Abigail Shrier is a journalist who wrote the book Irreversible Damage: The Transgender Craze Seducing Our Daughters which was published in 2020. That book, which made her politically and socially radioactive made the case that the rapid uptick of trans identifaction, especially among young girls, was the result of social contagion. The book also criticized the basis of gender-affirming care, something that seems prescient now.

Today, Shrier has written that, in her opinion, the gender fever has finally broken thanks to the executive order signed this week by President Trump. Her entire piece is a striking summary of the recent cultural landmarks related to this topic.

When the history of 21st-century gender mania is written, it should include this signal entry: In 2020, a website called GoFundMe, usually a place to find disaster-relief appeals and charities for starving children, contained more than 30,000 urgent appeals from young women seeking to remove their perfectly healthy breasts.

Another entry, from June 2020: The New England Journal of Medicine, America’s platinum medical publication, published a piece explaining that biological sex is actually “assigned at birth” by a doctor—and not a verifiable fact, based on our gametes, stamped into every one of our cells. In fact, biological sex ought to be deleted from our birth certificates—the authors claimed—because a person’s biological sex serves “no clinical utility.” Breaking news to gynecologists.

Public schools began asking elementary kids whether they might like to identify as “genderqueer” or “nonbinary.” Any dissent from this gender movement was met with suppression. The American Civil Liberties Union’s most prominent lawyer, Chase Strangio, announced his intention to suppress Irreversible Damage, my book-length investigation into the sudden spike in transgender identification among teen girls. “Stopping the circulation of this book and these ideas is 100% a hill I will die on,” he tweeted. Weeks later, Amazon deleted Ryan Anderson’s book criticizing the transgender medical industry.

It leaves you wondering how this could have happened in what is mostly a center-right country. And Shrier provides and answer to that question as well. According to her, the rapid change we've all witnesses was the result of Obamacare.

Section 1557 of the Affordable Care Act, President Barack Obama’s signature legislation incentivizing and coercing private insurers to offer their products on a government exchange, prohibited those companies from discriminating on the basis of sex. And in May 2016, six years after the bill’s enactment, the Obama administration’s Department of Health and Human Services added this fateful qualification: Discrimination on the basis of “sex” was to include discrimination on the basis of “gender identity.”

“Obama effectively wrote into law, through healthcare, that gender identity is a protected class,” healthcare executive and gender-medicine researcher Zhenya Abbruzzese told me. And that opened a huge new source of funding for these treatments. “Because once these insurers feel like they have to cover it, that’s it. You have just turned on the engine,” Abbruzzese said.

What this meant in practice is that insurance companies who offered coverage of the use of male hormones for men would also have to offer them for women who identified as men or risk being sued for discrimination.

Meanwhile leading activist researchers like Dr. Johanna Olson-Kennedy sat on evidence that gender affirming care didn't improve outcomes and activist groups like WPATH also sat on evidence and succumbed to political pressure to remove age limits on such care. In case you missed it, here's a bit of an Economist story from last year about how WPATH handled medical research carried out at Johns Hopkins.

From early on in the contract negotiations, WPATH expressed a desire to control the results of the Hopkins team’s work. In December 2017, for example, Donna Kelly, an executive director at WPATH, told Karen Robinson, the EPC’s director, that the WPATH board felt the EPC researchers “cannot publish their findings independently”. A couple of weeks later, Ms Kelly emphasised that, “the [WPATH] board wants it to be clear that the data cannot be used without WPATH approval”...

in May 2018 Ms Robinson signed a contract granting WPATH power to review and offer feedback on her team’s work, but not to meddle in any substantive way. After wpath leaders saw two manuscripts submitted for review in July 2020, however, the parties’ disagreements flared up again. In August the WPATH executive committee wrote to Ms Robinson that WPATH had “many concerns” about these papers, and that it was implementing a new policy in which WPATH would have authority to influence the EPC team’s output—including the power to nip papers in the bud on the basis of their conclusions.

The Hopkins team published only one paper after WPATH implemented its new policy: a 2021 meta-analysis on the effects of hormone therapy on transgender people. Among the recently released court documents is a WPATH checklist confirming that an individual from WPATH was involved “in the design, drafting of the article and final approval of [that] article”. (The article itself explicitly claims the opposite.) Now, more than six years after signing the agreement, the EPC team does not appear to have published anything else, despite having provided WPATH with the material for six systematic reviews, according to the documents.

This isn't science, it's public relations. Thankfully, Trump's executive order cuts off WPATH.

Trump’s executive order directs federally funded institutions to stop reliance on WPATH, calling its recommendations “junk science.” Cut off from what Abbruzzese calls WPATH’s “evidence laundering,” insurers will be forced to evaluate the gender medical evidence and issue policies on their own. Systematic reviews and investigations already undertaken in England, Finland, and Sweden indicate it’s not likely they will find the evidence for medically transitioning children to be terribly impressive.

The same order also says that no medical group which received federal money can provide pediatric gender transitions. Those that do risk losing Medicare and Medicaid contracts. Shrier says that some boutique medical practices that don't received federal money will still be able to pursue gender-affirming care for kids but in her view it was the omnipresence of gender-affirming care that was its chief strength. If it is now limited to a few fringe places it will be a lot less able to bully people into line.