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Toddlers unsnapping their onesies or pulling barrettes out of their hair are sending gender messages and could be transgender, says one expert in the field of gender medicine. Likewise, an adolescent with a long history of mental illness who suddenly announces a transgender identity is to be believed and immediately affirmed, according to the prevailing wisdom in gender clinics.

Reflecting these beliefs, in 2018, the American Academy of Pediatrics (AAP) 2018 produced a policy statement on gender-affirming care for minors that recommended affirming young people in their opposite-sex identities, stated that adolescents should have access to puberty blockers, cross-sex hormones, and bilateral mastectomies as a remedy for their gender distress, and called the traditional approach of watchful waiting “outdated” and unsupported by science.

Since the publication of this statement five years ago, thousands of American minors have received “gender-affirming” hormonal and/or surgical treatment for their self-declared transgender identities.