The Controversy Over Gender Identity Ideology in Children's Picture Books, pt. 2

Seven reasons why the challenges to this literature are never going to go away.

[Image: “Christchurch Pride book display, Tūranga” Christchurch City Libraries, Flickr. Reproduced under Creative Commons License 2.0]

[Approximately 30 minute reading time]

Introduction

In Part One of this essay, I situated the ongoing and intense controversy over gender identity ideology in children's picture books in libraries as a classic “wicked” problem (as understood in the policy sciences), and set out eight dimensions internal to the ideology that contribute to this wickedness. To recap, these were that gender identity ideology:

• is a highly contested belief, with no agreed-upon definition, and for which neuroscientists have yet to find empirical support;

• rejects the salience of biological sex in favour of highly regressive gender stereotypes;

• confuses phenomenology with ontology—feelings and experience for reality—with psychologically destabilizing consequences;

• is a profoundly metaphysical belief of physical disembodiment, akin to Gnosticism;

• is dealt with in children’s picture books as being a matter of fact, rather than as “something that some people believe in”;

• is Manichean in nature (seeing people as either good or evil)

• offers an unnecessary explanation for normal childish play behaviour, preferences, interests, and explorations; and

• is premised in and reliant upon a specific and postmodern vocabulary that its opponents reject, making shared understandings difficult if not impossible.

Now we turn to the external contexts, outcomes, and institutional dimensions of this wicked problem, so that we can better understand why the politics around these books are so fraught, and why our professional discourse has so badly misinterpreted what is going on.

The reader may well wonder why such an in-depth and multidimensional analysis would be necessary to understand objections to children’s picture books, when most challenges typically focus on the merits of one individual book. That’s simply not the case with children’s picture books promoting gender identity ideology: the cultural pushback against them cannot be understood and debated in such a self-contained way, for the ideology they promote is embedded within—and in some cases resists—a larger, complex and interrelated cultural and institutional ecosystem; and much of that culture and some of its institutions are, in turn, resisting the ideology.

I am therefore presenting my arguments below in terms of the probable real-world outcomes that logically follow from the consumption of these picture books by young readers, but viewed within this cultural and institutional ecosystem.

To put it another way, I am not in these essays setting out why I feel these books are of potential concern (even though I do); rather, I’m trying to explain the factors and perspectives that might be motivating members of the public and advocacy organization who are finding them so. For example, a good summary of perceived harms may be found on the website of California’s Interfaith4Kids coalition, which states that

Public Schools are INTENTIONALLY confusing children about their gender and CREATING gender dysphoria and mental crisis. These books that tell kindergartners their gender can change from day to day or from year to year based on their feelings and that their pronouns can change like the weather have been recommended into elementary schools and public libraries nationwide by the School Library Journal, Kirkus Review, Publisher’s Weekly, and Booklist, which is published by the American Library Association...These books CAUSE children to QUESTION their gender and pronouns. which then categorizes them as LGBTQ so they can access the gender exploration resources including “gender affirming care” that encompass medical intervention (puberty blockers / hormone therapy) (emphasis in the original).

Let’s break down this argument in more detail:

• children are suffering from confusion about the nature of reality, including their own bodies and the bodies of others;

• this confusion is contributing to a mental health crisis;

• this confusion is being instilled deliberately by teachers;

• teachers have chosen books to be the instrument of this deliberately-initiated state of confusion and resulting mental crisis;

• books are, therefore, a major causal factor in feelings of gender dysphoria;

• these books are being actively promoted by leading and trusted authorities in the book trade, including the American Library Association; and

• the feelings of gender dysphoria instilled by these books can lead to social transitioning (new pronouns) but also have lifelong medical consequences (“gender affirming care”).

This all may seem to some like hyperbole or even hysteria. However, I will argue below that these concerns may be not unreasonable and that some are, in fact, beginning to be shared by medical and psychiatric experts.

What follows is premised on arguments of logical extension: that is, they consider the possibility of what logically follows from at least some of the children who encounter these books being inspired to follow the example of the characters contained therein to question their own “gender identities” (see Part One for a thorough discussion of this concept) and then pursue this ideation with their families, friends and schools. Please note that this approach should not be confused with a fallacious “slippery slope” argument, which entails leaps of logic to arrive at rather far-fetched, “worst-case-scenario” conclusions. Rather, my arguments will consider potential outcomes based on the assumption that this literature functions precisely as intended. Because children are (intellectually speaking) very malleable, highly impressionable, and repeat everything they hear, it would be a tad disingenuous for the authors of any picture book promoting gender identity ideology to insist that their books were only intended to affirm children about the ideas they already had had on their own, and not to instill in them any new ones. Instead, it is as close to a 100% certainty (as one can be about such matters) that at least some of the toddlers who learn from (for example) Eric Geron’s Bye Bye, Binary that they can “see for THEMSELVES one day” what sex they are, will take the book up on that invitation and believe that such a thing is possible, declaring themselves to be the opposite sex.

Accordingly, this Part will set out seven potential real-world outcomes that logically follow from such emulation, and about which many stakeholders have (and, I believe, reasonably) expressed concern and objections.

Probable Outcomes Motivating Parental Concerns

Proposition: Picture books for young children that promote gender identity ideology are subject to objections by some members of the public because there is no other subgenre of children’s literature, the precepts of which, if followed to their logical conclusion, may contribute to…

1. …a child experiencing an ontological and epistemic crisis, in which they question not only the nature of reality, but of the reliability of their own sense-making capacities and those of their parents and other adult authorities.

In March 2025, the UK’s Department of Education revealed that during the 2022-23 year, a toddler aged between 3-4 had been suspended from a state-run day care for "abuse against sexual orientation and gender identity". No details of the alleged incident were made available, but it is all-too easy to imagine a scenario in which the so-called “transphobic toddler” would have raised the ire of activist educators. After all, child development research has determined that babies are capable of distinguishing between male and female faces as early as 3 months of age, and conceptualizing the sexes as comprising a matter of kinds by 24 months (Pickron & Cheries 2019). Furthermore, even infants are able to recognize correct and incorrect labels. As Mascaro and Morin (2015) explain,

infants detect the use of inaccurate labels for familiar objects. From their second year of life on, children also contradict adults who mislabel things, often using negation in correcting them. By age three, these corrections are sensitive to the type of speech act performed by speakers: three-year-olds are more likely to direct their protest at speakers who assert something false, than at those who give unobeyed orders. Three-year-olds can also explicitly tell that speakers who were factually incorrect were ‘not very good at answering questions’ or were ‘wrong’. This sensitivity to inaccuracy has well-documented effects on children’s trust. Toddlers and three-year-olds lower their trust in previously accurate informants; and they prefer to learn what an informant says if a third party assents to it, rather than dissents (p. 2).

All that unfortunate toddler would have needed do would be to point out the biological sex of a staff member, express confusion regarding someone’s trans identification, insist on using biologically-correct pronouns, or contradict the adults around them for being ‘wrong’ in referring to someone as if they were the opposite sex. It therefore was clearly morally reprehensible for the state authorities to punish that child for being developmentally and cognitively consistent with their age; which was also likely the case in many of the 94 other similar cases recorded by the Department over the same year in which children were temporarily or permanently suspended, “including 13 pupils as young as 4 or 5.”

Given the early development of these capacities—which are so necessary for our eventual full flourishing as epistemic agents—it is profoundly destabilizing to teach toddlers not to trust their sense-making and reasoning capacities, but to deny what they see and understand to be true by telling them that a boy is actually a girl, a girl a boy, or (as we saw in It Feels Good to be Yourself) that someone can be neither a boy or a girl. Another book that effectively undermines toddler epistemology is You Need to Chill by Juno Dawson, in which the main character essentially gaslights her classmates who are wondering where her brother Bill has gotten to, repeatedly admonishing them that “they need to chill”, revealing at the end that Bill is now her sister Lily—having presumably returned from “gender affirming” surgery. Not only does the book teach children to suppress their natural empathy and curiosity—of course children would wonder what had happened to a classmate’s sibling if they went missing without explanation—but it then demands that they accept a new reality that contradicts their previous knowledge, and about which they “need to chill”, i.e., not ask any questions.

To argue that this attempt to ideologically reshape reality is harmful to children is not pearl-clutching hyperbole; it has real-world effects. According to Radio-Canada International, in 2019 an Ontario family took the Ottawa-Carleton District School Board to court after their then-six year old daughter was left upset and confused by repeated classroom instruction in gender identity ideology which included the notion that “there’s no such thing as boys and girls…girls are not real and boys are not real.” According to her mother Pamela Buffone, the girl found this “extremely upsetting and unsettling”:

“At the age of six she was just figuring out that animals are divided into boys and girls; when she met a new dog on the street, for example, she would ask ‘is it a boy or a girl?’,” Buffone said. “So she was very confused by what her teacher was saying and was struggling to understand what it meant for her as a girl.” Buffone said following the lessons her daughter stated that she was not sure if she wanted to be a mommy when she grew up, and asked if she could “go to the doctor” to do something about the fact that she is a girl.¹

We should bear in mind that the sort of existential crisis experienced by the Buffone’s daughter was no accident or unintended consequence, but is precisely what is prescribed by the tenets of queer pedagogy. Kevin Kumashiro, in his 2002 book Troubling Education: ”“Queer”″ Activism and Anti-Oppressive Pedagogy argues that it is the responsibility of the educator to lead the student into a state of crisis regarding their identities, in order to further the cause of “anti-oppression”. He writes:

education involves learning something that disrupts our commonsense view of the world…what results from working through crisis is a change in the relationship students see between themselves and the binary of normalcy/Otherness…Thus, in addition to self-reflection (in which they ask how they are implicated in the dynamics of oppression), students can engage in self-reflexivity (in which they bring this knowledge to bear on their own senses of self). To put it another way, schools can encourage students to "queer" their understandings of themselves (p. 63-64, emphasis added).

It must be understood that in the realm of queer theory, “queer” has nothing whatever to do with being gay or lesbian, but rather standing in opposition to anything that society considers normal. In that sense queer pedagogy deliberately seeks to turn children against societal norms, and this is especially true as regards themselves—they too must be “queered”. Kumashiro acknowledges a few pages later that some might raise ethical concerns about “intentionally and constantly” leading students into such a crisis, but rationalizes this by arguing,

allowing students to continue living through the repetition of comforting norms, identities, knowledges, and practices is tantamount to perpetuating the oppressive status quo, which means that not teaching and learning through crisis is what is unethical (p. 69).

This then leads to something else that the research by Mascaro and Morin reveals: the extent to which children are naturally trustful of adults in authority (like their teachers) and base their assessments of the veracity of truth claims based on their trust of the speaker. It is therefore a violation of that trust to insist that children deny their own sense-making capacities. It also can’t help but cause the child to doubt the authority of adults who make assertions the child knows to be incorrect. Ultimately, it leaves the child epistemologically unmoored and uncertain whom or what to trust, and as a consequence, vulnerable to the influence of all manner of misinformation.

2. …a child succumbing to a social contagion.

In 2018, Dr. Lisa Littman (then with Brown University’s Department of Behavioral and Social Sciences) published an article in PLoS One entitled “Rapid-Onset Gender Dysphoria in Adolescents and Young Adults: A Study of Parental Reports”, which explored a previously-undescribed pathway into trans identification whereby (mostly) young women well into adolescence suddenly (and after heavy social media use) declare themselves to be trans, quite often in tandem with others in their peer groups. What Littman was describing with her newly-coined term Rapid Onset Gender Dysphoria (ROGD) is a variety of social or peer contagion, which she describes this way:

cluster outbreaks of gender dysphoria occurring in pre-existing groups of friends and increased exposure to social media/internet preceding a child's announcement of a transgender identity [which] raises the possibility of social and peer contagion. Social contagion is the spread of affect or behaviors through a population. Peer contagion, in particular, is the process where an individual and peer mutually influence each other in a way that promotes emotions and behaviors that can potentially undermine their own development or harm others (p. 3).

Accompanying this pathway, she argued, was a deterioration not only of the well-being of these young women, but of their relationships with their parents. Her thesis proved so intensely controversial that Brown University deleted its promotion of the article and then issued a series of statements in response to the complaints it had received from activists (many of them anonymous), with the result that Littman was compelled to revise the paper to emphasize that her findings were based on parental reports. Brown’s actions were, in turn, criticized as a threat to academic freedom while Littman herself was subject to an online mobbing campaign and was forced out of her consulting job with the Rhode Island Department of Health.

Yet, lost in all of this furor is the fact that the phenomenon of social contagion is hardly a controversial idea, being foundational in sociology (discussed under such terms as diffusion theory and social network theory) and was first introduced to the literature in 1901 (see Perry 2001). It is also widely discussed in relation to other mental health conditions (see Corzine et al) making it extremely applicable for a condition so entirely concerned with subjective experiences and feelings. Abigail Shrier would depend heavily on Littman’s paper for her 2021 book Irreversible Damage: The Trangender Craze Seducing Our Daughters and has been followed up on by a number of other researchers, most notably by J. Michael Bailey and Suzanna Diaz in a 2023 article entitled “Rapid Onset Gender Dysphoria: Parent Reports on 1655 Possible Cases” (Bailey is best known as the author of the book The Man Who Would be Queen and a leading proponent of Ray Blanchard’s typology of autogynephilia, the paraphilia of being aroused by the thought of oneself as the opposite sex). Like Littman’s paper, this one would also prove controversial—so much so that Springer Nature would, under pressure, retract it over an alleged methodological technicality, an action which biologist Colin Wright described as a “scientific scandal”.

The retraction of this article is all the more scandalous because researchers in other medical fields have taken note of the same phenomenon: Julie Bakker, in her 2024 Hormones and Behavior article, “Neurobiological Characteristics Associated with Gender Identity” argued with concern that

[a]t present, there is an urgent need for these studies [into possible neurobiological explanations for cases of gender dysphoria] considering the dramatic but unexplained rise in number of referrals to specialized gender identity clinics worldwide and associated increasing demands for hormonal interventions such as puberty suppression and cross-sex hormones (p.8, emphasis added).

It should be considered the responsibility of social scientists, when encountering a “dramatic but unexplained” social phenomenon, to seek causal explanations for that phenomenon, not shut down inquiry into it. While a discussion of the merits of the ROGD hypothesis is beyond my scope here, what is essential to note for our purposes is that the possibility that young people are being influenced by social media and each other to adopt transgender ideation has entered the public consciousness, such that concern over ROGD is a political reality. Therefore, no discussion of the challenges to gender identity ideology in picture books for children can ignore this political reality—that many parents will have become familiar with this theory and will be concerned about the possible role these books might play in the spread of transgender ideation.

3. …a child undergoing social transition.

As we saw in Part One, several of the highlighted picture books (It Feels Good to be Yourself; Jamie is Jamie; When Aidan Became a Brother) depicted children socially transitioning to live as the opposite sex (or as “nonbinary”) in each case with the support of loving families, while Jacob’s Room to Choose portrays social transition in a school setting—again with the knowledge and support of the characters’ parents.

What is concerning so many parents is that it has become policy in a number of states, provinces, and school districts for school employees to facilitate students’ gender transitions—complete with “gender plans”—without informing parents. In July 2024, California Governor Gavin Newsom signed into law a bill which would ban schools from informing parents of their child’s social transition at school. Such policies are also on the books in Canada: As reported in an April 2024 article in Canada’s National Post,

[t]ransitioning at school can begin by using a different name, new personal pronouns, even the use of different bathrooms. All the parents who spoke to the Post said board policies undermined their children’s well-being, destabilized the family and alienated them from their children. They said it represented a massive overreach by teachers and school administrators into their family lives...Ontario school boards say the reason for keeping parents in the dark is for the protection and privacy of the children, that creating safe spaces for students to express their genders, and in which their genders are affirmed, are their primary concerns.

Worried about possible consequences for their children and thus finding these policies unacceptable, some parents have responded with an insurgent “parental rights” movement, arguing that public education systems have no right to make such life-altering decisions about their children without their consent. Such groups include (in the U.S.) Moms for Liberty and Parents Defending Education, while in Canada opponents of these policies have coalesced under the Parents Rights Coalition of Canada, as well as many other national and regional groups, including Parents for Parents’ Rights, and Parents Rights Ontario.

Some readers may reject the politics of such groups, or cite the Southern Poverty Law Center (which has, itself, had its credibility questioned for ideologically-motivated smear campaigns against conservative groups) calling Moms for Liberty a “far right anti-government organization”. Nonetheless, the fact remains that parents’ concerns about the potentially detrimental effects of social transition are shared by medical and psychological experts, who point out that social transition is not a neutral act but can contribute to exacerbating a young person’s feelings of gender-related distress, and thus lead to medicalization. Kenneth Zucker, writing in the pages of Child and Adolescent Mental Health, argues that

A gender social transition in prepubertal children is a form of psychosocial treatment that aims to reduce gender dysphoria, but with the likely consequence of subsequent (lifelong) biomedical treatments as well (gender-affirming hormonal treatment and surgery). Gender social transition of prepubertal children will increase dramatically the rate of gender dysphoria persistence when compared to follow-up studies of children with gender dysphoria who did not receive this type of psychosocial intervention and, oddly enough, might be characterized as iatrogenic [i.e., a condition caused by the medical intervention] (p. 36).

Dr. Hillary Cass adds in the Cass Review that a systematic review of the literature had revealed that children “who had socially transitioned at an earlier age and/or prior to being seen in clinic were more likely to proceed to a medical pathway” (p. 31). In other words, early social transition (of the kind depicted in these picture books!) is quite likely to lead to medical transition. Writing in the March 2025 issue of the Journal of Sex & Marital Therapy, Zeki Bayraktar concurs, summarizing Dr. Riittakerttu Kaltiala—one of Finland’s most noted expert in pediatric gender medicine—by stating

affirming a child’s social transition by using their preferred name and pronouns is not a "neutral act." Instead, it is a significant intervention that turns what would otherwise likely be a temporary phase into a fixed mental state or "identity," solidifying it and leading the underage child toward medication/hormones and surgical procedures (p. 4).

There are all manner of issues arising from policies mandating that schoolteachers and administrators implement a “psychosocial treatment” about which they can have no trained expertise, and then keeping parents in the dark about it and its possible effects on these parents’ own children—especially when there is a strong likelihood that this process will lead to hormonal and medical interventions. It should be little wonder that parents would organize in response. As is the case with rising awareness of the possibility of ROGD, the parental rights movement is another political reality with which librarians must contend, and which cannot be dismissed by accusations of “bigotry”.

4. …a child being given a controversial, fluid, and underdetermined clinical diagnosis.

The bridge from a seemingly benign social transition to actual medicalization is a diagnosis by a registered clinician. Yet, the terms under which such diagnoses are offered have shifted over time, with the impediments to access (i.e., safeguarding measures) dropping ever lower, as British researcher Mia Hughes explains in the WPATH Report:

[IN 2013] the American Psychiatric Association (APA) released the 5th edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-5), in which “gender identity disorder” was renamed “gender dysphoria.” This redefinition shifted the focus of diagnosis from the identity itself to the distress and difficulty in social functioning arising from the incongruity between the mind and body…WPATH advises healthcare providers to use the World Health Organization’s International Classification of Diseases (ICD-11) classification of “gender incongruence” over the DSM-5’s “gender dysphoria.” This recommendation is motivated by the fact that the ICD-11 diagnosis is categorized as a “condition related to sexual health” and not a mental disorder, a move intended to destigmatize transgender identities further. A diagnosis of gender incongruence is even easier to obtain than one of gender dysphoria because all the patient needs to experience is a marked incongruence between their internal sense of self and their biological sex. There is no requirement for the presence of distress as a criterion, meaning a patient’s “embodiment goals” can be deemed medically necessary care (pp. 8-10).

In other words, what was once described as a mental health disorder was transformed linguistically and without any kind of evidentiary basis—that is, for purely ideological and political reasons—into a mere “feeling of incongruence”. Yet this is still sufficient warrant to deem intervention “medically necessary.”

The long-term consequences of repeatedly teaching impressionable children that they must identify themselves according to a dizzying array of gender classifications are unknown but should be concerning to all of us. A truly caring and cautious society would deem it reckless in the extreme to assume or assign an ontological finality to any stated childish or youthful phenomenology, especially if permanent medical procedures are being contemplated.

If we recall the discussion in Part One, gender distress should be understood as a phenomenology, not an ontology with any definable permanence; as neurobiologist Julie Bakker (2024) points out, “[a]t present, there is no unambiguous clinical or biological indicator available that predicts future persistence of [feelings of gender incongruence among young people]” (p. 5). In other words, empirical researchers cannot say with any certainty that a distressed child or teenager will continue to feel gender distress in the future, and thus remain a “trans kid.” The Cass Review also made this distinction on page 200, warning that labelling children as “trans” risks what is known in medicine as “diagnostic overshadowing” or the “misattribution of symptoms of one illness [e.g., autism or trauma deriving from sexual abuse] to an already diagnosed comorbidity [i.e., gender incongruence].” Accordingly, many mental health and medical practitioners advocate a “watchful waiting” approach, given that children’s brains (and hence self-concept) are not fully developed until their mid -20s. Indeed, research shows that most young people claiming discomfort with their sexed bodies grow up to simply be gay or lesbian, while the Cass Review also determined that “a diagnosis of gender dysphoria . . . is not predictive of whether that young person will have longstanding gender incongruence in the future . . .” (p. 67). As such, medicalizing children on these grounds would seem by any measure to be medically unjustifiable—yet is championed by progressive activists as a fundamental human right.

5. …a child undergoing improvisational, high-risk medical procedures of no established long-term benefit.

In March of 2024, journalist Michael Shellenberger's organization Environmental Progress released the "WPATH Files" prepared by Mia Hughes, comprised of leaked emails and videoconferences from the World Professional Association of Transgender Health which proved—using practitioners’ own words—that the medical "experts" relied upon for promoting the "gold standard in gender medicine" actually have no idea what they are doing. It is clear that they have been making things up as they went, and openly acknowledge among themselves that the young people with whom they were dealing (many of them with mental health conditions), and their families, did not understand the medical and lifelong consequences of medical transition. What Hughes’ WPATH Report reveals is that this can't even be said to be an experiment conducted on an entire generation of young people, because there have been no random clinical trials, no controls, and no follow-up studies on those who went through the procedures; instead it's all been improvisational. This is shaping up to be a medical scandal of enormous proportions, argues Environmental Progress, noting that a “growing number of medical and psychiatric professionals say the promotion of pseudoscientific surgical and hormonal experiments is a global medical scandal that compares to major incidents of medical malpractice in history, such as lobotomies and ovariotomies”.

There are indeed risks of grave medical consequences by those who undergo the injections and procedures, which according the WPATH Files Report include sterility, loss of sexual function (lifelong inability in males to achieve orgasm and painful orgasms in women), vaginal atrophy, liver tumors, brittle bones, and increased risk of heart attacks. Puberty blockers—so often touted by activists and in the news media as “fully reversible”—have been shown to have particularly serious, life-long effects. According to Bayraktar (2025) suppressing puberty

adversely affects bone, brain, and phallus development, fertility, and sexual function…(and) leads to a decline in bone mass accumulation, slower growth rates, increased fat mass, and halted maturation of sperm and oocytes. It also has sex-specific negative effects on cognitive and behavioral functions (neurodevelopment), with no evidence suggesting these effects are reversible (p. 5).

(Permanent effects to phallus development were most notoriously observed in the case of reality TV star Jazz Jennings, co-author of the autobiographical picture book I am Jazz [pictured above]: having been taking puberty suppressing drugs since age 11, Jazz had so little penile tissue available to construct a “pseudo vagina” that surgeons were required to create one instead using peritoneal tissue from the stomach, which subsequently collapsed days later and required three additional and painful corrective surgeries to repair [Hughes, p. 19]).

The advisability of prepubescent children chancing such permanent and risky outcomes is even more questionable given that recent research is showing that medical transition may not be the “life saving” intervention it has been touted to be: a 2025 study in The Journal of Sexual Medicine which followed 107,583 patients aged18 and older for two years following “gender affirming” surgery found them to be of “significantly higher risk” of “mental health disorders, specifically depression, anxiety, suicidal ideation, body-dysmorphic disorder, and substance use disorder” (p. 3; emphasis added). Not only that, but a 2024 scholarly article in BMC Medical Ethics admitted that what had to date been considered measures of “effectiveness” with these procedures should be reevaluated, in light of the ambiguous [read: negative] evidence that any improvement in well-being has resulted from gender-affirming medical treatment (or GAMT). The authors write,

improvement has become a norm that GAMT is required to meet in order to be justified, often operationalized by measurable, beneficial effects on the overall well-being of [trans and gender diverse] adolescents. However, our findings indicate ambiguity [i.e. negative outcomes] regarding the objectives of GAMT for adolescents. Should its primary aim be to alleviate gender-related distress, or the improvement of general well-being and functioning in order for it to be justified?…Furthermore, the (implicit) normative expectation that GAMT should result in improvements across multiple physical, psychological, and psychosocial outcomes risks undermining the provision of this care practice (p. 15, emphasis added).

Read that last sentence again. The authors are arguing that the provision of this “care practice” may be undermined by any expectation that it should result in demonstratable improvements in patients’ health and well-being. Yes, one would think that if a risky medical intervention doesn’t appear to be working, that medical authorities would step in and restrict or prohibit it! In the paper’s conclusion, the authors ask rhetorically,

questioning the current operationalization of “effectiveness” in GAMT for adolescents raises a critical question: if GAMT does not necessarily require demonstrating improvement to justify its provision, what should its objectives be?

Perhaps, they muse, “effectiveness” should be measured in terms of how well the procedures “help individuals achieve their embodiment goals. In this view, healthcare is provided and justified on the basis of personal desire and autonomy” (p. 17). In other words, it’s enough that children and adolescents be subjected to medical interventions of no discernable benefit but considerable risk simply because they want them. However, simply having “embodiment goals” hardly seems worth such a risk, especially as Bakker noted,

the current [medical] treatment protocols are increasingly being criticized due to the lack of sufficient solid scientific evidence to weigh the risks and benefits of these hormonal interventions in young people. There is thus increasing concern of young people regretting the transition and consequently, asking for a detransition (p. 8, emphasis added).

Beyond these risks and lack of evidence noted by medical and scientific experts, new research is also suggesting that the interventions themselves are exacerbating the problem they were intended to resolve—that they may be worsening feelings of gender dysphoria in patients, who then suffer negative medical consequences. Zeki Bayraktar (2025) describes this as iatrogenic harm (from the Greek words for iatros [doctor] and genesis [origin]), stating,

In the gender-affirming care model, early social and medical transitions not only increase the number of GD [Gender dysphoria] cases but also cause harm during the medical and surgical treatment processes of these cases. In GD cases, an iatrogenic harm cycle is forming. It seems that academic pressures, along with political and ideological factors, prevent the explanation of the negative outcomes of medical and surgical transitions, thereby contributing to the harmful cycle surrounding gender dysphoria cases (p 12).

To drive this point home, Bayraktar coins the new term iatrogenic gender dysphoria and cites Sarah Jorgensen (2023) who refers to detransitioners as “survivors of iatrogenic harm.”

In light of these disturbing findings, we should be considerably less sanguine about the future of Ruthie, Alex and J.J. and their friends in the picture book It Feels Good to be Yourself, knowing that it is very likely that they may follow this medicalized, risk-fraught path to fully realize their declared “identities.”

6. …an irreconcilable conflict with values held by communities of faith.

In the picture book Jacob's Room to Choose—discussed in Part One—a class of children and their teacher convert the washrooms in their school to be gender neutral, and face no opposition from parents. In the context of our highly pluralist multicultural and multifaith societies, this outcome is highly unlikely. As I argued in a July 2024 HiTS article, “SOGI or Multiculturalism?”, both Islam and Orthodox Judaism regard as utterly unacceptable the mixing of unrelated males and females in intimate public spaces such as washrooms, lockers, and showers. This is a major reason why gender identity ideology has inspired the creation of interfaith coalitions to oppose it. Because I’ve already written extensively on this theme—and I encourage readers to read this piece next to fully appreciate the seriousness and extent of this outcome—I will just stress here that this is perhaps the most insuperable (while at the same time least-acknowledged) barrier to widespread, mainstream acceptance of gender identity ideology in public policy. As I observed in my previous piece,

no amount of sloganeering or placard-waving on the part of activists is going to convince the majority of the world’s 2.4 billion Christians, 2 billion Muslims, 2 million Orthodox Jews, or 26 million Sikhs to abandon their sincerely-held religious beliefs and social practices concerning the existence and nature of the two sexes, which have developed over many hundreds or thousands of years and which comprise integral parts of their respective faith traditions. Not only will these conditions not obtain, but it is (frankly) a kind of cultural arrogance to presume otherwise.

Heedless of this global socio-cultural reality, however, the public school system is determined to push ahead with promoting gender identity ideology in as many capacities as possible.

7. …a larger and highly controversial program of persuasion deeply embedded at every level of the public education system.

On January 20^th, 2025, the Trump Administration issued the Executive Order, “Ending Radical Indoctrination in K-12 Schooling” which sought to protect parental rights by prohibiting public schools from engaging in

“Social transition” [or] the process of adopting a “gender identity” or “gender marker” that differs from a person’s sex. This process can include psychological or psychiatric counseling or treatment by a school counselor or other provider; modifying a person’s name (e.g., “Jane” to “James”) or pronouns (e.g., “him” to “her”); calling a child “nonbinary”; use of intimate facilities and accommodations such as bathrooms or locker rooms specifically designated for persons of the opposite sex; and participating in school athletic competitions or other extracurricular activities specifically designated for persons of the opposite sex.

The Order contextualized this prohibition by observing,

In recent years…parents have witnessed schools indoctrinate their children in radical, anti-American ideologies while deliberately blocking parental oversight. Such an environment operates as an echo chamber, in which students are forced to accept these ideologies without question or critical examination. In many cases…young men and women are made to question whether they were born in the wrong body and whether to view their parents and their reality as enemies to be blamed. These practices not only erode critical thinking but also sow division, confusion, and distrust, which undermine the very foundations of personal identity and family unity.

This EO expresses what is perhaps the most salient context for parental objections to picture books promoting gender identity: that they comprise a major element of a larger pedagogical project to promote gender identity ideology in schools. The organization Women’s Declaration International has (utilizing Freedom of Information requests) produced a report documenting these efforts in America’s public schools, revealing the extent to which such books play only a leading role in a suite of other measures to (in their words) indoctrinate students:

1. Books Read to Children: “Gender identity” picture books are being read to children from kindergarten onward.

2. Official “Gender Identity” Lessons: “Gender identity” materials are being included in Sex Ed. Children are presented with lies as if they were facts.

3. Warped Lessons on Reproduction and Sexual Anatomy. In many districts, the schools are intentionally avoiding words like “male” and “female,” or “man” and “woman,” even in the context of lessons on anatomy and sexual reproduction. Children are shown diagrams of male or female anatomy that are not identified as male or female.

4. “Gender Identity” Injected into Every Subject, including Science, Arts, and more.

5. Gender and Sexuality Clubs. GSA used to stand for Gay Straight Alliance. GSA now is said to stand for Gender Sexuality Alliance, and the primary focus is now on “gender identity.”

6. Teacher Trainings and Activist Teachers. Teachers are taking trainings offered by organizations and so-called experts that promote gender identity ideology.

7. Mailings, Events, Flags, Posters and More, Promoting “Gender Identity” Ideology. Already inundated with “gender identity” indoctrination, families and teachers are sent big piles of additional materials further imprinting that ideology in the homes of students.

8. School District Policies Mandating Affirmation and Keeping Secrets from Parents. Many school districts have adopted policies that require “affirmation” of trans and nonbinary identities.

The Report concludes,

All of these children are being denied sex-based rights and science-based educations. They’re being taught that there is no such thing as material reality. They’re being encouraged to keep secrets from adults, including their parents, and to engage in activities that contradict fundamental safeguarding standards.

In other words, public schools are practicing at scale the “queer” pedagogy advanced by Kevin Kumashiro (2002), by “intentionally and constantly” leading students into crisis over their identities in the name of “anti-oppression” (p. 69, emphasis added).

Summary

The analysis above provides, I think, ample support for the contention offered by California’s Interfaith4kids in the introduction: that public schools are, indeed, intentionally creating—through the use of widely-endorsed children’s books—the psycho-social conditions in which many students are led into existential and epistemic crises, which leave them vulnerable to the social media-fueled peer contagion of cross-sex ideation. Should a child then socially transition early, this is likely to solidify this identity, making all the more certain that that child will receive a diagnosis of gender incongruence and be put on an irreversible—and scandalously under-evidenced—medical pathway, one replete with life-altering risks but with little promise of improved mental health. All of this is of great concern for many communities of faith, as well as many parents and child advocacy groups.

It should be clear, I hope, that when viewed this way, the reaction against this literature in the form of challenges from parents and various organizations is not a “right wing attack on libraries” but something far more genuine and complex, and requiring a nuanced, sensitive, and mediating response from the library profession, not condemnation and retrenchment. We need to better understand not only the nature of the challenges to these materials, but our own professional role and conduct in contributing to the present crisis—matters I will take up in Part Three.

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References

Bakker, J. (2024). Neurobiological characteristics associated with gender identity: Findings from neuroimaging studies in the Amsterdam cohort of children and adolescents experiencing gender incongruence. Hormones and Behavior, 164, 105601.

Bayraktar, Z. (2025). Iatrogenic Gender Dysphoria and Harm Cycle in Gender Affirming Care. Journal of Sex & Marital Therapy, 1-18.

Cass, H. (2024). The Independent Review of Gender Identity Services for Children and Young People. London, UK: National Health Service and NHS Improvement.

Corzine, A., & Harrison, V. (2023). Social Contagion, from Suicide to Online Challenges to Eating Disorders: Current Research and Harm Mitigation Strategies for Youth Online. Journal of Online Trust and Safety, 2(1).

Diaz, S., Bailey, J.M. RETRACTED ARTICLE: Rapid Onset Gender Dysphoria: Parent Reports on 1655 Possible Cases. Archive of Sexual Behavior 52, 1031–1043 (2023). https://doi.org/10.1007/s10508-023-02576-9

Hughes, M. (2024). WPATH Files: Pseudoscientific Surgical and Hormonal Experiments on Children, Adolescents, and Vulnerable Adults. Albany, CA: Environmental Progress.

Jorgensen, S. C. J. (2023). Iatrogenic Harm in Gender Medicine. Journal of Sex & Marital Therapy, 49(8), 939–944. https://doi.org/10.1080/0092623X.2023.2224320

Kumashiro, K. (2012). Troubling Education : ”“Queer”″ Activism and Anti-Oppressive Pedagogy. Taylor and Francis.

Lewis, J. E., Patterson, A. R., Effirim, M. A., Patel, M. M., Lim, S. E., Cuello, V. A. & Lee, W. C. (2025). Examining gender-specific mental health risks after gender-affirming surgery: a national database study. The Journal of Sexual Medicine, https://doi.org/10.1093/jsxmed/qdaf026

Littman, L. (2018). Rapid-onset gender dysphoria in adolescents and young adults: A study of parental reports. PloS One, 13(8).

Mascaro, O., & Morin, O. (2015). Epistemology for beginners: Two-to five-year-old children's representation of falsity. PloS one, 10(10), e0140658.

Oosthoek, E.D., Stanwich, S., Gerritse, K. et al. Gender-affirming medical treatment for adolescents: a critical reflection on “effective” treatment outcomes. BMC Med Ethics 25, 154 (2024). https://doi.org/10.1186/s12910-024-01143-8

Perry, R. W. (2001). Diffusion Theories. In Encyclopedia of Sociology (2nd ed., Vol. 1, pp. 674-681). Macmillan Reference USA.

Pickron, C. B., & Cheries, E. W. (2019). Infants’ Individuation of Faces by Gender. Brain Sciences, 9(7), 163. https://doi.org/10.3390/brainsci9070163

Zucker, K. J. (2020). Debate: Different strokes for different folks. Child and Adolescent Mental Health, 25(1), 36–37. https://doi.org/10.1111/camh.12330

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1. The Buffone’s case citing sex discrimination and that the child’s rights to security of the person and equality under sections 7 and 15(1) of the Canadian Charter of Rights and Freedoms had been infringed upon was heard by the Human Rights Tribunal of Ontario over six days in March 2022, and dismissed that August.