When we place a child in the care of a doctor, we assume one thing above all else: that the person in the white coat is guided by the child’s wellbeing—not ideology, institutional pressure, or profit. But what happens when that trust is misplaced?
Sometimes the clearest way to understand a complicated issue is to follow the trail no one wants you to notice. In this eye-opening article, Alexis Tarkalson follows that trail through pediatric gender medicine. What she uncovers raises a much bigger question: When medicine, ideology, and money collide, who is making sure the child comes first?
Protecting our children,
Wendy Wixom, President
United Families International
When Ideology Replaces Medicine: Money, Medical Fraud, and Detransitioners
Alexis Tarkalson
There was a young girl named Sydney confused about who she was and scared of her impending puberty. To escape that discomfort she began to pursue something, unbeknownst to her, that would be even more discomforting: sex-rejecting procedures. After starting cross-sex hormones at fourteen, she found herself four years later struggling to recover from the removal of her breasts in a double mastectomy.
Side effects from her procedures started making their appearance and in the end it was written, “After all of the time and money she invested into her perceived identity, she is left with regret and unalterable consequences.”
Why was Sydney’s story allowed to continue down a path of which she is no longer able to return? Where were the so-called “medical professionals” throughout the process, to stop her from making irreversible changes to her body? And where was the mental health screening to put up a red flag after learning about her past sexual abuse, a disrupted family home after divorce, and intense fears about puberty following severe menstrual symptoms?
The Department of Health and Human Services (HHS) in the U.S. recently released a report titled, “Wolves in White Coats: How Doctors and Hospitals Pushed and Profited from the Fraud of “Gender Medicine””, wherein they detail what could be an answer to the above questions. They reveal the fraud happening within gender medicine and the perplexities of professional associations pushing the gender affirming care model at the expense of their credibility.
This article seeks to summarize the report’s findings and the reason the experiences of detransitioners are being suppressed.
The Gender Industrialization Complex
There is not much money to be had in the pediatric medicine world. Your pediatrician is making significantly less money than those in specialized or surgical fields. When 82% of your patient database has no chronic illness that requires them to be seen regularly, your workload for the day might be a little lighter than your colleagues in different fields of medicine.
Everything changed when gender-affirming care entered the medical scene. The youth demographic is 3.3% transgender, and an additional 2.2% wonder if they are. This is a small population, but there is a lot of money to be made within that small population.
If you have a minor patient come into your clinic claiming gender dysphoria, and you can convince them to begin sex-rejecting interventions, the medical community now has a regular, lifetime patient. Cross-sex hormones alone will cost an individual between $25,000 and $75,000 (depending upon whether they select the higher-quality hormones) in their lifetime if they begin as a minor. This number does not include out-of-pocket costs for patients.
The next step on the conveyor belt is surgery, and that is not cheap. For a mastectomy, or to use their euphemism “top surgery”, the cost is nearly $15,000. For “bottom surgery”, or a vaginoplasty or phalloplasty, the cost ranges from $53,645 and $133,911 (these numbers exclude out-of-pocket costs), respectively.
Adding all of that up, you are looking at a lifetime cost of $100,000 to $170,000. Devastatingly enough, that number still does not include the further costs such as: paying for complications like urethral strictures, loss of sensation, and cosmetic appearance, or follow-up care to fix past surgeries, or receiving hair removal and voice therapy, or fertility preservation.
If you can keep them on the gender-affirming path, you have a guaranteed golden goose. And there is more where that came from. Since 2019, the HHS has identified nearly $120 million in claims for sex-rejecting procedures involving minors, and there could be much more. There have been 5,500 surgical procedures and 8,500 courses of hormones or blockers dispensed.
Insurance Fraud and Greed in the Gender Affirming World
To guarantee the cash continued to flow, some doctors went a step further in their exploitation. The HHS’s report explains that insurance fraud has become rampant in the gender medicine domain.
There are two types of insurance codes: ICD, which explains the diagnosis, and CPT, which explains what the treatment will be. Upon the submission of these codes, insurance will look at them and decide if they are going to cover the costs of said treatments. As the report explains, fraud happens when, “They…record an inaccurate – or less specific – diagnostic code to increase the odds of coverage for the treatment provided.”
Doctors are utilizing this route to secure gender-affirming care coverage for minors. Instead of using the gender-identity disorder codes found under F64.0, they are instead claiming codes like “Endocrine disorder, unspecified” which is E34.9., or “precocious puberty” under E30.1. One study found that after looking at 1,480 different patients said to have endocrine disorders, less than five percent actually had said disorder.
The HHS report states, “Indeed, the openness, even pride, with which they discuss this practice shows their confidence that neither the medical establishment nor the insurance industry would dare challenge the field on this critical matter.”
Precocious puberty is not diagnosed unless a minor is between the ages of 8-11 (ages vary depending upon the sex of the child). So then why, you might ask, did Pennsylvania Medical Assistance data show over a 1,000 claims for puberty blockers for minors 14-18 years of age? And why, over the course of ten years, was $11 million billed for puberty blockers for patients said to have “precocious puberty” when in fact they were between 13 and 17 years old?
The answer is simple, to ensure pockets were lined with money from public and private insurance.
These findings are not the findings of tin foil hat wearers. No, the gender-affirming care community themselves admits to their dishonesty when filing for insurance. Look at these instances where medical professionals gave insurance “advice”:
- Founder of QueerDoc, an organization of “queer and trans healthcare providers” for telemedicine, said, “[s]ome providers use the code E34.9, Endocrine disorder, unspecified. E34.9 can sometimes be used for labs, prescriptions, and visits.”
- A Planned Parenthood in Southeastern Pennsylvania posted to their website, “In order to meet the needs of most insurance companies and patients, we typically use the code E34.9 (endocrine disorder, unspecified) and occasionally will use F64.9 (gender identity disorder, unspecified) if necessary.”
- A blog titled, “Coding and Billing for Transgender Care While Protecting Patient Confidentiality” details the following, “when ordering labs or prescriptions related to gender-affirming care, consider whether a general endocrinology, adolescent medicine, or mental health-related diagnostic code is appropriate.”
- Whistleblower Vanessa Sivadge accused Texas Children’s Hospital of “illegally billing Medicaid for transgender procedures,” and she went on to say, “I saw how the hospital had also misdiagnosed patients for the purpose of justifying those treatments, labeling a biological male with an estrogen deficiency in order to justify to prescription of estrogen, and labeling a biological female with a testosterone deficiency in order to justify the prescription of testosterone. I witnessed how the hospital would falsify medical records by listing the preferred gender identity of the patient on the medical record instead of the birth sex, creating a web of confusion and lies making the fraudulent billing difficult to detect.”
- The World Professional Association of Transgender Health (WPATH) had some of their files leaked and those files show a doctor saying in an online forum, “A decade ago, for privacy reasons, I would switch from a F64.9 diagnosis to a hypogonadism diagnosis as soon as it made sense, especially for those who had insurance through their workplace. It also helped improve privacy at the pharmacy pick up window.”
Maybe they justify this because, “A 12-year-old put on gonadotropin-releasing hormone analogues (GnRHa, or “puberty blockers”) will be in a state of iatrogenic hypogonadotropic hypogonadism—an endocrine disorder.” But this is only after the submittal of the initial diagnosis and treatment codes. And even then, those codes are not specific enough for what is now a doctor-induced disorder.
Detransitioners Are Being Ignored
Detransitioners who are choosing to leave the transgender community are faced with hostility and skepticism. The HHS report shares experiences such as, “Detransitioning was not met with support. When she began stating plainly that she was a woman and regretted undergoing sex-rejecting interventions, providers became hesitant and evasive. Once her former doctors learned she was detransitioning, they ceased responding to emails and calls.”
Another similar experience was penned, “At age 17, Jane began to question her “transition.” She realized she had expected testosterone and surgery to bring relief and make her feel “truly happy.” Instead, she felt she was maintaining a facade. So without guidance or medical supervision, she tapered herself off testosterone. When she stopped picking up prescriptions, no provider followed up. When she declined referral to an adult gender clinic, no one asked why.”
Pediatric endocrinologist Dr. Quentin Van Meter, a contributor for the HHS’s report, was reached out to concerning this. If the institutions are really all about the money, wouldn’t they follow up to get their “patients” back on the conveyor belt? He responded,
“The actual patient numbers and outcomes are not being honestly shared because the outcomes may be likely unfavorable. Those detransitioners who leave are a thorn in the side of the image of perfect outcomes…If they don’t follow up, they don’t have to record the detransition, which protects their claim of perfect outcomes and prevents the accumulation of data that would contradict their narrative.”
Despite the transgender community’s attempts to reframe detransitioners as merely youth on their “gender journey” (this way treatment failure is impossible), they still would rather not hear from them because it looks bad. This is not good for those opposing gender-affirming care because now we don’t know what the real number of detransitioners are, or the regret levels.
Protecting the Next Generation
Our children are in trouble. Many are being targeted and manipulated onto a path that could lead them to serious mental health and physical issues. When gender-affirming doctors such as Dr. Diane Ehrensaft can say that children as young as three years old know if they are transgender, we know that this attack is happening much sooner than we would like to think. And when endocrinologist Dan Metzger admits it’s like “talking to a blank wall” when trying to get consent from a minor for cross-sex hormones, and still prescribes them anyway, we know they are willing to do anything to push their ideology.
Through a manipulative statement, “Would you rather have a dead daughter or a live son?” they corner parents into accepting such treatments (even though a recent two year study that was almost suppressed reported mental health after puberty blockers did not improve).
We must take a stand against this. Even if your children are not in danger of such ideology, other children are, and it’s our responsibility to share what we know about the dangers of gender-affirming care. Read the HHS’s “Wolves in White Coats” report, as well as their report “Treatment for Pediatric Gender Dysphoria” to learn more about the multiple studies refuting gender-affirming care.
This is a conversation that needs to be had for the sake of boys and girls like Sydney whose futures can be permanently altered before they are old enough to understand the consequences. The evidence deserves to be examined honestly, dissenting voices deserve to be heard, and children deserve doctors who put their long-term wellbeing ahead of ideology, politics, or profit. Resources such as the HHS reports, the Cass Review, and United Families International’s HomeFront Project provide parents with important information and questions that deserve answers.
As Dr. Hilary Cass observed in her landmark review of gender services for young people, “Polarisation and stifling of debate do nothing to help the young people caught in the middle of a stormy social discourse.” She is right. When adults stop asking questions because the answers are uncomfortable, it is children who pay the price.
This is about more than a medical debate. It is about what we owe our children. When a confused child is struggling with puberty, trauma, or questions about identity, the answer should not be to rush that child toward irreversible changes. Children need time, wisdom, careful evaluation, and adults willing to walk patiently beside them—even when the right answer is difficult.
Sydney cannot undo what was done to her. But perhaps her story can help us prevent the same tragedy from happening to someone else. We have a responsibility to ask hard questions, follow the evidence, and speak when children cannot yet speak for themselves. Our children do not need us to affirm every fear they have about who they are. They need us to love them enough to help them discover who they are and to protect the future they have yet to live.
Alexis Tarkalson graduated from Brigham Young University-Idaho with her degree in Political Science and an emphasis in American Government. She loves spending time with her husband and two children, reading, hiking mountains, and learning new hobbies. The family unit is immensely important to her, as is protecting the associated rights, which is why she volunteers her time towards United Families International.