Excellent essay extending Part One on Gender Identity Ideology and its origins in certain ideologies that are not well--supported at all but which are powerful about the malleable concept of "gender." Points made here about social contagion are especially important. I look forward to reading Part Three !
Thank you for this series. One thing I know from being embedded in a very progressive corner of higher ed is that there is, in the academy, something akin to a master plan here: trans (including non-binary) identity is now considered superior to cisheterosexual and cishomosexual--where "cis" just refers, often pejoratively, to people knowing their own biological sex--identities. For my colleagues, the fact that if left alone gender dysphoria will usually resolve itself in gay, lesbian, or bi identity isn't a consolation; it's a problem. In spite of the cover of "LGBTQAT*, queer activism aims to make it as uncomfortable as possible for people to identify as "gay"--that is, to identify as people who are same-sex oriented.
That's why WPATH and many queer activists will not desist from the path they're on, even at the risk of helping to elect people like Trump. I know that what I'm saying sounds conspiratorial and slightly crazy to people who are just trying to help kids or serve their interests. But "helping kids" isn't a typical activist agenda. The people who devise and sell policies like California's, which require schools to lie to parents while they socially transition their children, aren't paying close attention to the evidence and recoiling at harm. They're doing everything they do on purpose, with activist goals in mind.
Thank you. That's what so few people understand: that "queering" not only has nothing to do with being gay or lesbian but is actually hostile to homosexuality as a stable category. I once marched in Pride parades to show support for the same-sex attracted, but won't again until this ideology is repudiated.
We should oppose including this stuff in children’s collections for the same reason we should oppose evangelical Christian books in children’s collections. Of course Moms for Liberty would be quite happy to have a children’s collection in a public school full of the latter, though it meets all the criteria of “creating confusion about reality”.
What is disheartening is that the Democrats have completely bought in and are willing to destroy not just their party but democracy as well. "Vote for us. We are the lesser of the two evils" is not a rousing campaign slogan, but increasingly the choice we are offered.
You almost have to wonder if there is some type of mental impairment. I don’t see how it’s possible not to be aware of the consequences. But. the same thing happened in the UK with Labor when Jeremy Corbyn was crushed…….nothing learned.
And I see you’re in Winnipeg. My Winnipeg is one of my favorite Guy Madden movies. Haven't seen it since it came out so need to revisit and see how much I forgot as I got older.
As a librarian, I believe our role is to ensure that every member of the public has equitable access to a wide range of materials—especially those that reflect the lives and experiences of marginalized communities. This includes transgender youth and their families.
The assertions in Part Two of this series frame gender identity literature as a psychological and medical threat. But these claims are based on selective readings of discredited or retracted research or drawn from ideological sources rather than from the large body of peer-reviewed, clinical literature that affirms gender-affirming care as both medically sound and psychologically protective.
For those looking to understand what the most current and widely cited research says, here are several high-impact, peer-reviewed studies from the last five years that provide a more rigorous and humane view of gender-affirming care and transgender youth mental health:
Evidence-Based Research (2019–2024)
1. Turban, Jack L., et al. (2022).
Title: Access to gender-affirming hormones during adolescence and mental health outcomes among transgender adults.
Key finding: Youth who received gender-affirming care had 60% lower odds of depression and 73% lower odds of suicidality compared to those who had not yet received care.
3. Green, Amy E., et al. (2021).
Title: Association of Gender-Affirming Hormone Therapy with Depression, Thoughts of Suicide, and Attempted Suicide Among Transgender and Nonbinary Youth.
Key finding: Gender-affirming hormone therapy is associated with lower odds of recent depression and suicidal thoughts among trans and nonbinary youth.
4. Olson-Kennedy, Johanna, et al. (2019).
Title: Psychological Functioning of Transgender Youth After Two Years of Hormones.
Key finding: The Pediatric Endocrine Society confirms that gender-affirming care is the current standard of care and must be individualized, evidence-based, and rooted in respect for youth autonomy and safety.
As a profession, we do not diagnose or decide what patrons should believe, but we do safeguard access to knowledge, and we trust our patrons—including youth—to explore their identities with the support of their families and communities. Libraries are not sites of indoctrination; they are homes for complexity, dialogue, and growth.
If anything, the real “wicked problem” we face is the suppression of that access through fear, misinformation, and censorship.
Thank you for commenting. However note that the purpose of my article methodologically was to support reported parental concerns with what scholars are also finding and discussing, not to discuss the merits of medical interventions per se. But just on that level, there are serious methodological limitations to all the papers you cite here in that the time frames in which they performed their follow ups were very brief:
1. Turban, Jack L., et al. (2022).
Title: Access to gender-affirming hormones during adolescence and mental health outcomes among transgender adults. Journal: PLOS ONE.
Time period: over the past year.
2. Tordoff, Diana M., et al. (2022).
Title: Mental Health Outcomes in Transgender and Nonbinary Youths Receiving Gender-Affirming Care. JAMA Network Open
Time period: over a 12-month follow-up.
3. Green, Amy E., et al. (2021).
Title: Association of Gender-Affirming Hormone Therapy with Depression, Thoughts of Suicide, and Attempted Suicide Among Transgender and Nonbinary Youth. Journal: Journal of Adolescent Health
Time period: Before March 2020 and in July 2020
4. Olson-Kennedy, Johanna, et al. (2019).
Title: Psychological Functioning of Transgender Youth After Two Years of Hormones. The New England Journal of Medicine.
Time period: 2 years after start of hormones
It's going to require longitudinal studies with 5- 10-year time frames (or longer) before we can say in confidence that these radical and under-evidenced interventions were ultimately beneficial, and that the patients don't regret them, given that many of the patients will be sterile and find themselves in their 30s and wishing they could start families, to say nothing of experiencing medical complications (brittle bones, heart disease, cognitive issues, etc.)
Thank you, Michael, for presenting your perspective and drawing attention to what you frame as a “wicked problem.” I share your belief that libraries are uniquely positioned to foster thoughtful public dialogue on difficult issues.
However, I’d like to respectfully offer another view, grounded in peer-reviewed research and the current medical consensus regarding gender-affirming care for young people. Importantly, this conversation centers on a very small and vulnerable segment of youth. The idea that gender-affirming care is easily accessible or being imposed widely through public education or children’s books does not reflect the lived experience of most transgender and nonbinary youth.
A large number of trans youths never receive affirming care at all. According to a 2022 study published in JAMA Pediatrics, more than 1 in 3 transgender youth report experiencing homelessness or housing instability—often due to family rejection. ¹ The same study finds that youth who experience stable housing and access to affirming environments show significantly better mental health outcomes.
Meanwhile, major professional medical associations—including the American Academy of Pediatrics, American Psychiatric Association, Endocrine Society, and World Professional Association for Transgender Health (WPATH)—support gender-affirming care as evidence-based and medically necessary when delivered thoughtfully, carefully, and age-appropriately. This includes:
Social support and mental health care are often the only interventions provided in early adolescence.
Puberty blockers are fully reversible and are used to pause physical changes while gender identity continues to develop.
Gender-affirming hormone therapy is typically offered in later adolescence under strict guidelines and only after psychological evaluation.
Surgical interventions are exceedingly rare before age 18 and only considered after an extensive multidisciplinary review.
Key peer-reviewed studies supporting gender-affirming care include:
Chen et al. (2023) – A two-year study of trans youth receiving hormones found significant improvements in anxiety, depression, and life satisfaction.
Turban et al. (2022) found that trans adults who accessed gender-affirming hormones as adolescents had lower rates of psychological distress and suicidal ideation later in life.
According to the Trevor Project’s 2023 national survey, only 39% of trans and nonbinary youth reported living in a home where their gender identity was respected, and less than half could access mental health care when they needed it.²
Rather than overestimating the reach of gender-affirming care, the data point to a crisis of unmet need, especially for LGBTQ+ youth of color, youth in rural areas, and those facing housing insecurity.
What this means for libraries:
Libraries serve all families and communities. That includes the child with two moms, the teen exploring their identity, and the youth quietly trying to find a book that reflects how they feel. We must continue to support access to age-appropriate, evidence-informed resources that affirm a diversity of identities not as ideology but as a core commitment to intellectual freedom and inclusion.
Hi Rebekah -- Thank you again for your thoughtful response and for referring readers to other sources. And yes, homelessness and family rejection combined with other comorbidities (autism, depression, resisting one's same-sex attraction) leave trans-identified youth very vulnerable, and they need the best care society can offer. However, without reading the articles, I would question whether or not those better mental health outcomes might also have been achieved with simple talk therapy, rather than irreversible hormonal or surgical procedures. And sorry, but contrary to the "consensus view" puberty blockers if taken for long enough are *not* fully reversible--the human body only goes through puberty for a given time and then stops. Boys who take puberty-suppressing drugs for long enough are left with a micro-penis for the rest of their lives, and are sterile. And no, it's not the case that "gender-affirming hormone therapy is typically offered in later adolescence under strict guidelines and only after psychological evaluation"or that "surgical interventions are exceedingly rare before age 18 and only considered after an extensive multidisciplinary review" because we have numerous accounts of very young teens being prescribed puberal suppression and for girls double mastectomies after a single consultation. See for example https://tinyurl.com/yfhevmbx
Thank you again for your continued engagement. I want to offer a perspective grounded in lived experience as someone who has received gender-affirming care after a bilateral mastectomy due to cancer, and as someone who has seen firsthand how misinformation harms our ability to care for each other.
It’s important to recognize that gender-affirming care is not a monolith, and most of the care provided to transgender and gender-diverse youth is mental health support, talk therapy, and support for social transition. The idea that children are receiving irreversible surgeries is not supported by leading medical associations, including the American Academy of Pediatrics, the Endocrine Society, and WPATH. These organizations have clear age-based guidelines and multidisciplinary review processes for any medical interventions involving hormones—let alone surgery, which is exceedingly rare for minors and only considered in exceptional cases.
I also want to gently challenge the assertion that the rare and extreme examples cited represent common practice. Outliers are not policy. I’ve had friends who were prescribed growth hormones as children for height or delayed puberty—common in sports and other medical situations—and no one cried scandal. Hormonal care is not inherently harmful or experimental; it’s widely used and studied in pediatric endocrinology across many conditions.
Let’s be mindful: the small, deeply vulnerable population of trans youth is often already facing rejection, homelessness, and suicide risk—not because of their identity, but because of how society responds to them. Libraries, like hospitals and schools, are often the only safe space for these kids to exist, learn, and ask questions.
And this isn’t just theoretical. I’ve lost friends to suicide because they didn’t have access to affirming care or support when they needed it. These are real lives—not just policy debates or philosophical thought experiments.
We owe it to them, and to our profession, to uphold facts, to listen to lived experiences, and to approach this with humility, not hyperbole. Compassion and curiosity should guide us, not fear.
Hi Rebekah -- I certainly respect your lived experience, both as regards yourself and the friends you've lost, and you have my compassion. And of course, you're quite correct, nobody objects to hormonal treatments for delayed (or precocious) puberty, but those are completely different medical contexts. And absolutely, libraries should be safe places for troubled and vulnerable youth. But that doesn't mean we shouldn't include in our collections a diversity of viewpoints and research on this complex matter, even if some activists object to the conclusions (e.g., Lisa Littman's 2018 article on Rapid Onset Gender Dysphoria, and Abigail Shrier's Irreversible Damage). In terms of your counterargument (here and in your other comment) that young children aren't being rushed into hormonal or surgical treatments, and your reliance on the authority of WPATH and other medical associations, I would suggest you read Mia Hugh's WPATH Files report - https://environmentalprogress.org/big-news/wpath-files
These reports argue that the needs of trans-identifying youth are being poorly served by the medical establishment, which rushed an under-evidenced "innovative practice" into the mainstream without conducting clinical trials. I believe that arguing for more sound science in this area is not reducing vulnerable young people to political talking points, but rather seeking to ensure their long-term well-being.
As a librarian and cancer survivor who received gender-affirming care after my mastectomy, I want to say this plainly: gender-affirming care is health care.
The framing of gender-affirming care as uniquely controversial, only when applied to trans people, is medically inconsistent and ethically problematic. Hormone therapy, for example, is used in a wide variety of treatments: to support growth in sports, to regulate puberty, to treat endometriosis and infertility, and yes, as part of affirming gender identity. The protocols are often the same. The stigma is not.
We cannot ignore that the same care that helps one person feel whole is vilified when provided to another, solely because they are transgender. That’s not medical caution; that’s scapegoating a small, already vulnerable population.
Let’s also ground this in reality: babies and preschoolers are not getting surgeries. They’re getting haircuts. They’re playing dress-up. They’re reading stories in public libraries and learning to recognize differences as a part of life. The public panic about “irreversible harm” is not just hyperbole; it’s misinformation. Most youth who access gender-affirming care do so under strict, evidence-based guidelines, with mental health assessments, family support, and time for decision-making. Surgical interventions for minors are exceedingly rare.
I understand that critiques of organizations like WPATH and studies like the Cass Review are now part of this conversation. I’ve read them. They call for caution and better evidence, but they also acknowledge the lived experiences of trans youth and the importance of individualized, careful care. This is not a rejection of gender-affirming care, it’s a call for high standards, better research, and transparency. That’s something most practitioners, patients, and librarians can agree on.
Yet, the way these critiques are weaponized in public discourse has not led to better care. It’s led to bans, misinformation, and fear, creating more barriers for families trying to do right by their kids.
As a librarian, I uphold intellectual freedom. I wouldn’t remove Irreversible Damage from a library, even though reading it made me want to puke. We need debate. We need data. But what we don’t need is cruelty masquerading as caution.
So many of the youth being targeted in this discourse aren’t even accessing care. They’re trying to survive. Many are couch-surfing, unhoused, or estranged from their families. And libraries? Libraries are often the third place where they feel safe.
We should be clear: health care is self-care, and it’s deeply personal. It belongs at kitchen tables, not on campaign slogans. Supporting trans youth shouldn’t be controversial, it should be compassionate.
Let’s stop turning trans lives into talking points. Let’s return to the core question: how can we help every kid feel seen, safe, and whole?
Excellent essay extending Part One on Gender Identity Ideology and its origins in certain ideologies that are not well--supported at all but which are powerful about the malleable concept of "gender." Points made here about social contagion are especially important. I look forward to reading Part Three !
Thanks Craig!
Thank you for this series. One thing I know from being embedded in a very progressive corner of higher ed is that there is, in the academy, something akin to a master plan here: trans (including non-binary) identity is now considered superior to cisheterosexual and cishomosexual--where "cis" just refers, often pejoratively, to people knowing their own biological sex--identities. For my colleagues, the fact that if left alone gender dysphoria will usually resolve itself in gay, lesbian, or bi identity isn't a consolation; it's a problem. In spite of the cover of "LGBTQAT*, queer activism aims to make it as uncomfortable as possible for people to identify as "gay"--that is, to identify as people who are same-sex oriented.
That's why WPATH and many queer activists will not desist from the path they're on, even at the risk of helping to elect people like Trump. I know that what I'm saying sounds conspiratorial and slightly crazy to people who are just trying to help kids or serve their interests. But "helping kids" isn't a typical activist agenda. The people who devise and sell policies like California's, which require schools to lie to parents while they socially transition their children, aren't paying close attention to the evidence and recoiling at harm. They're doing everything they do on purpose, with activist goals in mind.
Thank you. That's what so few people understand: that "queering" not only has nothing to do with being gay or lesbian but is actually hostile to homosexuality as a stable category. I once marched in Pride parades to show support for the same-sex attracted, but won't again until this ideology is repudiated.
Thank you for this, Michael. I applaud your clear language, your thoroughness, and the “seek to understand” approach you are encouraging here.
As before, I will be sharing this with others, and look forward to Part 3.
You're welcome - and I appreciate your acknowledgement of my approach. Thank you for sharing!
Very thoughtful and thorough essay.
We should oppose including this stuff in children’s collections for the same reason we should oppose evangelical Christian books in children’s collections. Of course Moms for Liberty would be quite happy to have a children’s collection in a public school full of the latter, though it meets all the criteria of “creating confusion about reality”.
What is disheartening is that the Democrats have completely bought in and are willing to destroy not just their party but democracy as well. "Vote for us. We are the lesser of the two evils" is not a rousing campaign slogan, but increasingly the choice we are offered.
They don't get that this issue has been a disaster for them.
You almost have to wonder if there is some type of mental impairment. I don’t see how it’s possible not to be aware of the consequences. But. the same thing happened in the UK with Labor when Jeremy Corbyn was crushed…….nothing learned.
And I see you’re in Winnipeg. My Winnipeg is one of my favorite Guy Madden movies. Haven't seen it since it came out so need to revisit and see how much I forgot as I got older.
As a librarian, I believe our role is to ensure that every member of the public has equitable access to a wide range of materials—especially those that reflect the lives and experiences of marginalized communities. This includes transgender youth and their families.
The assertions in Part Two of this series frame gender identity literature as a psychological and medical threat. But these claims are based on selective readings of discredited or retracted research or drawn from ideological sources rather than from the large body of peer-reviewed, clinical literature that affirms gender-affirming care as both medically sound and psychologically protective.
For those looking to understand what the most current and widely cited research says, here are several high-impact, peer-reviewed studies from the last five years that provide a more rigorous and humane view of gender-affirming care and transgender youth mental health:
Evidence-Based Research (2019–2024)
1. Turban, Jack L., et al. (2022).
Title: Access to gender-affirming hormones during adolescence and mental health outcomes among transgender adults.
Journal: PLOS ONE
https://doi.org/10.1371/journal.pone.0261039
Key finding: Adults who had access to gender-affirming hormones during adolescence had significantly lower odds of suicidal ideation and depression.
2. Tordoff, Diana M., et al. (2022).
Title: Mental Health Outcomes in Transgender and Nonbinary Youths Receiving Gender-Affirming Care.
Journal: JAMA Network Open
https://doi.org/10.1001/jamanetworkopen.2022.5145
Key finding: Youth who received gender-affirming care had 60% lower odds of depression and 73% lower odds of suicidality compared to those who had not yet received care.
3. Green, Amy E., et al. (2021).
Title: Association of Gender-Affirming Hormone Therapy with Depression, Thoughts of Suicide, and Attempted Suicide Among Transgender and Nonbinary Youth.
Journal: Journal of Adolescent Health
https://doi.org/10.1016/j.jadohealth.2021.04.005
Key finding: Gender-affirming hormone therapy is associated with lower odds of recent depression and suicidal thoughts among trans and nonbinary youth.
4. Olson-Kennedy, Johanna, et al. (2019).
Title: Psychological Functioning of Transgender Youth After Two Years of Hormones.
Journal: The New England Journal of Medicine
https://doi.org/10.1056/NEJMoa2206297
Key finding: Gender-affirming hormones were associated with improved psychological functioning over two years in transgender youth.
5. Hill, Dara, et al. (2023).
Title: The benefits and risks of gender-affirming care for transgender youth: A position paper from the Pediatric Endocrine Society.
Journal: Hormone Research in Paediatrics
https://doi.org/10.1159/000531765
Key finding: The Pediatric Endocrine Society confirms that gender-affirming care is the current standard of care and must be individualized, evidence-based, and rooted in respect for youth autonomy and safety.
As a profession, we do not diagnose or decide what patrons should believe, but we do safeguard access to knowledge, and we trust our patrons—including youth—to explore their identities with the support of their families and communities. Libraries are not sites of indoctrination; they are homes for complexity, dialogue, and growth.
If anything, the real “wicked problem” we face is the suppression of that access through fear, misinformation, and censorship.
Thank you for commenting. However note that the purpose of my article methodologically was to support reported parental concerns with what scholars are also finding and discussing, not to discuss the merits of medical interventions per se. But just on that level, there are serious methodological limitations to all the papers you cite here in that the time frames in which they performed their follow ups were very brief:
1. Turban, Jack L., et al. (2022).
Title: Access to gender-affirming hormones during adolescence and mental health outcomes among transgender adults. Journal: PLOS ONE.
Time period: over the past year.
2. Tordoff, Diana M., et al. (2022).
Title: Mental Health Outcomes in Transgender and Nonbinary Youths Receiving Gender-Affirming Care. JAMA Network Open
Time period: over a 12-month follow-up.
3. Green, Amy E., et al. (2021).
Title: Association of Gender-Affirming Hormone Therapy with Depression, Thoughts of Suicide, and Attempted Suicide Among Transgender and Nonbinary Youth. Journal: Journal of Adolescent Health
Time period: Before March 2020 and in July 2020
4. Olson-Kennedy, Johanna, et al. (2019).
Title: Psychological Functioning of Transgender Youth After Two Years of Hormones. The New England Journal of Medicine.
Time period: 2 years after start of hormones
It's going to require longitudinal studies with 5- 10-year time frames (or longer) before we can say in confidence that these radical and under-evidenced interventions were ultimately beneficial, and that the patients don't regret them, given that many of the patients will be sterile and find themselves in their 30s and wishing they could start families, to say nothing of experiencing medical complications (brittle bones, heart disease, cognitive issues, etc.)
Thank you, Michael, for presenting your perspective and drawing attention to what you frame as a “wicked problem.” I share your belief that libraries are uniquely positioned to foster thoughtful public dialogue on difficult issues.
However, I’d like to respectfully offer another view, grounded in peer-reviewed research and the current medical consensus regarding gender-affirming care for young people. Importantly, this conversation centers on a very small and vulnerable segment of youth. The idea that gender-affirming care is easily accessible or being imposed widely through public education or children’s books does not reflect the lived experience of most transgender and nonbinary youth.
A large number of trans youths never receive affirming care at all. According to a 2022 study published in JAMA Pediatrics, more than 1 in 3 transgender youth report experiencing homelessness or housing instability—often due to family rejection. ¹ The same study finds that youth who experience stable housing and access to affirming environments show significantly better mental health outcomes.
Meanwhile, major professional medical associations—including the American Academy of Pediatrics, American Psychiatric Association, Endocrine Society, and World Professional Association for Transgender Health (WPATH)—support gender-affirming care as evidence-based and medically necessary when delivered thoughtfully, carefully, and age-appropriately. This includes:
Social support and mental health care are often the only interventions provided in early adolescence.
Puberty blockers are fully reversible and are used to pause physical changes while gender identity continues to develop.
Gender-affirming hormone therapy is typically offered in later adolescence under strict guidelines and only after psychological evaluation.
Surgical interventions are exceedingly rare before age 18 and only considered after an extensive multidisciplinary review.
Key peer-reviewed studies supporting gender-affirming care include:
Chen et al. (2023) – A two-year study of trans youth receiving hormones found significant improvements in anxiety, depression, and life satisfaction.
NEJM, 388(3), 240–250. https://doi.org/10.1056/NEJMoa2206297
Tordoff et al. (2022) – Youth who accessed affirming care had 60% lower odds of depression and 73% lower odds of suicidality.
JAMA Network Open, 5(2), e220978. https://doi.org/10.1001/jamanetworkopen.2022.0978
Turban et al. (2022) found that trans adults who accessed gender-affirming hormones as adolescents had lower rates of psychological distress and suicidal ideation later in life.
PLOS ONE, 17(1), e0261039. https://doi.org/10.1371/journal.pone.0261039
Yet, access remains a major barrier:
According to the Trevor Project’s 2023 national survey, only 39% of trans and nonbinary youth reported living in a home where their gender identity was respected, and less than half could access mental health care when they needed it.²
Rather than overestimating the reach of gender-affirming care, the data point to a crisis of unmet need, especially for LGBTQ+ youth of color, youth in rural areas, and those facing housing insecurity.
What this means for libraries:
Libraries serve all families and communities. That includes the child with two moms, the teen exploring their identity, and the youth quietly trying to find a book that reflects how they feel. We must continue to support access to age-appropriate, evidence-informed resources that affirm a diversity of identities not as ideology but as a core commitment to intellectual freedom and inclusion.
Hi Rebekah -- Thank you again for your thoughtful response and for referring readers to other sources. And yes, homelessness and family rejection combined with other comorbidities (autism, depression, resisting one's same-sex attraction) leave trans-identified youth very vulnerable, and they need the best care society can offer. However, without reading the articles, I would question whether or not those better mental health outcomes might also have been achieved with simple talk therapy, rather than irreversible hormonal or surgical procedures. And sorry, but contrary to the "consensus view" puberty blockers if taken for long enough are *not* fully reversible--the human body only goes through puberty for a given time and then stops. Boys who take puberty-suppressing drugs for long enough are left with a micro-penis for the rest of their lives, and are sterile. And no, it's not the case that "gender-affirming hormone therapy is typically offered in later adolescence under strict guidelines and only after psychological evaluation"or that "surgical interventions are exceedingly rare before age 18 and only considered after an extensive multidisciplinary review" because we have numerous accounts of very young teens being prescribed puberal suppression and for girls double mastectomies after a single consultation. See for example https://tinyurl.com/yfhevmbx
Hi Michael,
Thank you again for your continued engagement. I want to offer a perspective grounded in lived experience as someone who has received gender-affirming care after a bilateral mastectomy due to cancer, and as someone who has seen firsthand how misinformation harms our ability to care for each other.
It’s important to recognize that gender-affirming care is not a monolith, and most of the care provided to transgender and gender-diverse youth is mental health support, talk therapy, and support for social transition. The idea that children are receiving irreversible surgeries is not supported by leading medical associations, including the American Academy of Pediatrics, the Endocrine Society, and WPATH. These organizations have clear age-based guidelines and multidisciplinary review processes for any medical interventions involving hormones—let alone surgery, which is exceedingly rare for minors and only considered in exceptional cases.
I also want to gently challenge the assertion that the rare and extreme examples cited represent common practice. Outliers are not policy. I’ve had friends who were prescribed growth hormones as children for height or delayed puberty—common in sports and other medical situations—and no one cried scandal. Hormonal care is not inherently harmful or experimental; it’s widely used and studied in pediatric endocrinology across many conditions.
Let’s be mindful: the small, deeply vulnerable population of trans youth is often already facing rejection, homelessness, and suicide risk—not because of their identity, but because of how society responds to them. Libraries, like hospitals and schools, are often the only safe space for these kids to exist, learn, and ask questions.
And this isn’t just theoretical. I’ve lost friends to suicide because they didn’t have access to affirming care or support when they needed it. These are real lives—not just policy debates or philosophical thought experiments.
We owe it to them, and to our profession, to uphold facts, to listen to lived experiences, and to approach this with humility, not hyperbole. Compassion and curiosity should guide us, not fear.
Hi Rebekah -- I certainly respect your lived experience, both as regards yourself and the friends you've lost, and you have my compassion. And of course, you're quite correct, nobody objects to hormonal treatments for delayed (or precocious) puberty, but those are completely different medical contexts. And absolutely, libraries should be safe places for troubled and vulnerable youth. But that doesn't mean we shouldn't include in our collections a diversity of viewpoints and research on this complex matter, even if some activists object to the conclusions (e.g., Lisa Littman's 2018 article on Rapid Onset Gender Dysphoria, and Abigail Shrier's Irreversible Damage). In terms of your counterargument (here and in your other comment) that young children aren't being rushed into hormonal or surgical treatments, and your reliance on the authority of WPATH and other medical associations, I would suggest you read Mia Hugh's WPATH Files report - https://environmentalprogress.org/big-news/wpath-files
which thoroughly discredits the organization.
or the Cass Review - https://webarchive.nationalarchives.gov.uk/ukgwa/20250310143933/https://cass.independent-review.uk/home/publications/final-report/
These reports argue that the needs of trans-identifying youth are being poorly served by the medical establishment, which rushed an under-evidenced "innovative practice" into the mainstream without conducting clinical trials. I believe that arguing for more sound science in this area is not reducing vulnerable young people to political talking points, but rather seeking to ensure their long-term well-being.
As a librarian and cancer survivor who received gender-affirming care after my mastectomy, I want to say this plainly: gender-affirming care is health care.
The framing of gender-affirming care as uniquely controversial, only when applied to trans people, is medically inconsistent and ethically problematic. Hormone therapy, for example, is used in a wide variety of treatments: to support growth in sports, to regulate puberty, to treat endometriosis and infertility, and yes, as part of affirming gender identity. The protocols are often the same. The stigma is not.
We cannot ignore that the same care that helps one person feel whole is vilified when provided to another, solely because they are transgender. That’s not medical caution; that’s scapegoating a small, already vulnerable population.
Let’s also ground this in reality: babies and preschoolers are not getting surgeries. They’re getting haircuts. They’re playing dress-up. They’re reading stories in public libraries and learning to recognize differences as a part of life. The public panic about “irreversible harm” is not just hyperbole; it’s misinformation. Most youth who access gender-affirming care do so under strict, evidence-based guidelines, with mental health assessments, family support, and time for decision-making. Surgical interventions for minors are exceedingly rare.
I understand that critiques of organizations like WPATH and studies like the Cass Review are now part of this conversation. I’ve read them. They call for caution and better evidence, but they also acknowledge the lived experiences of trans youth and the importance of individualized, careful care. This is not a rejection of gender-affirming care, it’s a call for high standards, better research, and transparency. That’s something most practitioners, patients, and librarians can agree on.
Yet, the way these critiques are weaponized in public discourse has not led to better care. It’s led to bans, misinformation, and fear, creating more barriers for families trying to do right by their kids.
As a librarian, I uphold intellectual freedom. I wouldn’t remove Irreversible Damage from a library, even though reading it made me want to puke. We need debate. We need data. But what we don’t need is cruelty masquerading as caution.
So many of the youth being targeted in this discourse aren’t even accessing care. They’re trying to survive. Many are couch-surfing, unhoused, or estranged from their families. And libraries? Libraries are often the third place where they feel safe.
We should be clear: health care is self-care, and it’s deeply personal. It belongs at kitchen tables, not on campaign slogans. Supporting trans youth shouldn’t be controversial, it should be compassionate.
Let’s stop turning trans lives into talking points. Let’s return to the core question: how can we help every kid feel seen, safe, and whole?