chloe cole transition
© Courtesy of Chloe Cole
At 12 years old, Chloe Cole decided she was transgender. At 13, she was put on puberty blockers and prescribed testosterone. At 15, she underwent a double mastectomy. Less than a year later, she realized she'd made a mistake.
"I was failed by the system. I literally lost organs."

When Chloe was 12 years old, she decided she was transgender. At 13, she came out to her parents. That same year, she was put on puberty blockers and prescribed testosterone. At 15, she underwent a double mastectomy. Less than a year later, she realized she'd made a mistake — all by the time she was 16 years old.

Now 17, Chloe is one of a growing cohort called "detransitioners" — those who seek to reverse a gender transition, often after realizing they actually do identify with their biological sex. Tragically, many will struggle for the rest of their lives with the irreversible medical consequences of a decision they made as minors.

"I can't stay quiet," said Chloe. "I need to do something about this and to share my own cautionary tale."

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In recent years, the number of children experiencing gender dysphoria in the West has skyrocketed. Exact figures are difficult to come by, but, between 2009 and 2019, children being referred for transitioning treatment in the United Kingdom increased 1,000% among biological males and 4,400% among biological females. Meanwhile, the number of young people identifying as transgender in the US has almost doubled since 2017, according to a new Centers for Disease Control & Prevention report.

Historically, transitioning from male to female was vastly more common, with this cohort typically experiencing persistent gender dysphoria from a very young age. Recently, however, the status quo has reversed, and female-to-male transitions have become the overwhelming majority.

Dr. Lisa Littman, a former professor of Behavioral and Social Sciences at Brown University, coined the term "rapid onset gender dysphoria" to describe this subset of transgender youth, typically biological females who become suddenly dysphoric during or shortly after puberty. Littman believes this may be due to adolescent girls' susceptibility to peer influence on social media.

chloe cole
© Courtesy of Chloe Cole
“I can’t stay quiet,” said Cole, as a boy and today as a girl. “I need to do something about this and to share my own cautionary tale.”
Helena Kerschner, a 23-year-old detransitioner from Cincinnati, Ohio, who was born a biological female, first felt gender dysphoric at age 14. She says Tumblr sites filled with transgender activist content spurred her transition.

"I was going through a period where I was just really isolated at school, so I turned to the Internet," she recalled. In her real life, Kerschner had a falling out with friends at school; online however, she found a community that welcomed her. "My dysphoria was definitely triggered by this online community. I never thought about my gender or had a problem with being a girl before going on Tumblr."

She said she felt political pressure to transition, too. "The community was very social justice-y. There was a lot of negativity around being a cis, heterosexual, white girl, and I took those messages really, really personally."

Chloe Cole, a 17-year-old student in California, had a similar experience when she joined Instagram at 11. "I started being exposed to a lot of LGBT content and activism," she said. "I saw how trans people online got an overwhelming amount of support, and the amount of praise they were getting really spoke to me because, at the time, I didn't really have a lot of friends of my own."

Experts worry that many young people seeking to transition are doing so without a proper mental-health evaluation. Among them is Dr. Erica Anderson, a clinical psychologist specializing in gender, sexuality and identity. A transgender woman herself, Anderson has helped hundreds of young people navigate the transition journey over the past 30 years. Anderson supports the methodical, milestone-filled process lasting anywhere from a few months to several years to undergo transition. Today, however, she's worried that some young people are being medicalized without the proper restraint or oversight.

"I'm concerned that the rise of detransitioners is reflective of some young people who have progressed through their gender journey very, very quickly," she said. She worries that some doctors may be defaulting to medicalization as a remedy for other personal or mental-health factors. "When other issues important to a child are not fully addressed [before transition], then medical professionals are failing children."

According to an online survey of detransitioners conducted by Dr. Lisa Littman last year, 40% said their gender dysphoria was caused by a mental-health condition and 62% felt medical professionals did not investigate whether trauma was a factor in their transition decisions.

"My dysphoria collided with my general depression issues and body image issues," Helena recalled. "I just came to the conclusion that I was born in the wrong body and that all my problems in life would be solved if I transitioned."

Chloe had a similar experience. "Because my body didn't match beauty ideals, I started to wonder if there was something wrong with me. I thought I wasn't pretty enough to be a girl, so I'd be better off as a boy. Deep inside, I wanted to be pretty all along, but that's something I kept suppressed."

She agrees with Dr. Anderson that more psychological evaluation is needed to determine whether underlying mental health issues might be influencing the desire to transition.

"More attention needs to be paid to psychotherapy," Chloe said. "We're immediately jumping into irreversible medical treatments when we could be focusing on empowering these children to not hate their bodies."

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Until 2019, Marcus Evans was the Clinical Director of Adult and Adolescent Services at the Tavistock and Portman NHS Trust, a publicly funded mental-health center in the UK where many youth seek treatment for gender dysphoria. But he resigned three years ago over what he viewed as the unnecessary medicalization of dysphoric adolescents.

"I saw children being fast-tracked onto medical solutions for psychological problems, and when kids get on the medical conveyor belt, they don't get off," Evans said. "But the politicization of the issue was shutting down proper clinical rigor. That meant quite vulnerable kids were in danger of being put on a medical path for treatment that they may well regret."

Indeed, transitions are getting younger and hastier. Puberty blockers are commonly administered at the first sign of development to children as young as 9, according to the World Professional Association for Transgender Health. Testosterone and estrogen injections are frequently prescribed at age 13 or 14, despite the Endocrine Society's recommendation of 16. And serious surgeries like mastectomies are sometimes performed on children as young as 13.

Although medical intervention for minors requires parental consent, many mothers and fathers approve surgery and hormone therapy at the recommendation of affirming medical professionals or even out of fear their child might self-harm if denied treatment.

"It's very hard for parents to know exactly how to evaluate their own kids, and they rely quite heavily on experts to tell them," said Jane Wheeler, a former regulatory health-care attorney who founded Rethink Identity Medicine Ethics, a non-profit that promotes ethical, evidence-based care and treatment for dysphoric children. "There's obviously a lot of concern about the capacity for the adolescent or minor to fully appreciate what medicalization really means."

Medical professionals typically follow the affirmative-care model, which is supported by the American Psychological Association, validating a patient's expressed gender identity regardless of their age. As a result, detransitioners frequently report that getting prescriptions is a breeze. A total of 55% said their medical evaluations felt inadequate, according to Dr. Littman's survey.

In Helena's case, all it took to get a testosterone prescription was one trip to Planned Parenthood when she was 18. She said she was given four times the typical starting dose by a nurse practitioner in less than an hour, without ever seeing a doctor.

Chloe said she was fast-tracked through her entire transition — from blockers to a mastectomy — in just two years, with parental consent. The only pushback she said she encountered came from the first endocrinologist she saw, who agreed to prescribe her puberty blockers but not testosterone when she was 13. But she said she went to another doctor who gave her the prescription with no trouble.

"Because all the therapists and specialists followed the affirmative care model, there wasn't a lot of gate-keeping throughout the whole transition process," she recalled. "The professionals all seemed to push medical transition, so I thought it was the only path for me to be happy."

Evans, the author of "Gender Dysphoria: A Therapeutic Model for Working with Children, Adolescents, and Young Adults," now runs his own private practice with his wife in Beckenham, England, where he helps parents struggling with how to address their children's dysphoria.

A varietyofstudies suggest that as many as 80% of dysphoric children could ultimately experience "desistance" — or coming to terms with their biological gender without resorting to transition. Which is why many professionals like Evans think it's wise to hold off on potentially irreversible medical intervention for as long as possible. "I'm not against transition. I just don't think kids can give informed consent."

All these treatments run the risk of side effects that critics argue are too serious for children to fully understand. In the short term, puberty blockers can stunt growth and effect bone density, while the long-term effects are still unknown since they were only approved by the FDA in 1993. Side effects of testosterone include high cholesterol, cardiovascular disease, diabetes, blood clots and even infertility. Currently just three states — Arkansas, Arizona and Texas — have policies limiting gender-affirming treatments for minors, including surgery, hormones and speech therapy.

For those who ultimately end up regretting their transition, the consequences of hormone therapy and surgery can be devastating. For Helena, testosterone caused emotional instability that culminated with two hospitalizations for self-harm.

While in the hospital she came to the realization that her transition was a mistake. "I saw a montage of photos of me, and when I saw how much my face changed and how unhappy I looked, I realized this was all f****d up and I shouldn't have done it. It was a really dark time."

Chloe said testosterone altered her bone structure, permanently sharpening her jawline and broadening her shoulders. She said she also struggles with increased body and facial hair. She has a large scar across her chest from her mastectomy, which disturbed her about surgery. "The recovery was a very graphic process, and it was definitely something I wasn't prepared for," she said. "I couldn't even bear to look at myself sometimes. It would make me nauseous."

Gravest of all concerns is her fertility. Although she'd like to have children one day, Chloe doesn't know whether the viability of her eggs was compromised by years of testosterone injections. She's working with doctors to find out, and her medical future is uncertain. "I'm still in the dark about the overall picture of my health right now," she said.

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The subject of detransitioning is often met with vitriol from the transgender activist community, which claims that stories like Chloe's and Helena's will be used to discredit the trans movement as a whole.

This is understandable, although unlikely, as research reveals that up to 86% of trans adults feel that transitioning was the right long-term decision for them. But, as more and more children are entrusted to make serious medical decisions with permanent implications, the numbers of disaffected detransitioners is almost certain to grow.

That's why Dr. Anderson feels compelled to speak out on their behalf, as a transgender woman herself. "Some of my colleagues are worried that conversation about detransitioners is going to be more cannon fodder in the culture wars, but my concern is that if we don't address these problems, there will be even more ammunition to criticize the appropriate work that I and other colleagues are doing."

And, like Anderson, these young people — who will forever live with the consequences of hasty transition — refuse to be silenced. "I want my voice to be heard," said Chloe. "I don't want history to repeat itself. I can't let this happen to other kids."