THOUGH SOME CRITICS lambasted the study, Littman isn’t alone in her findings.

Lisa Marchiano, a secular therapist in Pennsylvania, wrote a blog post in 2016 cautioning parents about plunging into medical interventions with children and teens claiming to be transgender. Afterward, she began taking phone consultations with parents of teens experiencing ROGD. A year later, she wrote, “I am overwhelmed by the sheer volume of parents who call me.”

Some parents plead with Marchiano to allow them to fly their children into town for therapy or to help them find a therapist who won’t push their teens to transition with cross-sex hormones.

“At times I am able to offer advice that helps a family steer clear of drastic medical intervention of dubious benefits or necessity,” she wrote. “But sometimes all I can do is stand helpless and watch the wreckage.”

Marchiano described working with a family whose daughter declared transgenderism at age 18. The young woman had experienced other mental health problems but hadn’t expressed a conflict with her sex until high school. The parents had taken her to a clinician, and after a 30-minute consult, a physician’s assistant made an appointment for the teen to begin testosterone injections the following week.

Her parents convinced her to wait, but by the end of her freshman year of college the teenager had begun taking cross-sex hormones and had undergone a mastectomy—paid for by student health insurance. (Eighty-six colleges nationwide have student health plans that include cross-sex hormones and cross-sex surgery.)

Marchiano says the parents reported the radical physical steps didn’t decrease their daughter’s mental anxiety. She had dropped out of college and remained mostly isolated in her home.

Some teenagers report feeling relief after taking hormones or pursuing surgery, and some transgender activists claim social acceptance is a key to transgender adolescents becoming happy. But given that many parents who worry about their teenagers’ decline after experiencing ROGD also expressed left-leaning views of sexuality, social conditions alone don’t account for the distress some adolescents and young adults still feel.

And short-term relief doesn’t negate the long-term consequences of a person rejecting his or her sex and beginning lifelong medical interventions. For example, cross-sex hormones can cause sterility, leaving teenagers to decide whether to forgo having biological children later in life.

Other experts say cross-sex hormones increase risk of stroke and that puberty blockers could decrease bone density in adolescents. And since the practice of giving cross-sex hormones to children is only about a decade old, even pro-transgender physicians admit they don’t know the long-term outcomes.

More studies make sense, including research into the dangers of pursuing such paths. But while studies like Littman’s are under fire, the federally funded National Institutes of Health has given more than $5 million in grants to a group of doctors and psychologists tasked in part with studying transgender children over a period of decades.

The views of at least some of the researchers seem clear from the outset: Norman Spack is a Boston physician who opened the nation’s first gender clinic for children. Johanna Olson-Kennedy is a pro-transgender pediatrician who sees hundreds of children at the Center for Transyouth Health and Development at Children’s Hospital Los Angeles.

Late last year, the American Academy of Pediatrics (AAP) for the first time officially recommended that parents accept and encourage the preferred gender expression of their children.

That cuts across decades of therapists who argued parents should encourage their children to embrace their birth sex, knowing that some studies show as many as 80 percent of children who express gender dysphoria will outgrow those feelings by adulthood.

But in 2016, Cora Breuner, a pediatrician and head of the AAP’s committee on adolescence, told PBS she wanted to see gender clinics available to children all over the United States: “My goal is to make this absolutely mainstream.”

Research into alternate ideas doesn’t promise to become mainstream again any time soon.

Michael Bailey is a psychologist at Northwestern University who faced intense criticism a decade ago for challenging the prevailing ideas about male transgenderism. He still raises questions: “Right now there’s this bias for the narrative that all gender dysphoria is real and that it’s great to transition—and against people who are concerned about this.”

He doubts he’d be able to get a government grant to study the issue. Instead, Bailey’s working on a study similar to the one Littman released last year. He’s conducting a survey in conjunction with the website Parents of Rapid-Onset Gender Dysphoria Kids. (He notes it’s possible some of the same parents may respond to his survey as responded to Littman’s study.)

He says the study will likely be published later this year, but so far, he says the results are very similar to what Littman found. He thinks the reaction against her study was “clearly ideologically motivated” and that it communicated, “This is not valid … and let’s punish anyone who tries to study this.”

Bailey says he knows other psychologists who are worried about the push to encourage children to pursue medical interventions, but who don’t want to speak out for fear of retribution.

‘Right now there’s this bias for the narrative that all gender dysphoria is real and that it’s great to transition—and against people who are concerned about this.’—Michael Bailey

Paul Hruz, an endocrinologist at Washington University in St. Louis, says a substantial number of his colleagues feel the same way, but won’t speak up either: “It’s one of the ways we’re failing our patients.”

Hruz notes that when children or teens come seeking cross-sex hormones, they are usually physically healthy, but entering into lifelong dependency on hormones. And he emphasizes the biologically obvious: No one can change his or her sex.

“Sex is biologically determined from at the moment of conception” says Hruz. “It’s recognized at the time of birth, it’s not assigned at the time of birth. And even if you modify the appearance of the body, you don’t do anything to change the sex.”

Despite that biological reality and the many unknowns about the long-term consequences of cross-sex hormones (as well as the already-known side effects), he’s dismayed to see physicians and psychologists pushing such medical procedures on children:

“I’ve not in my career encountered another condition where we’ve moved ahead so rapidly and so vigorously to affirm one particular intervention with this level of evidence.” He hopes the medical community will wake up to the dangers: “But I don’t know how many children will have been harmed by then.”

ANDREW WALKER, author of God and the Transgender Debate and a fellow at the Ethics and Religious Liberty Commission, thinks in a hundred years people will look back on this era of medicine the way we now look back on the eugenicist movements of the early 20th century.

While many obvious biological reasons exist for opposing the embrace of transgenderism, Walker says Christians also should be well-versed in the Biblical teaching about God creating people male and female in His image.

He says that’s particularly important for parents talking with children about these issues: “And I err on the side of having the conversation sooner than later because if you don’t have the conversation with your children, the culture will.”

(Walker says a parent can teach even a young child that some people are confused about the way God made them, and that we should have compassion on those who are suffering in this way and help when possible.)

The suffering is intense for many. 

Hacsi Horvath, a lecturer in epidemiology and biostatistics at the University of California, San Francisco, has written about his own experience of trying to live as a woman for 13 years. He says he stopped taking estrogen in 2013 and “very rapidly came back to my senses.”

Today, he says he grapples with anger but writes about his experience because “I am far angrier that thousands of young people are being irreversibly altered and sterilized as they are inducted into a drug-dependent and medically maimed lifestyle.”

He hopes to spare others what he’s suffered: “an inward bruise … I have been badly harmed.”