How transgender medicine has gone astray: Protecting children from chemical and surgical mutilation

Written By Norbert Gleicher, MD, FACOG, FACS

By Norbert Gleicher, MD, Medical Director and Chief Scientist, at The Center for Human Reproduction in New York City. He can be contacted though The Reproductive Times or directly at either ngleicher@thechr.com or ngleicher@rockefeller.edu.

Because gynecologists and fertility specialists are currently usually only marginally involved in transgender care, the gynecology literature (infertility literature included) has so far largely ignored the controversies that have arisen in transgender medicine. This, of course, does not apply to The Reproductive Times, which – especially since the Cass Review was published in the UK in 2024 – has been covering the subject extensively. Several recent events and published articles, however, now mandate further comments.

In covering the updates on this subject, it — first and foremost — must be noted that on January 28, 2025, President Trump issued an Executive Order under the somewhat unusual title (which we here at least partially appropriated), “Protecting Children from Chemical and Surgical Mutilation” (1). Because this order has been widely commented on in the media — often with inappropriate and/or outright incorrect interpretations — we here offer some verbatim citations from this order. But before we do so, it is also important to point out that this Executive Order specifically refers only to children (under the age of 19). The order does not apply to adults (individuals over the age of 19), who, of course, under the law, are entitled to do almost anything they wish. And we quote:

REGARDING ITS PURPOSE: Across the country today, medical professionals are maiming and sterilizing a growing number of impressionable children under the radical and false claim that adults can change a child’s sex through a series of irreversible medical interventions. This dangerous trend will be a stain on our nation’s history, and it must end.

Countless children soon regret that they have been mutilated and begin to grasp the horrifying tragedy that they will never be able to conceive children of their own or nurture their children through breastfeeding. Moreover, these vulnerable youths’ medical bills may rise throughout their lifetimes, as they are often trapped with lifelong medical complications, a losing war with their own bodies, and, tragically, sterilization.

Accordingly, it is the policy of the United States that it will not fund, sponsor, promote, assist, or support the so-called “transition” of a child from one sex to another, and it will rigorously enforce all laws that prohibit or limit these destructive and life-altering procedures.

SELECTED DEFINITIONS: The phrase “chemical and surgical mutilation” means the use of puberty blockers, including GnRH agonists and other interventions, to delay the onset or progression of normally timed puberty in an individual who does not identify as his or her sex; the use of sex hormones, such as androgen blockers, estrogen, progesterone, or testosterone, to align an individual’s physical appearance with an identity that differs from his or her sex; and surgical procedures that attempt to transform an individual’s physical appearance to align with an identity that differs from his or her sex or that attempt to alter or remove an individual’s sexual organs to minimize or destroy their natural biological functions. This phrase is sometimes referred to as “gender-affirming care.”

SELECTED INSTRUCTIONS: The blatant harm done to children by chemical and surgical mutilation cloaks itself in medical necessity, spurred by guidance from the World Professional Association for Transgender Health (WPATH), which lacks scientific integrity.

An EDITORIAL COMMENT appears here appropriate regarding the increasingly popular abuse in medical practice of establishing what should be called “professional pseudo-societies,” which then take it upon themselves to claim authority to publish often self-serving professional guidelines. As previously noted in these pages, the infertility field has suffered similar abuse through the establishment of the PGDIS (Preimplantation Genetic Diagnosis Society), a highly conflicted professional group of individuals mostly making a living from preimplantation genetic testing for aneuploidy (PGT-A), which every few years has been publishing increasingly absurd guideline documents regarding PGT-A (at times without authors listed, at other times without references).

Similarly, the membership of the WPATH is mostly made up of individuals making their living to a significant degree from gender-affirming care. Both of these societies — though claiming special expertise and entitlement — should, however, be completely disqualified from establishing guidelines for clinical practice

And we continue with the citation of the Presidential Executive Order:

Agencies shall rescind or amend all policies that rely on WPATH guidance, including WPATH’s “Standards of Care Version 8”; and within 90 days of the date of this order, the Secretary of Health and Human Services (HHS) shall publish a review of the existing literature on best practices for promoting the health of children who assert gender dysphoria, rapid-onset gender dysphoria, or other identity-based confusion. The Secretary of HHS, as appropriate and consistent with applicable law, shall use all available methods to increase the quality of data to guide practices for improving the health of minors with gender dysphoria, rapid-onset gender dysphoria, or other identity-based confusion, or who otherwise seek chemical or surgical mutilation.

The head of each executive department or agency (agency) that provides research or education grants to medical institutions, including medical schools and hospitals, shall, consistent with applicable law and in coordination with the Director of the Office of Management and Budget, immediately take appropriate steps to ensure that institutions receiving federal research or education grants end the chemical and surgical mutilation of children.

Is there anybody who can argue with this Executive Order? We don’t believe so!

And now to a first related article, written by Abigail Shrier for The Free Press, which — though a relatively new and very successful media presence — has probably been the most important media outlet in the U.S. to break the story about abusive transgender medical care in this country.

Abigail Shrier is an American author and former opinion columnist for The Wall Street Journal, whose book, Irreversible Damage: The Transgender Craze Seducing Our Daughters, is probably the most interesting exploration of the “mystery” of why, during the last decade, the diagnosis of “gender dysphoria” — before that almost exclusively only observed in boys and men — suddenly exploded into an epidemic among teenage girls. [Regnery Publishing; Publishing Date 6/29/2021]

Under the title “How the Gender Fever Finally Broke,” the article basically summarized itself in one sentence: “Loving, naïve parents believed medical science was above politics and beyond question. Now, with the stroke of a pen, a destructive ideology has been eliminated” (2).

In its introduction, this excellent article noted two key occurrences in the truly bizarre history of medical care for gender transitions in children and juveniles: A first one involving almost incredulous numbers was the fact that the GoFundMe website in 2020 listed over 30,000 urgent appeals from young women seeking financial help to remove their perfectly healthy breasts. Over 30,000!!

The second occurrence is — from a medical standpoint, however — even more significant because it involved, in the same year (December 2020), a Perspective article in the highly prestigious New England Journal of Medicine, which — as Shrier noted — suggested that sex is actually “assigned” to newborns by doctors at birth (i.e., is not biologically predetermined) (3).

Though, based on the routine inspection of sex organs of the newborn after birth, the article in principle was correct about sex assignment at birth, only in extremely rare circumstances, usually involving chromosomal intersex conditions, can this quick inspection of sex organs be misleading. The three authors of the paper (the lead author at the time a pulmonology fellow, a second author a lawyer, and only the senior third author a prominent reproductive endocrinologist and close friend of the CHR) — we would hope without intent — in their article basically proposed a new and — frankly controversial — concept by arguing that, “sex designations on birth certificates offer no clinical utility, and can be harmful for intersex and transgender people. Moving such designations below the line of demarcation (in their opinion) wouldn’t compromise the birth certificate’s public health function but could avoid harm” (3).

As Shrier correctly noted in her article, this statement broke news to gynecologists and other interested parties, including members of school communities, with schools outright starting to ask children in elementary school whether they might not like to identify as “genderqueer” or nonbinary.

HOW THE ASRM DEFINES BIOLOGICAL SEX (4)

  • Biological sex is based on physical characteristics of genitalia at birth and other biological determinants.

  • Gender is a sociological and legal construct, varies by culture, and is a highly complex topic.

  • Sexual differentiation occurs during fetal development and is driven by genetic and hormonal factors.

  • This process determines the development of (in principle only) female and male physical traits but can — due to hormonal and/or chromosomal variations — result in a spectrum of outcomes (intersex).

  • While XX and XY chromosomes are usually associated with, respectively, female and male sex, sex-chromosome variations, such as XXY or XYY, can occur in 1/1500-1/2000 live births, in those rare cases challenging the binary model of sex assignment as female or male.

  • This means that the U.S. currently has approximately 200,000 – 330,000 so-affected individuals.

  • Primary (genitalia and reproductive organs) and secondary sex characteristics (body hair and breast development) are shaped by genetics and hormones and can, even within the same chromosomal sex, vary widely.

And then there was Section 1557 of President Obama’s Affordable Care Act, which very clearly included discrimination on the basis of “gender identity” as discrimination on the basis of “sex,” and immediately opened the purse as a huge source of funding for all treatments relating to gender transitions. And once a financing source has been identified for a new treatment, we in infertility, of course, know better than most other medical specialties how quickly a whole industry is created in collaborative efforts between pharma, hospitals, manufacturing, and, of course, practicing physicians, to feed on this new financial source. Once President Obama had written into law that individuals with issues regarding their gender identity had to be considered a “protected class,” this new industry was — for all practical purposes — already fully at work.

But things continued to get worse. As Shrier also noted in her article, WPATH, of course, very quickly issued practice guidelines, which were instantly adopted by all insurance companies, as well as Medicaid and Medicare, as the “standard of care.” WPATH presented the guidelines as “evidence-based,” once again demonstrating that what, for one highly conflicted professional society, represents “best evidence” cannot be expected to align with what an unbiased, three-year study – like the Cass Review – would consider “best evidence.”

One key conclusion of the Cass Review was, indeed, that there was insufficient “best evidence” for treating children and young adults with any of the treatments – whether chemical or surgical. This, however, was exactly what WPATH had found to represent evidence-based standard of care.

As a lawsuit attempting to overrule Alabama’s ban on gender-transforming care for minors revealed, WPATH lacked any solid evidentiary basis for its guidelines, and the society’s leadership knew this but suppressed publications of systematic reviews. [EDITORIAL COMMENT: Following, once again, exactly in the footsteps of the PGT-A scandal in reproductive medicine.]

What made the situation even worse was the support of the Biden administration for these treatments. As Shrier noted, not only did Biden’s Justice Department sue states that enacted bans on such treatments for minors, but Assistant Secretary for Health, Admiral Rachel L. Levine, MD, herself a well-known female transgender adult – and, imagine that, a pediatrician – successfully pressured WPATH to drop the minimum age for medical and surgical treatments for minors in its 2020 published standard of care.

In the same year, the Department of Health and Human Services, under her leadership, published a fact sheet that claimed gender-affirming care for children and teens was crucial for their overall health and well-being.

The analogies to the mismanagement of the COVID-19 pandemic by the federal government are, of course, all too obvious and contribute to the growing mistrust in all government-provided health care information the public has had since the pandemic. Shrier points out that all the recent disclosures, and especially President Trump’s new Executive Order on this subject, hopefully have finally broken “the spell” that made parents (wrongly and often naively) believe that medical science was beyond politics.

She also pointed out that many bad actors, including a pediatrician Assistant Secretary of Health, surgeons, medical endocrinologists (who, to the luck of reproductive endocrinologists, took the lead in this matter), psychiatric therapists, social workers, and, of course, too many teachers and even clergy, took advantage of circumstances and joined the earnings bandwagon.

Finally, Shrier described in the article what has been happening with transgender care for minors as a “spell” over parents who allowed their children to transition at such young ages. With the publication of Trump’s Executive Order, it appears this spell has finally been broken, as the similarities between the incompetence of the federal government in managing this health problem and the management of the COVID-19 pandemic have come into increasing focus. She indeed sees those parents as naïve in having assumed that medical science was above politics and beyond questioning. The disgusting and factually incorrect threat from counselors that they almost always fell for (suicides, indeed, have been surprisingly rare) was, “Would you rather have a live son or a dead daughter?”

The President’s new Executive Order does not necessarily prevent continued treatments of children that are privately paid for, but one can assume that these – at worst – will be rare because hospitals and universities will be hesitant to face the legal and potential financial consequences from the government for ignoring the Executive Order.

This makes the intervention by New York’s Attorney General, Letitia James, all the more significant. On February 3, 2025, she advised New York hospitals to ignore the government’s Executive Order, as it contradicted state law. As of this writing, what New York’s hospitals have decided to do – or not to do – going forward regarding the issue is still unclear.

Never a dull moment here in New York politics!

Norbert Gleicher, MD, FACOG, FACS
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