and clothing of the desired sex. Girls may wear a chest binder to make their chests appear flatter and may pack their groin with material to provide a bulge. Boys may add stuffing to chest, hips and buttocks to add prominence, and do tucking – an awkward maneuver to hide their penis and testicles.

   
   

2. Puberty Blockers are given to those who have not yet gone through puberty to halt the normal physiologic process. Parents are told that puberty blockers (PBs) buy time, yet 96-98% of young people who take PBs go on to take cross-sex hormones (CSHs).(9)(10)(11) Parents are told that puberty blockers are reversible, yet they have long-term risks, including decreased bone density, loss of sexual function, sterility, and neurologic effects.(12)(13)(14)

   
   

3. Cross Sex Hormones are given to produce the secondary sex characteristics of the opposite sex. Females who desire to appear male are given testosterone, which results in facial and body hair, a deepened voice, fat redistribution, increased libido, and an enlarged clitoris. Testosterone carries risks including heart disease, stroke, high blood pressure, liver dysfunction, and more. Males who desire to appear female are given estrogen, which results in increased body fat, decreased lean body mass, decreased sperm count, decreased libido, erectile dysfunction, and more. Estrogen also carries significant risks, including heart disease, stroke, breast cancer, clots, and benign pituitary tumors.

   
   

4. Gender reassignment surgery (also known as gender-affirming surgery) is the next step for those who choose to proceed. 

   1. Female to male: The most common of these surgeries is “top surgery” in young girls, which is a double mastectomy. Girls who undergo “top surgery” will never be able to breastfeed. If they proceed to the next step, removal of their uterus and ovaries, they will never be able to bear a child. The final step is genital surgery which consists of closing off the vagina and construction of a penis-like structure (phalloplasty or metoidioplasty). 

      
      

   2. Male to female: Boys who desire to appear female may under go breast implants, facial and vocal surgery, and genital surgery, which consists of amputation of the penis and testicles and construction of a vagina-like pouch and female-appearing external genitalia (vaginoplasty).

Gender reassignment surgeries are permanently disfiguring. The genital surgeries, in particular, have high complication rates and detrimental effects on sexual and genitourinary functioning. In fact, in the original studies that formed the basis for youth gender transition (the “Dutch Protocol”), one of the seventy young people died from a complication after the vaginoplasty procedure.(15)(16) Yet these studies, which had no control group and have never been replicated, form the basis of youth gender transition today.

Adolescents who undergo these transition steps–and their parents–are made to believe that gender transition will solve their problems, yet there is no adequate data that shows that these steps provide benefit to those with GD.(17) Those who suffer from GD often suffer from other mental health issues, and they are indeed at increased risk for suicide although there is no adequate evidence that transition decreases suicide rates. The best study we have demonstrates that adults who undergo surgical transition have 19 times the risk of suicide compared to controls.(18) The American College of Pediatricians (not to be confused with the American Academy of Pediatrics) states, 

There is not a single long-term study to demonstrate the safety or efficacy of puberty blockers, cross-sex hormones and surgeries for transgender-believing youth. This means that youth transition is experimental, and therefore, parents cannot provide informed consent, nor can minors provide assent for these interventions. Moreover, the best long-term evidence we have among adults shows that medical intervention fails to reduce suicide.(19)

Researchers and physicians in European countries have come to realize the lack of evidence for gender affirming care and recommend psychotherapy rather than hormones and surgery for gender dysphoric youth.(20) And in a review of the evidence just published May 1, 2025, the United States Department of Health and Human Services has finally come to the same conclusions.(21)

Many young people today are struggling with mental health issues, trauma, abuse, and gender dysphoria. Gender-affirming care is not the solution. Those struggling with these difficult issues deserve a full evaluation and treatment of their underlying issues, not irreversible, harmful interventions to their bodies. Young people deserve better. 

Get immediate access to the author's full research through our friends at Reasons to Believe. Register at their website to receive both of her team's gender identity white papers.

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References

1. Arcelus J, Bouman WP, Van Den Noortgate W, Claes L, Witcomb G, Fernandez-Aranda F. Systematic review and meta-analysis of prevalence studies in transsexualism. Eur Psychiatry. Sep 2015;30(6):807–15. doi:10.1016/j.eurpsy.2015.04.005

2. Department of Health and Human Services. Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices 2025.

3. Littman L. Parent reports of adolescents and young adults perceived to show signs of a rapid onset of gender dysphoria. PLoS One. 2018;13(8):e0202330. doi:10.1371/journal.pone.0202330

4. Shrier A. Irreversible damage: the transgender craze seducing our daughters. Regnery Publishing, a division of Salem Media Group; 2020:xxiv, 264 pages.

5. Zucker KJ, Cohen-Kettenis PT, Drescher J, Meyer-Bahlburg HF, Pfäfflin F, Womack WM. Memo outlining evidence for change for gender identity disorder in the DSM-

6. Arch Sex Behav. Jul 2013;42(5):901–14. doi:10.1007/s10508-013-0139-4

7. de Freitas LD, Léda-Rêgo G, Bezerra-Filho S, Miranda-Scippa Â. Psychiatric disorders in individuals diagnosed with gender dysphoria: A systematic review. Psychiatry Clin Neurosci. Feb 2020;74(2):99–104. doi:10.1111/pcn.12947

8. Sorbara JC, Chiniara LN, Thompson S, Palmert MR. Mental Health and Timing of Gender-Affirming Care. Pediatrics. Oct 2020;146(4)doi:10.1542/peds.2019-3600

9. Kallitsounaki A, Williams DM. Autism Spectrum Disorder and Gender Dysphoria/Incongruence. A systematic Literature Review and Meta-Analysis. J Autism Dev Disord. May 20 2022;doi:10.1007/s10803-022-05517-y

10. Brik T, Vrouenraets L, de Vries MC, Hannema SE. Trajectories of Adolescents Treated with Gonadotropin-Releasing Hormone Analogues for Gender Dysphoria. Arch Sex Behav. Oct 2020;49(7):2611–2618. doi:10.1007/s10508-020-01660-8

11. Carmichael P, Butler G, Masic U, et al. Short-term outcomes of pubertal suppression in a selected cohort of 12 to 15 year old young people with persistent gender dysphoria in the UK. PLoS One. 2021;16(2):e0243894. doi:10.1371/journal.pone.0243894

12. Wiepjes CM, Nota NM, de Blok CJM, et al. The Amsterdam Cohort of Gender Dysphoria Study (1972-2015): Trends in Prevalence, Treatment, and Regrets. J Sex Med. Apr 2018;15(4):582–590. doi:10.1016/j.jsxm.2018.01.016

13. Delemarre-van de Waal HA, Cohen Kettenis P. Clinical management of gender identity disorder in adolescents: a protocol on psychological and paediatric endocrinology aspects. European Journal of Endocrinology. 2006;155:S131–S137. doi:10.1530/eje.1.02231

14. Ludvigsson JF, Adolfsson J, Höistad M, Rydelius PA, Kriström B, Landén M. A systematic review of hormone treatment for children with gender dysphoria and recommendations for research. Acta Paediatr. Apr 17 2023;doi:10.1111/apa.16791

15. Laidlaw M, Cretella M, Donovan K. The Right to Best Care for Children Does Not Include the Right to Medical Transition. Am J Bioeth. Feb 2019;19(2):75–77. doi:10.1080/15265161.2018.1557288

16. de Vries AL, Steensma TD, Doreleijers TA, Cohen-Kettenis PT. Puberty suppression in adolescents with gender identity disorder: a prospective follow-up study. J Sex Med. Aug 2011;8(8):2276–83. doi:10.1111/j.1743-6109.2010.01943.x

17. de Vries AL, McGuire JK, Steensma TD, Wagenaar EC, Doreleijers TA, Cohen-Kettenis PT. Young adult psychological outcome after puberty suppression and gender reassignment. Pediatrics. Oct 2014;134(4):696–704. doi:10.1542/peds.2013-2958

18. Hruz PW. Deficiencies in Scientific Evidence for Medical Management of Gender Dysphoria. Linacre Q. Feb 2020;87(1):34–42. doi:10.1177/0024363919873762

19. Dhejne C, Lichtenstein P, Boman M, Johansson AL, Långström N, Landén M. Long-term follow-up of transsexual persons undergoing sex reassignment surgery: cohort study in Sweden. PLoS One. Feb 22 2011;6(2):e16885. doi:10.1371/journal.pone.0016885

20. American College of Pediatricians. Transgender Interventions Harm Children: No Evidence that Transgender Interventions are Safe for Children. Accessed April 3, 2023. https://acpeds.org/transgender-interventions-harm-children

21. Kaltiala R, Takala L, Byng R, et al. Youth Gender Transition Is Pushed Without Evidence; Psychotherapy, not hormones and surgery, is increasingly the first line of treatment abroad. Wall Street Journal. 11. 2023;CCLXXXII(July 14, 2023). July 14, 2023. Accessed July 14, 2023. https://www.wsj.com/articles/trans-gender-affirming-care-transition-hormone-surgery-evidence-c1961e27