A scan of the comments on Pamela Paul’s bombshell piece on detransitioners in the New York Times revealed that many readers were shocked at the reports of minors undergoing irreversible medical procedures for gender dysphoria without first receiving adequate psychological evaluations. They were especially horrified by the story of Kasey Emerick, whose gender distress, depression, anxiety, and suicidal ideation were ultimately rooted in her being sexually abused by a caregiver when she was a small child, along with internalized homophobia. While Kasey gained valuable insight into the nature of her identity struggles through the transition process, it came at the permanent cost of her breasts and the masculinizing effects of testosterone therapy.

Some readers interpreted Paul’s stories as tragic, one-off failures of oversight. But those who have studied so-called gender-affirming care know that these cases of apparent incompetence reflect built-in features of the treatment model. Gender medicine’s failures result not from a “few bad apples” but from its ideological foundations.