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US rollout

Between 2010 and 2024, the United States experienced explosive growth in transgender care — more than 100 pediatric clinics, Planned Parenthood as the largest hormone issuer under "informed consent," and federal support under Biden. Since 2023, states have been rolling back en masse. WPATH, the Endocrine Society, and AAP are institutional capture in its purest form: their "consensus" was a product of lobbying, not science.

Clinics and revenue: from a few centers to industry

Starting in 2007, Norman Spack launched the first pediatric gender clinic at Boston Children's Hospital, explicitly adopting the Dutch Protocol . Today, the US has more than 100 such clinics—Lurie Children's (Chicago), Seattle Children's, Children's Hospital Los Angeles, Vanderbilt. Under the informed-consent model, Planned Parenthood became the largest hormone provider: cross-sex hormones after a single consultation sometimes lasting less than 30 minutes, without psychiatric evaluation. A factory line, not clinical practice.

The ideological backing came from WPATH (see SOC versions ), the Endocrine Society, and the American Academy of Pediatrics — all three drafted their affirmative guidelines without a GRADE evidence base. The 2018 AAP resolution was proposed by consensus while the majority of members had provided no substantive input. Conflict of interest: board members had direct financial ties to gender clinics and pharmaceutical sponsors.

Federal policy under Biden (2021–2024)

The Biden administration focused on protecting gender-affirmative care at the international and federal levels. HHS reports emphasized the assumption that this care was "medically necessary," despite the absence of evidence. The Department of Justice pursued lawsuits against states that restricted care for minors. The WPATH Files (2024) show that the Biden administration directly influenced WPATH to remove age limits in SOC8 — institutional capture at the highest level.

Setback at state level (2022+)

Florida (2022), Arkansas, Tennessee, Texas, Alabama, Mississippi, and more than 25 other states banned hormones and surgeries for minors. The Florida Agency for Health Care Administration (AHCA) published a systematic evidence review that concluded the care was not evidence-based — exactly the signal that WPATH had suppressed. In June 2025, the Supreme Court confirmed in United States v. Skrmetti that states are constitutionally permitted to enact such bans. A legal turning point that the affirmative lobby had tried to silence for years with "prohibited discrimination" rhetoric.

The HHS Review 2025

The Trump administration published a 400-page evidence review (HHS) in May 2025 that confirmed the conclusions of Cass , SBU , NICE , and COHERE Finland : gender-affirmative care for minors has a "remarkably weak" empirical basis. The HHS Review also documented how the US affirmative consensus came about — a coordination between WPATH, AAP, the Endocrine Society, and advocacy organizations, not through independent evidence-based review.

Detransition and legal liability

Chloe Cole, Soren Aldaco, Layla Jane, and others have filed lawsuits against Kaiser, Stanford, and their treating physicians. The rising detransition rates make the iatrogenic damage visible; see also regret research . What was defended as dogma—affirmation as the only valid route—now proves legally untenable. The comparison with the European turnaround and the Dutch tenacity ( Dutch rollout ) is stark: the US is actively rolling back, while the Netherlands is dragging its feet.

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