Planned Parenthood is known as the nation’s largest abortion provider. They are also at the forefront of trans treatments.

From The Free Press. For Cristina Hineman, the situation felt urgent: the 17-year-old needed treatment at Planned Parenthood, where she knew she wouldn’t be subjected to humiliating questions, or an unnecessary waiting period, or lectures, or prying about her certainty. But it wasn’t an abortion she sought. It was testosterone.

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Planned Parenthood was founded a century ago to promote birth control. Today, its nearly 600 clinics nationwide make it the largest single provider of abortion, contraception, reproductive care, and sex education in the U.S.

It has also, in less than a decade, become the country’s leading provider of gender transition hormones for young adults, according to insurance claim data. In 2015, around two dozen of their clinics began offering this service. Now it’s available at nearly 450 locations. Insurance claim information provided to The Free Press by the Manhattan Institute shows that at least 40,000 patients went to Planned Parenthood for this purpose last year alone, a number that has risen tenfold since 2017. The largest proportion, about 40 percent, were 18- to 22-year-olds.

Faced with her parents’ skepticism, Hineman waited to make an appointment for just after her 18th birthday in November 2021 at the Planned Parenthood in Hudson, NY. …

After she filled out forms in the Planned Parenthood waiting room, a nurse led her to an exam room and handed her a consent form for “masculinizing hormone therapy.”

Records show that a nurse practitioner asked about Hineman’s identity and desires; she noted that “patient has consulted with a mental health provider”—meaning Hineman had previously talked to therapists. The two discussed the “expected changes” related to testosterone—growing a beard and body hair, deepening voice, and that “changes to fertility may be permanent or reversible.”

Then the first nurse took Hineman’s blood, and she was given a prescription for testosterone gel. She remembers all this taking under 30 minutes.

Like many others in the rising wave of female teens seeking to masculinize, she had been battling a cluster of mental health problems: self-harm, depression, and anxiety. Also like many of these teens, Hineman has autism. …

The viral YouTubers she was watching convinced her that gender was the problem. “I was like, oh my god, trans includes all the things I’ve been feeling—my discomfort with my chest, my discomfort with being called ‘young woman,’ not being sure of who I was or what I wanted to be,” she said.

Just over a year into treatment, Hineman realized she had made a terrible mistake, and that gender was not the source of her problems. “I was brainwashed,” she says now. “A lot of people say that adults should be able to do whatever they want. But if you have mental illness that’s clouding your view, or you’re so misinformed about what gender dysphoria even means, then you cannot consent to such invasive treatments.”

Hineman, who went from identifying as “nonbinary” to “agender” to “trans” over the course of a year, now considers herself a “detransitioner”—someone who, if possible, has returned to living as their birth sex, often with medical side effects.

Today, reported exclusively in The Free Press, she is a plaintiff in the first detransitioner lawsuit against Planned Parenthood Federation of America. In the medical malpractice suit, filed in April, she’s seeking unspecified damages for negligence and failure to obtain informed consent from all the health providers—including those at Planned Parenthood—who facilitated her medical transition: from therapists who “encouraged” her desire to change genders, to the plastic surgeon who removed her breasts after a superficial consult when she turned 19, to the nurse practitioner at Planned Parenthood who wrote Hineman the prescription for testosterone. (In June, Planned Parenthood filed its answer to the complaint, disputing Hineman’s claims.)

She joins more than a dozen young people who, in separate lawsuits across the country, are alleging medical malpractice by institutions such as Kaiser Permanente as well as individual practitioners, and are seeking compensation for the harm they claim has been done to them. …

Hineman, who is now 20 years old, has permanent effects from testosterone, like hair on the backs of her hands and side of her face. …

Talking about the double mastectomy is even more difficult: her chest is concave, scarred, and alternately numb and raw. She didn’t think about breastfeeding when she was seeking to transition, but now is haunted by the fact she’ll never be able to.  …

How did Planned Parenthood transform itself from an organization devoted to women’s health into one of the country’s largest suppliers of testosterone?

Planned Parenthood traces its origins to the opening of a birth control clinic in New York in 1916 by a nurse named Margaret Sanger. It was swiftly shut down and Sanger was arrested because, at the time, distributing birth control—even distributing information on birth control—was illegal. Sanger persevered in her mission of bringing contraception to the masses, infamously making an alliance with the eugenics movement.

Today, the organization serves more than two million patients a year, and has for decades provided affordable gynecological care for women who can’t find it elsewhere. It has revenues of around $2 billion, of which nearly $700 million comes from publicly funded programs such as Medicaid. Its motto is “Care, no matter what.”

In 2005, a northern California affiliate expanded that care to a pilot program in Santa Cruz intended mainly for male-to-female transsexuals, as they were then commonly called. …

Dr. Jen Hastings, a Santa Cruz family physician working at Planned Parenthood, spearheaded the program. …

Hastings then focused her career on expanding transgender services throughout Planned Parenthood. At a 2015 conference of reproductive health clinicians, Hastings led a session titled “Transgender health care in your affiliate: You can do it!” ,,,

It was around that time that two physicians active in expanding access to hormonal treatments started advising Planned Parenthood. Both have advocated against what’s derisively known as “gatekeeping”—that is, requiring a mental health evaluation, or a certain number of therapy sessions, or a referral letter to initiate treatment. They supported early intervention, at the cusp of puberty, based on the argument that doing so spared gender dysphoric young people the trauma of a “wrong” puberty. …

The organization would not give specific numbers, or respond to multiple requests for comment, but the insurance claim data (estimates that do not include patients who pay out of pocket) suggest that 1 in 6 U.S. teens and young adults who sought gender hormones last year were seen at Planned Parenthood. Between 2017 and 2023, affiliated clinics filed gender-related insurance claims for 12,000 youths aged 12–17.

There were plans to bring in even younger patients. In 2022, the Planned Parenthood in Santa Cruz launched another pilot, this time offering puberty blockers and hormones for teens aged 15 and under. The goal was to expand the program, but only “a small handful” of families came, an affiliate spokesperson told me, and it was shuttered. Meanwhile, the St. Louis affiliate is under investigation by the state attorney general for allegedly eliding parental consent when providing gender-transition care to minors.

Dr. Nicole Chaisson, associate medical director of Planned Parenthood North Central States, told me easy access to appointments and treatment for young people seeking transition is precisely the point. Chaisson defends a quick consult that allows a teenager to “leave the clinic with their prescription.” She told me that “otherwise healthy patients” who have been living as trans for some time tend to have already given sufficient thought to making irreversible changes. …

Dr. Vanessa Cullins was Planned Parenthood’s VP of Medical Affairs when it wrote transgender services into the national guidelines, allowing the program to expand nationally. Originally, the impetus was facilitating bodily autonomy in a small population of mostly male adults seeking to transition.

I reached Cullins in Florida, where she’s resided since retiring from her position and medicine generally in 2016. She told me she was “proud” to have started the transgender services program. But when I shared the updated guidelines with her and told her about what Hineman and Anna have gone through, she expressed concern. “We have to be vigilant when we’re giving powerful medications to young people, and these are powerful medications,” Cullins told me, which must necessarily involve side effects. If someone is not fully informed and prepared, “it could be a nightmare.”  …

Trading one biological sex hormone for the other has a multitude of profound impacts: on metabolism, on risk of cardiovascular disease and stroke, on bone health, on mood stability, on cognition, and on sexual function and fertility. Female sex organs thrive on estrogen, which the ovaries cease to produce under the sway of testosterone. After a few years, atrophy may affect the entire reproductive tract.  …

Dr. Nicole Chaisson said that side effects are part of the conversation, but acknowledged that some may go unmentioned, saying it would be wrong to point patients to things that might happen 10 or 20 years down the road when “they’re having lifesaving care right now.”

Chaisson is referring to a claim often repeated by gender practitioners: that without access to “affirming” treatments, young people will commit suicide. This is a threat that’s been commonly held over parents reluctant to approve transition for their child.

Fortunately, there is now good evidence to refute this dire claim. Researchers in Finland recently published the largest study to date looking at suicide in gender-distressed patients and found that suicide is rare, and the greatest predictor of it is previously diagnosed psychiatric conditions. Lead author Dr. Riittakerttu Kaltiala has called it “dishonest and extremely unethical” for clinicians to exaggerate risk. Dr. Hilary Cass was also clear in her review: “the evidence does not adequately support the claim that gender-affirming treatment reduces suicide risk.”

After the 2016 presidential election of Donald Trump—and the promised threat to abortion rights that came to pass—record donations funded many new hires at Planned Parenthood’s national office. I spoke to several physicians who served in high-level positions within the organization who expressed frustration with the national office for pouring more resources into advocacy than medical services. …

Many of the new staffers in the national office “believed in every so-called progressive issue, and at that time the forefront was gender-affirming care. That one issue became everything.” …

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(Excerpt from The Free Press. Photo Credit: Karollyne Videira Hubert on Unsplash)