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“I Often Think About Killing Myself”: Gender-Affirming Care Behind a Wave of Personal Tragedies

“Now that I've recovered from all the surgeries, I regret having them. The bottom surgery made me look butchered, and I often think about killing myself. I turned myself into a bad copy of a woman. But even after surgery, I knew I still wasn't one.” Brandon told The Florida Standard.

Brandon R., four months after facial surgery.

Less than two years after undergoing gender reassignment surgery, Brandon regrets his decision. “This was a terrible idea. I feel like my life is completely ruined, and I'm only 19 years old,” he told The Florida Standard.

Children and teens with long-standing gender dysphoria are often directed towards gender-affirming care and prescribed puberty blockers to delay the onset of puberty in a body where the child is uncomfortable. It also gives the child and their parents more time to decide what to do, sometimes leading to more drastic measures such as hormone therapy and surgery.

Pediatricians differ on the type of care considered appropriate for minor children. For instance, some physicians explain that because gender-assignment surgery is permanent and causes infertility, and children and teens may express regret as adults, the procedures are dangerous.


Brandon was bullied in elementary school. He was sensitive and wasn't interested in sports like the other boys in his class. In middle school, he discovered pornography on the internet, then heard about transgenderism. “I convinced myself that I was a girl,” he said.

After working up the nerve to tell his mother at the beginning of eighth grade, she took him to what he called an “informed-consent clinic,” where a doctor began to treat him after his fifteenth birthday.

“From that point on, I pulled away from everyone. I just stayed home and played video games. I was on the internet all the time. I stopped riding my bike and reading,” Brandon said. Instead, he surrounded himself with people who validated his choices.

A month after he turned eighteen, Brandon had what he called “bottom surgery.” For males, bottom surgery is a refashioning of the male genitalia into a pseudo-vagina. Unfortunately, the first surgery caused complications that required another surgery a few months later. Brandon also had facial surgery that made him look more feminine.


Around the globe, most physicians use a watchful waiting approach when treating gender-diverse children. But the American Academy of Pediatrics (AAP) has rejected that idea, instead calling for gender affirmation as the only approach.

According to Dr. Bob Hamilton, a pediatrician in southern California, most pediatricians in the U.S. genuinely care about the health and safety of their patients. “I am deeply concerned about the recent trend of young girls wanting to transition,” he said, explaining that most adolescents experience feelings or emotions that change by the time they reach adulthood.

A group of AAP-affiliated pediatricians argues that the AAP blocked their efforts to review its influential policy on gender-affirming care at the recent leadership meeting in Chicago. Members said that the AAP changed the rules on policy review by blocking a member-drafted resolution. Concerns began to fill the comments section of the AAP's members-only website.

Leaked documents reveal a large group of pediatricians speaking out against the academy's drugs first approach to children and teens suffering from gender dysphoria. The group insists that therapy and counseling, a more cautious approach similar to other associations in other countries, should be the first line of treatment.

Talk therapy and counseling, however, have clashed with gender-affirming care, where patients self-diagnose themselves as trans. The gender-affirming method is considered best practice according to the AAP.

Therapy is dismissed even in cases where drugs or puberty blockers can be harmful to the child. Powerful drugs given to trans-identifying children from nine years old often lead to infertility, anorgasmia, and osteoporosis.

The AAP maintains that its guidelines – to reinforce a gender selected by the child through hormones, drugs, and eventually surgery – are widely supported and evidence-based. Additionally, the AAP guides the work of over 67,000 AAP-affiliated physicians and the gender-affirming policy of President Joe Biden's administration.

The current White House policy against “conversion therapy” is inconsistent with progressive countries that have begun to reverse course on gender-affirming care because of a lack of evidence that the treatment improves mental health outcomes for dysphoric children.

Policy changes made by the governments of Norway, Sweden and France now include focusing on psychological issues before pushing drugs and hormones. Erica Anderson, a psychologist and transgender woman, told The Washington Post that more adolescents identify as transgender because of increased LGBTQ representation in the media, broader access to information online, and wider acceptance of the gender-diverse community.

Laura Edwards-Leeper, a leading pediatric psychologist maintains that the solution shouldn't begin in law books, but in the doctor's office. Edwards-Leeper suggests that another contributing factor to gender dysphoria is an ongoing mental health crisis among children and teens in America. “That's certainly not the case for all youth, but it does explain why we're seeing such a huge increase in young people identifying this way,” Edwards-Leeper told The Washington Post.


Medications used by clinicians to suppress puberty in trans-identifying children are known as gonadotropin-releasing hormone analogs (GnRH). However, the drugs are only FDA approved to treat central precocious puberty, a medical condition that causes early sexual development in young boys and girls.

Physicians who prescribe the blockers for trans-identifying children do so off-label. When administered regularly, GnRH analogs suppress the release of sex hormones, including estrogen and testosterone. The process effectively pauses puberty, stopping the growth of genitalia and facial and body hair in boys and halting breast development and menstruation in girls.

Injectable blockers, such as Lupron, must be administered regularly by a physician. Newer implants, placed under the skin, can last up to 24 months, making the process much more convenient.

Two nearly identical implants, both made by Endo Pharmaceuticals, are approved by the FDA for different uses. Supprelin LA is approved for central precocious puberty and has a list price of $37,300. Vantas is approved for late-stage prostate cancer and has a list price of $4,400.

Both drugs list hormone blocker histrelin (GnRH), but one is more than eight times more expensive. Vantas has a 15-microgram difference in the daily dose. Doctors often recommend the drug because it has the same effectiveness for blocking puberty at a lower cost.

But in early 2021, Endo Pharmaceuticals reported that they had a problem with the manufacturing of Vantas. As a result, due to quality control issues, they could not release the drug to the public. Although Vantas is manufactured at the same facility as Supprelin, the bad batches only affected Vantas.

Later in August of 2021, Endo's President and CEO Blaise Coleman told investors that Supprelin was making enormous profits for the company. Revenues of Supprelin had risen 79 percent compared to the same quarter the previous year. Coleman explained that the growth was driven “by stronger-than-expected demand resulting from expanded patient awareness.”

In September, Endo Pharmaceuticals told the FDA that it would no longer make Vantas because it couldn't find a suitable solution to fix the manufacturing issue.

A February 2021 study concluded that treatment with either histrelin implant (Supprelin LA or Vantas) had the same effect on the suppression of gonadotropins and sex steroids in early-to-mid-pubertal youth with gender dysphoria.


Across the country, in clinics and hospitals, minors are being disfigured by surgical procedures recommended by clinicians under the pretense of gender-affirming care. Brandon represents the front line of a new wave of youth contending with gender dysphoria, who are starting to push back against the gender affirmation intervention committed against them.

More and more de-transitioners who have been sterilized and mutilated as minors are raising their voices, and others worldwide have filed lawsuits against medical facilities. These individuals are becoming known as “detransitioners” or “trans-desisters.”

Caught up in the moment's pressure, vulnerable young people head down a path of life-altering treatment involving medications and surgeries with irreversible effects. Complex surgeries, hormones, and puberty blockers can all lead to permanent damage, including destroying reproductive organs.

Parents and caregivers have an obligation to protect their children from an industry that profits from long-term, lucrative hormone prescriptions and complex surgeries. Parents who give consent for cross-sex interventions on their children are often pressured by physicians and professional groups like the AAP.

Brandon and other detransitioners feel that children should be questioned and challenged through counseling and psychotherapy during their struggle with gender dysphoria. They also believe extended waiting periods are necessary, in line with a “watchful waiting” approach.

The AAP, on the other hand, strongly discourages that approach. In an official statement, the AAP told physicians “to be a reliable source of validation, support, and reassurance” and to exclusively pursue “affirmation-based approaches” for children and teens mental health, including pharmacological and surgical interventions.

For years, the AAP has promoted the research of Dr. Jack Turban. But his research has been riddled with mistakes, according to his colleagues. In a 2020 study, Dr. Turban alleged that the suicide risk is reduced in trans-identifying teens using puberty blockers. His paper was published in the AAP's flagship journal, Pediatrics.

Highly respected colleagues, including Michael Biggs, a U.K. researcher, noted that the actual attempted suicide rate among those using puberty blockers was twice as high. Biggs submitted a rebuttal to the AAP, which the organization refused to publish. According to Biggs, Dr. Turban failed to set up a control group where mental health issues were alleviated through other factors and interventions.

Dr. Turban often accuses dissenting medical professionals and colleagues of "disinformation" on Twitter. He has insisted through his writings that puberty blockers are effective and safe. However, based on government financial records, Dr. Turban received a $15,000 payment in 2019 from Arbor Pharmaceuticals, a manufacturer of the very drugs he claims are safe.


Florida's "Parental Right in Education bill, often called “Don't Say Gay” by critics, took effect on July 1, 2022. The bill restricts LGBTQ and gender discussion and instruction in Florida schools. Teachers and school officials cannot keep any issues affecting a child's physical, emotional or mental health from their parents.

When Governor DeSantis signed the bill, he referenced a Leon County case where parents sued the school district for alleged concealment of information about their thirteen-year-old child's identity transition. The concealment violated their rights as parents and harmed their relationship with their children, according to the parents.


Brandon learned the hard way that a man is not a woman and can never be a woman, even with surgically altered genitals or facial surgery to create a more feminine appearance.

“Now that I've recovered from all the surgeries, I regret having them. The bottom surgery made me look butchered, and I often think about killing myself. I turned myself into a bad copy of a woman. But even after surgery, I knew I still wasn't one. I still feel deeply depressed,” he said.

Brandon is a bright young man, but he never had sound, effective therapy or counseling to discuss his gender dysphoria, which may have prevented him from making a horrible mistake, one that he will have to deal with for the rest of his life.

“I can't believe that I went through this, it’s unreal. No one told me what life would really be like. No one asked me about having kids in the future, or if I wanted any,” he said.

“No one is willing to help me detransition”, said Brandon. The clinic, which Brandon called an “informed-consent clinic,” refuses to treat him. He says that this reckless ideology has destroyed his life.

Most pre-adolescent kids who self-identify as trans eventually revert to the identity of their biological sex as long as gender-affirming care is not advocated or pursued. The most recent follow-up study in 2021 of boys experiencing gender dysphoria (Singh, Bradley, Zucker, 2021) reveals the same result as previous studies. “Of the 139 participants, 17 (12.2%) were classified as persisters, and the remaining 122 (87.8%) were classified as desisters.”

To get help for children with gender identity confusion or find trusted counselors, psychologists, and psychiatrists near you, visit Focus on the Family’s Transgender Resources.