Ignoring the costs of transgenderism

Editor’s note: This story contains descriptions of some transgender surgeries.

Jamie Reed remembers when a 19-year-old girl who wanted a double mastectomy came to the transgender center where Reed worked. Reed, then a case manager at Washington University Transgender Center at St. Louis Children’s Hospital, also remembers when the patient regretted her decision.

“Within three months of her surgery, she ended up calling back and asking, begging the surgeons to have her breasts put back on,” Reed told WORLD. The patient no longer identified as male, and while there were some surgical remedies, the surgery could not be fully reversed, Reed said.

“The thing that I found very troubling was that the surgeons themselves would not even call her back,” Reed said. Instead, they asked Reed and another nurse to follow up with her. The surgeons eventually told the patient she would have to wait a year to have a reconstruction surgery—double the amount of time she waited for the initial removal, Reed said.

Reed, who identifies as queer and is married to someone who identifies as transgender, left the center in 2022 because she said it was not using an evidence-based approach. She accused the center of using children to get a higher Healthcare Equality Index rating from the Human Rights Campaign for the hospital, which could help it get more donor dollars. After she left, Reed filed an affidavit with Missouri’s attorney general and became one of the first people from within the transgender industry to go public with their concerns.

Since Reed went public, some co-workers and patients at the center have disputed her claims, saying they benefited from provided interventions or at least didn’t have the same experience she did. But since then, other doctors from within the industry and people who no longer identify as transgender, known as detransitioners, have started coming forward with similar concerns.

As those concerns come to light, some U.S. states are passing laws protecting children from medical attempts to change their sex characteristics. But others are removing safeguards despite increasing research showing the harms of many transgender medical practices, even as the U.K. pulls back from a harmful care model.

England’s National Health Service released the Cass Review earlier this year, finding that there is little to no evidence supporting the current model of “gender-affirming” care. By April 1, the United Kingdom had stopped prescribing the drugs to minors for gender confusion and shut down the only NHS transgender center that accepted child patients.

Last week, the American College of Pediatricians, along with other pediatricians, doctors, and medical organizations, signed a petition asking other American medical institutions to change their guidance on transgender interventions. They say medical organizations should recommend therapy aimed at underlying mental health issues and adhere to evidence-based research like watchful waiting. But many major medical associations, such as the much larger American Academy of Pediatrics, still support transgender protocols.

“It is a combination of big ideology meets big industry,” said Dr. Andre Van Mol, a board-certified family physician in California and member of the Christian Medical and Dental Associations. “People very much expect the healthcare professional to be the vending machine that gives them what they want,” Van Mol said. So, if corporations can make more people believe they need a certain treatment, more people will ask for or require that treatment.

That treatment can also be very expensive. One study published in The Journal of Law, Medicine, and Ethics found that it can cost anywhere from $6,927 to $63,432 for the initial orchiectomy, vaginoplasty, or phalloplasty surgeries for one person to remove or replace healthy organs. But the interventions frequently required more than one procedure, resulting in costs reaching $133,911. A 2018 study published in LGBT Health found that if someone’s insurance does not cover transgender interventions, they may also spend anywhere from $72 to $3,792 out of pocket on a 30-day supply of medications for hormone therapy.

Many patients falsely assume that transgender interventions are shown to be safe and effective, Van Mol said. So when doctors or other professionals push back against performing the requested surgery or even just delay it, patients may “view that as obstructionist or [that] they’re not getting proper care when, in fact, they are,” he said.

Van Mol pointed to some big organizations helping perpetuate this idea. Every year, the Human Rights Campaign releases a Healthcare Equality Index, which rates an organization’s LGBTQ services. The hospital where Reed worked scored an 85 out of 100 this year. The campaign also lists its biggest “corporate partners” like Accenture, Amazon, and American Airlines using big logo thumbnails. “There is something that’s gained by being able to claim status for your corporation as being . . . given the gold stamp of the rainbow flag,” Reed said.

Other foundations and individuals are using big dollars to sway public opinion. Organizations like the Gill Foundation, Arcus Foundation, and Tawani Foundation all put a significant amount of resources toward campaigning for pro-LGBTQ groups. The groups they fund include the Human Rights Campaign and the World Professional Association for Transgender Health, or WPATH—an organization that was recently outed for knowingly using unscientific methods to create the guidelines hospitals use for assessing patients who identify as transgender.

Since part of the problem is financial incentive, Van Mol said, endangering the profit margin with lawsuits could help keep the industry in check. Attorneys like Josh Payne in Birmingham, Ala., are making it their mission to help people harmed by the transgender industry. Doctors are supposed to be the first line in protecting vulnerable people, Payne said. “That’s where firms like ours have a role in policing that and asking the question, ‘Were the healthcare professionals doing their job in this particular case?’”

Payne’s firm, Campbell Miller Payne, represents detransitioners from North Carolina, Texas, and Rhode Island, among others. The complaints include doctors’ withholding information, ignoring underlying health concerns, and lying about what transition surgery would accomplish and the permanent damage it would do.

Van Mol said that some companies or medical professionals consider the financial benefits of promoting transgender treatments. “Actuaries don’t care about ideology, they care about math and dollars,” Van Mol said. “They see the writing on the wall, they do the calculations, and the insurance rates are going up for these clinics, because what they’re doing is not benign. And it’s going to be rewarded with lawsuits for what they’ve done to these kids.”