And so it begins. What common sense and courage would not do, the almighty dollar will.
It was only a matter of time before the youthful victims of irreversible “gender-affirming care” began to turn on their caregivers.
In January, a young woman who underwent gender-transition surgery at age sixteen was awarded a landmark $2 million jury verdict in her malpractice lawsuit against the medical practitioners who encouraged her into life-changing “treatment.” The monetary award may be cold comfort: She will not get her breasts back. The jury decision is a promise that psychologists, psychiatrists, hospitals, and urological surgeons will pay a price for their misadventure into a brave new gender world. Expect them to lose their malpractice insurance as well. This is not the first litigation by those who have been damaged: Dozens of other individuals have also filed suits, but this is the most public and most significant.
To try and understand how all of this has unfolded, it helps to remember what Alice learned on the other side of the looking glass:
“When I use a word,” said Humpty-Dumpty, in a rather scornful tone, “it means just what I choose it to mean—neither more nor less.”
Predictably then, words and phrases like “counseling,” “therapy,” “gender affirming care,” “true selves,” and “evidence-based care” have camouflaged the foul nature of this activity.
Sudden Reversals
Other than the tragedy inflicted on thousands of youngsters, perhaps most reprehensible in this whole affair is the duplicity of the medical professional associations. Only two days after the verdict was announced, the American Society of Plastic Surgeons (ASPS) changed its position, stipulating that transgender procedures should not be undertaken until patients reach adulthood.
The ASPS statement is remarkable in that the enthusiasm for faddish gender dysphoria treatment is replaced by doubt and caution. The ASPS admits, “There’s no data to suggest that you can predict who will benefit from surgery and who will have a negative outcome.” For that reason, these surgeries should be deferred or postponed “until the age of 19.”
For many of these kids, a “better-late-than-never” admission is, tragically, late but not better.
This is an admission of guilt couched in vague language. By now, thousands of 12–18-year-old children have received gender-related “care” in the US, according to a review of hospital data. Many of those harrowing procedures involve—euphemistically speaking—“chest surgery.” But, now the plastic surgeons’ group admits that existing research does not clearly show lasting benefits from irreversible operations that may cause “treatment complications and potential harms.” For many of these kids, a “better-late-than-never” admission is, tragically, late but not better.
Even at that, ASPS could not resist trying to cover its tracks, explaining, “Doctors have said early breast development can be deeply distressing for transgender teens.” That involves a faulty premise that leads to a horrid conclusion: “Transgender teens” will always have transgender inclinations and that dismemberment is the right remedy.
But as recently as 2019, the ASPS had said surgery could “help gender dysphoria patients align their bodies with whom they know themselves to be and improve their overall mental health and well-being.” In other words, the surgery is justified by what a pubescent child “knows themselves to be.” But what kind of medical standard is it that provides “chest and genital surgical interventions” based on a young teenager’s certainty of who they are?
It is maddening to have to state the obvious—namely, that teenagers undergo dramatic changes during this uncertain time—and to base radical, life-changing, nonessential, and irrevocable surgery on a boy or girl’s tentative self-understanding defies the most elementary common sense. Did this medical enthusiasm extend to the families of those who promoted it? Have they raised teenagers? We are reminded of a comment Flannery O’Connor made after speaking at an all-girls school infected with ideology: “These girls live in a world that God never created.”
The ASPS belatedly acknowledged that a physician’s “role is not simply technical but ethical.” But why does such a statement even have to be made? While it may be an attempt to impress the reader with the shallow thoughtfulness of those involved in contemporary gender “care,” it does the opposite, since the average reader will likely ask, “Are you only now acknowledging the moral dimensions of your profession?”
The “Venerable” AMA
In the same week of the ASPS reversal, the venerable American Medical Association (AMA) walked back its earlier advice for such “treatment.” Previously the AMA had sharply criticized “dangerous” government intrusion that sought to restrict these practices on children. It may only be a matter of time before the American Pediatric Association yields to the inevitable and “clarifies” its position as well. Of course, it takes a 100 milligram dose of naivete to imagine that these professional U-turns are not a frantic response to the jury verdict.
What kind of medical standard is it that provides “chest and genital surgical interventions” based on a young teenager’s certainty of who they are?
The AMA “clarified” its position: “In the absence of clear evidence, the AMA agrees with ASPS that surgical interventions in minors should be generally deferred to adulthood,” acknowledging “gaps in research. . . . Better studies are needed before these procedures become more common for minors.” It seems that the proper response to gender dysphoria has not yet reached an “evidentiary threshold.” *
In 2021, the AMA asserted, “Gender-affirming care is medically necessary, evidence-based care that improves the physical and mental health of transgender and gender-diverse people.” At that time, the AMA fortified its position by implying that anyone questioning its wisdom was guilty of “discrimination based on an individual’s sex, sexual orientation, or gender identity.” The AMA insisted that “transgender and gender-diverse minors have the opportunity to explore their gender identity under the safe and supportive care of a physician.” The stern Hippocratic admonition that physicians “do no harm” apparently did not apply to cases in which youngsters’ lives have been permanently disordered by puberty blockers and hormone therapy, or who have been maimed by anatomical disfigurement. We might ask what kind of medical training prepares a physician to provide “safe and supportive care” as children “explore their gender identity”? Let’s not mince words: This is presumptuous and foolhardy malpractice.
Money, Fads, Tenure, Promotion, and Reputation
How are we to understand the moral, intellectual, and professional betrayal by the medical professional community?
It’s not so hard, at least up to a point. So-called gender affirmative care is lucrative. The surgery is complex and multilayered, involving several possible procedures. Without considering the aftercare and counseling (or the presurgical and postsurgical consultation support), the surgery alone can easily reach $100,000. Like anyone else, medical professionals may get bored with their work. There must be a kind of creative thrill in meeting the challenge of a vaginoplasty, a phalloplasty, and facial feminization. We all, moreover, enjoy celebrity and eschew censure. Those who have criticized the new gender practices have often been brutishly attacked from multiple quarters. No one wants to be ostracized nor lose their job.
In addition, a growing number of academics have found gender a productive field for “research” and publication—requisites for tenure and promotion. Once they have built a reputation in this area, moreover, it becomes increasingly difficult, if not impossible, to tolerate criticism of their work, much less a renunciation of their efforts: “Oh, by the way, my body of research over the last three decades is faulty and misleading.”
For most medical physicians in practice, publication in the flagship journal of the AMA, the Journal of the American Medical Association (JAMA), is prestigious. Yet a survey of the journal over the last decade fails to find published studies that question the trend toward ill-conceived, aggressive intervention for dysphoric youth. On the contrary, every article endorses the heretofore prevailing trend in “gender-affirming care.” Just last July, JAMA Pediatrics, with an excursion into philosophy, published an article entitled “The Moral Injury of Denying Gender-Affirming Care.” It is important to recognize what academics already know: Every academic journal has its particular biases that guide which submissions the editors accept for publication; JAMA, moreover, is not only the scientific but seems to be the political voice of the AMA as well.
Normalizing the Abnormal
Gender dysphoria has long been recognized; nature makes mistakes. Sometimes nature just has a bad day. But those are exceptions to the norm. Now, however, nothing is abnormal anymore; conversely, everything is normal, based on one’s subjective feelings. Aristotle anticipated our time. In his Nicomachean Ethics, the philosopher explained that a good life involves two distinct things: knowing what a good life is and knowing how to get there. He writes, “There are two things that [living well] consists of for all: one of these is in correct positioning of the aim and end of actions; the other, discovering the actions that bear on the end.” By analogy, he notes that if a doctor does not know what a healthy human being should look like, he will be unable to guide his patients to achieve that end. This is where relativism has brought us; it has been a long time coming and we have arrived at a dangerous place indeed. The fight against reckless “gender care” may prevail in the short run, but the war may not be over.
If normality is now nowhere and everywhere, the next front may open anywhere.
In June 2025, the US Supreme Court ruled in Mahmoud v. Taylor that public schools must allow parents to opt their children out of radical curricular materials that conflict with their religious beliefs, specifically regarding extreme “LGBTQ+-inclusive books.” The 6–3 decision held that denying these opt-outs constitutes an unconstitutional burden on religious exercise. The decision was rightly celebrated on this site and others. When I listened to the oral arguments, however, I was troubled that the case was argued solely on the grounds of religious freedom. I thought, “Can we no longer simply say, ‘I don’t want my kids subject to this stuff and this classroom misdirection because it is abnormal?’” Whatever the composition of the court, conservative or liberal, there is no constitutional protection for normality. That must be found elsewhere.
Gender Politics and More Tortured Language
Meanwhile, the political battles continue. A growing number of states have either banned or restricted “gender-affirming care” for youth, and this has put additional pressure on medical professionals and misguided ideologues. Genuine science and reason are, however belatedly, winning victories over ideological fashion. Recently, in Mirabelli v. Bonta (2026), the Supreme Court blocked an ill-conceived 2024 California law. The law, signed by Governor Gavin Newsom, prohibited teachers from sharing information from parents if a student experienced gender dysphoria or if they perceived the student was “gender transitioning.” The law further required teachers to use a student’s “preferred pronouns” and even an alternate name that the student may choose. One set of parents challenged the law after their eighth-grade daughter attempted suicide, and they discovered the school had been keeping them in the dark while their child was struggling all through seventh grade.
After the decision, Governor Newsom doubled down on the law, complaining that teachers should be free to teach and not act as “gender cops.” Another critic of the Court decision complained that teachers will now have to “out” students to their parents. What a nonsensical abuse of language!
What will future generations think of this costly blunder into a brave new world, an era in which millennia-old ideas about boys and girls were suddenly “discovered” to have been a cruel hoax? Will it be seen as a lapse into temporary insanity or a temporary setback in a foolish march into the abyss?
* Shortly after this article was published, the AMA requested a retraction from The New York Times. The New York Times has refused to issue a retraction, explaining that their original reporting is accurate.