The Cracks in the Mirror: A Scientific Reckoning with the Medical Trans Culture
Sunday, July 13, 2025. This is for Kyle, who listened.
Once upon a time, puberty blockers were used to delay puberty in eight-year-olds with a pituitary problem. Testosterone was for men in midlife crisis.
Surgeons would not remove healthy breasts unless they were asked very nicely by an oncologist.
Then, for reasons both noble and tragically naïve, we rewrote those rules.
We called it progress.
And for some, it was. For others, it was a detour into a medical maze with no exit and no map.
This isn’t about whether transgender people deserve care. They do.
The question is whether we’re giving them good care—or just fast care with bad evidence and even worse incentives.
The Dutch Protocol: A Study, Not a Permission Slip
In the early 2000s, a careful team in the Netherlands treated 70 adolescents with puberty blockers and later, cross-sex hormones.
These teens had early-onset, persistent gender dysphoria, no major mental illness, and came from supportive families. They did well. It was hopeful.
Then, someone mistook hope for data. The Dutch model was exported wholesale to other countries, applied to thousands of teenagers who bore little resemblance to the original cohort.
The Cass Review (2024)—the UK’s largest independent review of gender care—put it dryly:
“There is no convincing evidence that the benefits of early medical transition outweigh the risks in the broader population of gender-diverse youth.”
Translation: good for seventy handpicked kids in Amsterdam ≠ good for every confused 14-year-old on Discord.
WPATH: Science by Committee, Not by Trial
The World Professional Association for Transgender Health (WPATH) writes what are politely called standards of care and impolitely resemble suggestions that sound good on Twitter.
In its latest edition (SOC-8), WPATH:
Removes minimum ages for surgery
Bases recommendations on expert opinion and case series
Publicly asserts that minors can consent to irreversible treatments, even as leaked internal meetings reveal private doubts
This is not medicine. This is policy laundering—where consensus substitutes for data, and the stakes are your kid’s endocrine system.
When Doctors Whisper and Institutions Applaud
Dr. Hilary Cass, who led the NHS review, said:
“The evidence was disappointingly poor.”
Not “flawed,” not “limited.” Just—poor. Like a term paper with no footnotes.
Dr. Julia Mason, a pediatrician who’s seen the inside of this system, calls it what it is:
“We’ve turned adolescent identity distress into a lifetime medical subscription.”
And yet, in the U.S., medical associations appear allergic to reassessment. Not because they’ve read better studies—but because dissent is treated like malpractice.
Pharma: No One’s Driving the Bus, But Someone’s Selling the Gas
Lupron—originally used to treat prostate cancer—is now a $25,000/year puberty blocker.
Testosterone and estradiol are dirt cheap to make and require a prescription forever.
No randomized controlled trials.
No FDA approval for use in gender dysphoria in minors.
No incentive to study the long-term effects—because the market's already moving, and everyone’s too scared to hit the brakes.
Is this a conspiracy? No. It’s just unregulated Limbic Capitalism with a rainbow sticker on the bottle.
From Diagnosis to Declaration
It used to be that a diagnosis required clinical work: developmental history, psych evaluation, differential diagnosis. Today?
A teenager can walk into a clinic, say “I’m trans,” and walk out with a prescription for testosterone by the end of the week. Sometimes by the end of the day.
Lisa Littman’s (2018) study on Rapid-Onset Gender Dysphoria dared to suggest that peer influence and trauma might play a role. She was professionally flogged, but the idea didn’t go away—because thousands of clinicians keep seeing it.
And they whisper. Because saying it aloud can get you fired.
Regret Is Rare, They Say—But They Don’t Call Back the Kids Who Left
Studies claiming “less than 1% regret” are based on older adults, mostly white, mostly surgical patients, often followed for 6–12 months.
They don’t include the teenager who started testosterone at 15, dropped out at 17, and quietly regrets everything at 19. Because that kid never got counted.
Vandenbussche (2021) surveyed detransitioners and found that many felt rushed, poorly evaluated, and shut out of mental health support once they questioned their transition.
These patients are not anomalies. They are canaries in a mine we pretend isn’t full of gas.
Europe Reaches for the Brake Pedal
While the U.S. shouts affirmations like a haunted yoga retreat, European health systems are doing something radical: reading the data.
Sweden: (2022): Puberty blockers now restricted to clinical trials.
Finland: (2020): Psychotherapy-first. Hormones second.
UK: (2024): Tavistock Clinic closed. No blockers without trial enrollment.
Norway: (2023): Similar pivot—more questions, fewer prescriptions.
These are not theocracies.
These are progressive public health systems, and they’ve decided that science trumps slogans.
What We Owe Our Children: Real Science and Real Safeguards
I am not anti-trans. I am pro-science.
Here’s where we need to course correct:
Randomized Trials: must replace professional opinion polls.
Differential Diagnosis: must precede hormone prescriptions.
Consent: must be age-appropriate, developmentally informed, and real.
Dissent: must be allowed—because when science becomes ideology, patients become experiments.
The kids coming into your clinic aren’t just exploring gender. They’re also exploring trauma, identity, loss, autism, culture, and loneliness.
And they deserve more than a one-path protocol and a bottle of T.
Let’s starting talking about this instead of another ridiculous conversation about pronouns.
Be Well, Stay Kind, and Godspeed.
REFERENCES:
Bränström, R., & Pachankis, J. E. (2020). Reduction in mental health treatment utilization among transgender individuals after gender-affirming surgeries: A total population study. American Journal of Psychiatry, 177(8), 727–734. https://doi.org/10.1176/appi.ajp.2019.19010080
Cass, H. (2024). Independent review of gender identity services for children and young people: Final report. NHS England. https://cass.independent-review.uk
Littman, L. (2018). Parent reports of adolescents and young adults perceived to show signs of a rapid onset of gender dysphoria. PLOS ONE, 13(8), e0202330. https://doi.org/10.1371/journal.pone.0202330
Mason, J. (2023). [Quoted in] Society for Evidence-Based Gender Medicine. https://segm.org
National Board of Health and Welfare (Sweden). (2022). Care of children and adolescents with gender dysphoria – Summary. https://www.socialstyrelsen.se
Vandenbussche, E. (2021). Detransition-related needs and support: A cross-sectional online survey. Journal of Homosexuality, 69(9), 1602–1620. https://doi.org/10.1080/00918369.2021.1919479
World Professional Association for Transgender Health (WPATH). (2022). Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. International Journal of Transgender Health, 23(S1), S1–S259. https://doi.org/10.1080/26895269.2022.2100644