Transgender politics have taken Americans by surprise, and caught some lawmakers off guard.
Just a few short years ago, not many could have imagined a high-profile showdown over transgender men and women's access to single-sex bathrooms in North Carolina.
But transgender ideology is not just infecting our laws. It is intruding into the lives of the most innocent among us — children — and with the apparent growing support of the professional medical community.
I speak as someone intimately familiar with the pediatric and behavioral health communities and their practices. I am a mother of four who served 17 years as a board-certified general pediatrician with a focus in child behavioral health prior to leaving clinical practice in 2012.
For the last 12 years, I have been a board member and researcher for the American College of Pediatricians, and for the last three years I have served as its president.
I also sat on the board of directors for the Alliance for Therapeutic Choice and Scientific Integrity from 2010 to 2015. This organization of physicians and mental health professionals defends the right of patients to receive psychotherapy for sexual identity conflicts that is in line with their deeply held values based upon science and medical ethics.
I have witnessed an upending of the medical consensus on the nature of gender identity. What doctors once treated as a mental illness, the medical community now largely affirms and even promotes as normal.
Here's a look at some of the changes.
The New Normal
Pediatric "gender clinics" are considered elite centers for affirming children who are distressed by their biological sex. This distressful condition, once dubbed gender identity disorder, was renamed "gender dysphoria" in 2013.
In 2014, there were 24 of these gender clinics, clustered chiefly along the East Coast and in California. One year later, there were 40 across the nation.
With 215 pediatric residency programs now training future pediatricians in a transition-affirming protocol and treating gender-dysphoric children accordingly, gender clinics are bound to proliferate further.
Last summer, the federal government stated that it would not require Medicare and Medicaid to cover transition-affirming procedures for children or adults because medical experts at the Department of Health and Human Services found the risks were often too high, and the benefits too unclear.
Undeterred by these findings, the World Professional Association for Transgender Health has pressed ahead, claiming — without any evidence — that these procedures are "safe."
Two leading pediatric associations — the American Academy of Pediatrics and the Pediatric Endocrine Society — have followed in lockstep, endorsing the transition-affirmation approach, even as the latter organization concedes within its own guidelines that the transition-affirming protocol is based on low evidence.
They even admit that the only strong evidence regarding this approach is its potential health risks to children.
The transition-affirming view holds that children who "consistently and persistently insist" that they are not the gender associated with their biological sex are innately transgender.
(The fact that in normal life and in psychiatry, anyone who "consistently and persistently insists" on anything else contrary to physical reality is considered either confused or delusional is conveniently ignored.)
The transition-affirming protocol tells parents to treat their children as the gender they desire, and to place them on puberty blockers around age 11 or 12 if they are gender dysphoric.
If by age 16, the children still insist that they are trapped in the wrong body, they are placed on cross-sex hormones, and biological girls may obtain a double mastectomy.
So-called "bottom surgeries," or genital reassignment surgeries, are not recommended before age 18, though some surgeons have recently argued against this restriction.
The transition-affirming approach has been embraced by public institutions in media, education and our legal system, and is now recommended by most national medical organizations.
There are exceptions to this movement, however, in addition to the American College of Pediatricians and the Alliance for Therapeutic Choice. These include the Association of American Physicians and Surgeons, the Christian Medical & Dental Associations, the Catholic Medical Association, and the LGBT-affirming Youth Gender Professionals.