Scarred for life

She has an all-too-familiar story. It’s one that follows nearly every pattern of pain that countless young women endure.

For Isabelle Ayala, being a boy was psychological survival. At eight years old, she was raped. The trauma of childhood sexual abuse brought feelings of self-hatred. She was severely depressed, even emotionally numb.

Then came the self-harm. At 11, Isabelle began cutting herself, leaving scars on her upper thighs. For this wounded little girl, the feeling of physical pain was at least something. Compounding her vulnerability, Isabelle is on the autism spectrum, a condition that is overrepresented among trans-identifying teens.

That’s when she found Tumblr and the suggestion that her distress had a source and a name: transgender identity.

Isabelle declared herself a transboy and quickly started her gender transition journey. A chest-binder to flatten her developing breasts. Voice exercises to sound masculine. Anything to feed her hope that the “weak, vulnerable, 13-year-old girl” could be replaced by a “strong, confident, independent boy.”

Her mother didn’t approve, a hurdle she easily overcame by moving to her out-of-state father’s home, where she found no shortage of gender-affirming care. She faked a suicide attempt to get on cross-sex hormones. At 14, Isabelle walked out of a doctor’s office with a testosterone prescription in a matter of minutes.

And here’s where her story takes on national importance: This doctor had access to her full mental health history. This doctor claimed Isabelle showed “minimal signs of depression and suicidal ideation” despite a later, genuine suicide attempt. This doctor even prescribed Isabelle more testosterone without parental consent.

Isabelle later moved back with her mother, a Florida resident, and stopped the hormone injections “cold turkey.” Miraculously, her gender dysphoria dissipated. Now 20, she’s suing the American Academy of Pediatrics and multiple medical professionals for civil conspiracy, medical malpractice, gross negligence, and fraud.

Her case represents a bellwether in the future of gender transition treatments for minors. Countries like Sweden, Finland, and France—nations even more socially progressive than the United States—have restricted hormonal and surgical transitions for minors. As more countries reconsider the efficacy of hormone treatments for children’s mental health, will we reverse course as well?

If she wins her case, Isabelle will join the growing ranks of detransitioners holding doctors accountable for what can rightly be deemed medical experimentation on children. Detransitioners like Keira Bell, the U.K. woman who in 2020 won her initial lawsuit against Tavistock, the country’s only gender clinic. Between Keira’s case and a spate of damning evidence from whistleblowers, Tavistock eventually closed its doors.

On the one hand, Isabelle’s case is reason for optimism. In light of the mounting evidence that “gender-affirming care” for children not only fails to improve their anxiety and depression, but in many cases, worsens their condition, we might expect to see physicians reverse their stance. As the testimonies of detransitioners continue to surface, we would hope psychologists would advocate additional therapy, if not delayed gender transition. Even more, given the overwhelming success of “watchful waiting,” the previous standard of care that saw some 80 percent to 90 percent of gender-dysphoric children desist at the onset of puberty, we would hope medical health professionals would resume this approach.

But these hopes presume the foundation of “gender-affirming care” is based on the same criteria and standards as other therapeutic measures: Facts.

Yet “gender-affirming care” is not grounded in facts. It’s grounded in ideology. An ideology that has pervaded every facet of American society, including language, law, and professional literature. This ideology decenters cultural majorities, including the nuclear family along with its biologically based identities and ties. It dismantles the idea that sex and gender are binary in order to subvert the “cisheteropatriarchy.” And it doesn’t have to make sense empirically. It certainly doesn’t have to make sense morally. It just has to make sense ideologically.

Vulnerable, suggestible, and traumatized girls like Isabelle may not realize the political undertow waiting to sweep them away, but they are nonetheless caught in its current.

Legal measures protecting vulnerable children are essential. Legislation against the hormonal and surgical gender transition of minors is worthy. And initiatives to defend the rights of detransitioners critical.

But turning this tide will not be exclusively a matter of laws. The reversal of gender ideology will not be won or lost in the courts. Winning a case won’t win over hearts and minds, vital as it is that detransitioners like Isabelle prevail. As we witnessed with the overturning of Roe v. Wade, just laws will not de facto prevent unjust acts, much less their demand.

I hope Isabelle wins her case. It would mark the first step to hold accountable a medical community that has failed vulnerable adolescents and young adults. And it may signal the beginning of doctors, hospitals, and insurance companies becoming suddenly “enlightened” to the adverse effects of gender transition. But, if we are to follow the lead of other nations—if we are to reverse the collision course into which an entire generation has spiraled—we need to do more than present a series of facts. We need to persuade with better ideas.