Two recent developments highlight cracks in this wall of institutional indifference, which are beginning to become apparent. Last week, the Cleveland Clinic reached a settlement with the Department of Justice that includes a 20-year ban on gender transition treatments for minors and a commitment to provide detransition care to patients seeking to recover from medical procedures they now regret.

The agreement follows an announcement that Texas Children’s Hospital in Houston will open the country’s first dedicated detransition clinic, a move that came after Texas Attorney General Ken Paxton investigated the facility for violating state bans on pediatric gender-affirming treatments.

Thousands of children have been affected

The scale of the issue extends far beyond these two institutions. Research conducted by the organization Do No Harm has identified nearly 14,000 American children who received gender transition treatments between 2019 and 2023 through an analysis of insurance claims data.

The Children’s Hospital of Philadelphia administered gender transition treatments, including surgeries, to more than 120 minors during that period. Boston Children’s Hospital subjected more than 300 children to gender transition procedures. Dozens of pediatric hospitals across the country have performed similar procedures on vulnerable young patients.

These medical centers administered experimental hormone therapies with potentially severe side effects and performed irreversible surgical procedures, including mastectomies and genital surgeries on minors. However, when these same patients mature and seek help to reverse the harm, the hospitals that profited from their initial treatments have shown little interest in providing care.

Medical professionals silenced by fear

Some doctors claim they do not believe detransition is a legitimate medical phenomenon, even after encountering individuals seeking detransition in clinical settings. Others admit they are paralyzed by fear of retaliation from activists.

Healthcare professionals face real threats to their careers and institutions from organized pressure campaigns if they acknowledge the reality of detransition or offer treatment to help these patients, according to doctors familiar with the issue.

The medical needs of those attempting detransition are significant and lifelong. Patients must manage persistent surgical complications, deal with serious physiological effects from hormone treatments that altered their bodies during critical developmental years, and address deep psychological trauma.

Many people attempting detransition struggle with the realization that they may never be able to have children due to fertility damage caused by medical interventions. Others experience intense distress because they no longer recognize themselves or are unable to reclaim their pre-transition identity.

Medical organizations remain silent

Major medical organizations that actively promoted pediatric gender transition treatments have refused to issue treatment guidelines for those seeking detransition. The Endocrine Society and the American Academy of Pediatrics, both of which have published detailed protocols supporting gender transition in children, have remained completely silent on how to help patients seeking to reverse these procedures.

Repeated requests over a three-year period to the Endocrine Society for guidance on detransition care have gone unanswered, suggesting that only external pressure will force medical institutions to recognize these patients.

Ideally, hospitals with existing gender transition clinics should voluntarily establish detransition clinics to serve the patients they initially treated. However, given widespread institutional resistance, state and federal authorities may need to compel medical facilities to provide this care, following the Texas model.

The Cleveland Clinic’s financial settlement and Houston’s upcoming detransition clinic represent important first steps, but they cannot alone meet the nationwide demand for these services. Those pursuing detransition across the United States deserve access to doctors willing to help them recover from procedures that, it is argued, should never have been performed on children in the first place.