I am reviewing two very different books both addressing different aspects of the same non-medically necessary surgery on children. And yet these are not books about genital cutting per se but rather about another different issue that also involves medical “treatment” not applying evidence-based medicine: the startlingly high numbers of youths and children seeking surgery due to allegedly or actually being transgender, what used to be called transexuals.

This topic has become an eye of a very powerful storm of late. In recent years, the number of children and youths seeking surgery due to a stated view of themselves as belonging to a sex different than their birth sex has shot up by some counts a thousandfold in less than a decade. There has never been an issue with such a sudden and extreme surge of popularity. Even the terminology has gone bonkers, as the medically baseless surgery is commonly referred to as “gender affirming surgeries,” suggesting that for this anyway, physicians are giving up on their usual role of curing patients and are instead performing cultural functions, as we sometimes also see with so-called “religious” circumcisions. (Unfortunately, too, enthusiasm for what I think can fairly be characterized as this new craze has spilled over into censorship, with Shrier having to deal with troubles getting her book published and advertised, a publisher backing out after a threatened staff walkout, and Amazon’s erstwhile refusal to sell the book.)

Obviously adults, often but not always young adults, do also choose such procedures for such reasons, yet often it is minors (children) who are seeking the treatments. And all too often what they request is provided, with very little evident medical scrutiny, pursuant to a sort of woke party line that has only come into power in recent years.

Abigail Shrier’s Irreversible Damage: Teenage Girls and the Transgender Craze is a much shorter book than Barnes’ and the first of the two to appear, in 2020. Shrier overviews the recent female-to-male transgender craze. (By one metric, the number of kids making such an identification increased 1,000 times in nine years. There has never been another social movement with an adoption record anything like this.) I appreciate how Shrier draws analogies that are not necessarily evident with other social phenomena having dramatic adoption statistics. She is an excellent writer and despite the highly disturbing topic, her book reads like a spell-binding novel.

Shrier does a very good job pointing out the singularity of the medical treatment of gender dysphoria, which likely is only paralleled by the (different yet equally unjustifiable) singularity of medical treatment of male circumcision: “when we allow parents to consent to medical procedures for teens or tweens, it is typically to permit doctors to save, cure, or alleviate an observable medical problem. But in the singular instance of transgender medicine, we allow a parent to consent to intervention that halts normal, healthy biological functioning—essentially, introducing the ‘disease state’ brought on by a pituitary tumor—all based on self-reported mental distress.”

The author meets a good number of children born female who identify as transgender and sensitively lays out their individual stories in compelling detail. Shrier imagines possible outcomes if the American Psychological Association (APA) addressed anorexia like transgender kids are currently being treated: “Imagine a girl—5’6” tall, 95 pounds—approaches her therapist and says: ‘I just know I’m fat. Please call me ‘Fatty.’… Imagine the APA encouraged therapists to respond to such patients, ‘If you feel fat, then you are. I support your lived experience. OK, Fatty?’” Or, Shrier continues, we can imagine a black girl Nia who considers herself white and her therapist validates her view of herself.

In words also applicable to the specific London clinic examined in detail in Barnes’ book, Shrier writes: “We’d expect a therapist worth her salt to challenge Nia’s self-destructive intentions. We’d want that therapist to gently probe, to get to the root of her unhappiness: Why on earth did Nia start believing there was something wrong with being African American?… [W]e would never want [therapists] to automatically agree with the patients’ self-diagnosis…. It is worth asking whether a standard guided less by biology than by political correctness is in the best interest of patients.”

I appreciate Shrier’s ability to metaphorically take a step back while examining this fraught issue, as when she thoughtfully writes: “It’s worth noting how different this is from being the parent of a gay adolescent. An adolescent who comes out as gay asks her parents to accept her for what she is. An adolescent who is transgender-identified asks to be accepted for what she is not. Even the most loving parent might be forgiven for failing this mind-bending test.” To some extent kids who used to identify as gay or lesbian now instead are identifying as transgender. At Evergreen State College in 2020, fully half of all entering students identified as LGBTQ or “questioning,” a number that Princeton expert Heather Heying believes clearly out of whack with the usual reality of (at most) “around 10 percent” gay students. These days, unfortunately, in Shrier’s words, “For those undergrads ready to prove that a trans identity is more than a name and pronouns, the university is a well-stocked discount pharmacy.”

While it does happen, the looming specter of potential suicide, rarer among transgender kids than one might think, is routinely deployed as a silver bullet that compels parents to hew to the party line, or else. Over and over, the author heard the same question from therapists focusing on transgender children and also from parents to whom the therapists had talked: “Would you rather a dead daughter or a live son?” Talk about rigging the game!

Shrier points out that teens take more risks than any other age group, and are of course also highly focused on obtaining the approval of their peers. Studies indicate that from 70% (one study) up to 88% (another study by a doctor of over 100 of her patients) of children outgrow their gender dysphoria if they are not socially transitioned first. Sadly, at least in certain parts of the country, nowadays the social transitioning seems to happen more or less as a matter of course, without any meaningful prior scrutiny of other potentially relevant factors such as depression, autism, violence in the family, and so on.

Hannah Barnes in Time to Think: The Inside Story of the Collapse of the Tavistock’s Gender Service for Children limits herself to a more specific topic: the heyday followed by the collapse of what was until recently the United Kingdom’s only authorized public health service providing hormones and referrals for surgery in cases of transgender children, namely, the Gender Identity Development Service (GIDS) of the Tavistock and Portman Trust in North London. Barnes’ story is a somber one, one she must not have been happy to be retelling, and yet one that simply must be heard. GIDS developed a head of steam based on an evidently sincere desire to help children, and yet shockingly easily available data that should have been obvious to collect was not gathered. Compounding this failing, numerous GIDS staff that queried the almost uniform referral of children for off-label prescription of puberty blockers were rebuked and in some cases faced threats to or loss of their positions. Additionally, a shockingly high percentage of young people were prescribed cross-sex hormones following their completion of the course of puberty blockers. In Shrier’s words, “[]If an adolescent moves straight from puberty blockers to cross-sex hormones…. Infertility is almost guaranteed.”

GIDS routinely neglected to pursue other issues including family violence, depression, and autism that might be contributing to individual children’s difficulties and adopted puberty blockers as a “one size fits all” solution to all issues with which GIDS was presented. Some GIDS patients openly sought other forms of therapy or treatment instead of hormone blockers and were essentially refused alternatives and told puberty blockers would solve their problems. In many cases referrals for puberty blockers were given after only three or in some cases even just two appointments, despite four being the GIDS’ own stated minimum. Puberty blockers were billed by GIDS as offering the children “time to think” (the book’s title) and reflect on the best course and yet this was effectively the only available option! Evidence-based medicine appears to have been entirely out to lunch. GIDS allowed two grassroots transgender organizations to be inappropriately close to and influential of GIDS and to some extent these organizations enforced the rigid approach to treating trans kids.

The author interviewed or tried to interview everyone of importance in the GIDS saga past and present. Many felt cowed to talk to her, just as they felt silenced when they raised valid concerns (and/or proposed a treatment in a specific case other than the only approved course of puberty blockers) and were treated in many cases with accusations of being “transphobic.” No one can necessarily be said to have been malevolent and yet a lot of harm was done. Excuses were made and nothing was fixed, year after year after year, until a condemnatory external review was performed in response to an explosive lawsuit by a young woman (Keira Bell) regretting her hormones and gender surgery forced a legal reckoning that in the end led to GIDS announcing its closure.

Shrier may provide the best way to conclude this combined review of these two excellent books. She notes that now significant numbers of so-called detransitioners are cropping up, people who regret their earlier decision to transition. By some estimates, as many as one in three of trans children who transition will later detransition. I appreciate the author’s down-to-earth style though the story she tells is so tragic: “[E]ighteen may be the age of majority, but especially today, it’s still very young. So many of these girls who are drawn into the transgender world are already battling anorexia, anxiety, and depression. They are lonely. They are fragile. And more than anything, they want to belong.”