In 2007, Boston Children’s Hospital opened the first pediatric gender clinic in the United States. Known as the Gender Multispecialty Service (GeMS), the hospital describes it as “the first major program in the U.S. to focus on gender-diverse and transgender adolescents.” And the hospital touts the fact that, since founding GeMS, “we have expanded our program to welcome patients from ages 3 to 25.”

Age three is when a toddler can describe what is happening in a picture book. Yet that is the age of children to whom Boston Children’s Hospital offers “gender-affirmative care,” a euphemism used to describe novel medical interventions, such as drugs to prevent children from going through puberty at a normal age, cross-sex hormones, and sex reassignment surgeries.

As psychologist and advocate Diane Ehrensaft explained, the “gender-affirmative model” is defined as “allowing children to speak for themselves about their self-experienced gender identity and expressions and providing support for them to evolve into their authentic gender selves, no matter at what age.” This approach is promoted, despite its premise that gender “may be fluid” and “is not always binary,” and despite research showing that gender dysphoria in children usually resolves without medical treatment by adolescence — 85 percent of the time, according to the Endocrine Society. Why, then, are life-altering drugs given to children?

“Gender-affirming care” is a big business. “Gender-affirming” centers servicing children have proliferated: There are now more than 400 pediatric gender clinics in North America, according to the Gender Mapping Project. The U.S. sex-reassignment-surgery market was valued at $1.9 billion in 2021 and is expected to reach $5 billion by 2030, expanding at a compound-annual-growth rate of 11.23 percent, according to Grand View Research. AbbVie reported $720 million in net revenue in 2019 from sales of Lupron, a powerful hormone suppressant approved initially for the palliative treatment of advanced prostate cancer, and which has been used to chemically castrate sex offenders. The Food and Drug Administration has also approved Lupron for the treatment of “precocious,” or abnormally early, puberty. However, “gender-affirming” physicians have prescribed it for preventing puberty from occurring at a normal age — a use the FDA has not approved. The director of GeMS received press attention for observing that puberty blockers are “being given out a lot like candy” in this off-label fashion.

As medical interventions have increased, the demographics of individuals experiencing gender dysphoria have shifted. Until recently, adult men were the population most likely to identify as transgender. Now, adolescents and increasingly teenage girls identify as transgender or “gender non-conforming” at an alarming rate. The numbers among adolescents have skyrocketed, with surveys estimating 2-9 percent of high school students identifying as such. And the female-to-male ratio of adolescents experiencing gender dysphoria or transgender identification is as high as seven to one in some studies. Experts have described the drastic rise in gender dysphoria as a “social contagion,” fueled by social media and peer pressure.

Against this backdrop, there now appears to be the first wave of young women, and some men, who have undergone “gender-affirming” treatments and now realize that they were misled and deeply harmed. They recognize that they could never have become the opposite sex, and that they were rushed into life-altering procedures when their underlying mental-health issues should have been addressed instead. Notably, children and adolescents with gender dysphoria often have mental-health comorbidities, including severe depression, anxiety, autism, self-harm, eating disorders, and post-traumatic stress from past sexual abuse.

For those who were put on puberty blockers and cross-sex hormones, they realize their bodies did not develop normally. Now, they are in pain and unable to carry out bodily functions necessary to a healthy life. Many of them are unable to have sex or experience sexual pleasure. For those who underwent surgical procedures, they have lost healthy body parts. If they can become mothers — which is no certainty, as infertility is often caused by hormonal imbalance — they cannot nurse their children because their breasts are gone. Their pain is psychological, emotional, and physical.

These “detransitioners,” as they are sometimes known, feel betrayed. Their mental-health problems have not been solved by the medical interventions. In many cases, those problems are much worse and compounded by the realization that the promised cure was irreparably harmful.

Some detransitioners are seeking justice. Last fall, Camille Kiefel sued healthcare providers in Oregon who were responsible for a double mastectomy that she says was unnecessary. Chloe Cole, at only 18 years old, was the first detransitioner to file suit this year. She named Kaiser Foundation Hospitals and other providers in California who placed her on cross-sex hormones at age 13 and removed her breasts at age 15. Months later, Kayla Lovdahl sued her providers after her breasts were removed when she was just 13.

These cases are only the beginning. Our firm represents a growing number of detransitioners — indeed, we formed it with the mission of representing these individuals and helping them seek justice. Consistent with the trends, our clients are mostly vulnerable young women experiencing numerous mental-health issues, although young men have sought our representation as well.

Recently, along with attorneys at Envisage Law in Raleigh, we filed suit on behalf of Prisha Mosley in North Carolina. Prisha seeks to hold her doctors and counselors accountable for misleading her onto a path of medical intervention at the age of 16 that involved removal of her healthy breasts at age 18. We also represent Soren Aldaco in her Texas case against health-care providers who improperly prescribed cross-sex hormones and performed an unnecessary double mastectomy. Soren’s surgery was so poorly performed that it resulted in complications requiring emergency correction by different surgeons. We are evaluating additional cases across the country as more detransitioners come forward, from the West Coast to New England.

As the public debate surrounding “gender-affirming care” continues, detransitioners serve as a reminder of the irreversible nature of these medical procedures and the heavy price of the lifelong consequences.

Jordan Campbell, Ron Miller, Josh Payne, and Daniel Sepulveda are the founders of Campbell Miller Payne, PLLC, a law firm that represents individuals who were misled and abused — many as children — into psychological and physical harm through a false promise of “gender-affirming care.”