Cat Cattinson had struggled for years with feelings that she was a boy. She had trauma in her past and a history that included treatment for an eating disorder and suicide attempts. After hearing that Planned Parenthood provided testosterone shots, she gave them a call in early 2020 and got testosterone that same day, after merely a 30-minute phone call in which her psychological history did not come up.

The young California woman was surprised, thinking “there would be at least some kind of process to get the hormones” or “just some kind of psychological evaluation,” but, instead, she had a 30-minute phone conversation with a doctor, and “it was pretty clear she didn’t look at my chart.”

After receiving testosterone, when Cattinson later looked into scheduling a double mastectomy, she obtained “a permission letter from Planned Parenthood. I just called, and this time they transferred me to another clinic, where I talked to a different doctor who I’d never met in person.” After 45 minutes, “she wrote me a letter for top surgery without ever meeting me in person. My surgeon said that the insurance wouldn’t cover it if I didn’t have a letter.” 

Cattinson subsequently detransitioned because of the negative effects caused by the hormonal treatments, but her experience in easily obtaining life-changing treatments is no anomaly for Planned Parenthood. The country’s top abortion provider now is also among the largest providers of hormone injections to transgender-identifying teens and young adults. 

Planned Parenthood’s “informed-consent” approach to hormones does not involve the requirement of therapy prior to beginning hormone treatments and has sparked criticism from former patients, transgender individuals working in the field, and critics of the transgender ideology. The group quietly went from offering these services to transgender individuals in 16 states at 65 locations in 2015 to currently offering these services in 41 states at more than 200 of their centers to more than 35,000 individuals nationwide. 

Many Planned Parenthood affiliates are open about this approach in their description of services on their websites. Planned Parenthood Mar Monte in San Jose, California, states, “In most cases your clinician will be able to prescribe hormones the same day as your first visit. No letter from a mental health provider is required.” 

Similarly, Planned Parenthood of Western Pennsylvania states: “A therapist's letter is not required to begin hormone therapy at our health centers,” and “Most patients are prescribed hormones that day.” 

Planned Parenthood of Metropolitan Washington, D.C., says: “Informed Consent is a model of care in which patients are able to access hormones during a visit with their provider, where they’ll discuss the risks and benefits of care. No visit with a mental health professional is required.” 

In an Instagram video for Planned Parenthood of South Texas, a transgender individual, Gideon Del Rio, recommends Planned Parenthood to peers saying, “They trust we’re able to make our own medical decisions and don’t make us go and grab letters of recommendation from therapists or other doctors before receiving care.” 

While these services are widely available for those 18 years of age and older, some locations also explicitly advertise hormones for minors with parental consent. Puberty blockers are available at Upper Hudson Planned Parenthood “to transgender and gender non-conforming adolescents who are entering puberty and wish to prevent the irreversible and undesirable changes that develop,” but the Planned Parenthood affiliate adds that “parental permission is required for this service.” 

Additionally, Planned Parenthood Great Northwest, Hawaii, Alaska, Indiana, Kentucky advises that it is able to provide letters for “gender-affirming surgery” if that is a route the patient would like to take.

 

Planned Parenthood and Detransitioners

Jennifer Lahl, president of the Center for Bioethics and Culture Network, told the Register the center is set to release the documentary film The Detransition Diaries on Sept. 19. It looks at the lives of three young women who took hormones to transition into living as men, but then regretted those decisions and now argue against such treatments for young people struggling with dysphoria. Two of the women in the film, Cattinson and Helena Kerschner, procured hormones at Planned Parenthood at the ages of 27 and 18, respectively.

Kerschner said in the documentary that the initial Planned Parenthood appointment “took about an hour.” She remembers being told, “I was a perfect candidate for testosterone, and since I had traveled so far, and seemed ‘so sure,’ that they would even work around their typical policy of taking blood samples and waiting for test results to prescribe the hormones, and give me my prescription that very day.”

In another interview, Kerschner said the nurse told her they would start her on 25 milligrams of testosterone, but she said to the nurse, “I think that I need more because my hips are big, so I think I have extra estrogen, and I’m going to need more testosterone to look like a boy.’” 

The nurse then gave Kerschner a 100-milligram dose. She said that “the testosterone and the rage attacks were so intense that I ended up actually hurting myself. So I had to be hospitalized twice for these reasons.”  

Stories from other individuals dissatisfied with or taken aback by Planned Parenthood’s approach to providing hormones abound on social media. One YouTube personality, Ryan Barnes, told the story of her transition then detransition on that platform, including a video detailing her negative experience with Planned Parenthood. 

She made the decision to transition as a young adult and went to Planned Parenthood for testosterone. 

“I went in, and I signed, like, a little consent form,” she said. “They didn’t really ask me any questions, and they took a blood draw, and then I scheduled to come back for two weeks later, after the lab results had come in, and get my prescription; that was it.”

Barnes said she is supportive of people who wish to transition but said that, “with Planned Parenthood just kind of willy-nilly, just almost handing out hormones like candy to anybody who walks in the door, regardless if you’re actually transgender or not or just confused or not, I feel it’s almost disrespectful to people who are actually transgender. They’re trained medical professionals: Shouldn’t they be asking you more questions and, like, taking more care to give you what you actually need?”

“If it wasn’t just as easy as just walking in and signing a form for something that permanently changes your body for essentially the rest of your life in some aspects,” she said, “I don’t think I probably would have transitioned because I think the longer I would have thought about it, and given it more time to think and given it more consideration, I think it may have played a part, and it may have influenced me transitioning.” 

She also contended Planned Parenthood did not inform her of a sensitivity to testosterone that was causing her to have dangerously elevated levels. According to Barnes, a doctor at a different Planned Parenthood facility informed her that her testosterone count was at 1,350, far above the target range of between 300 and 500, telling her: “You must have some sort of sensitivity to it because you should be nowhere near this high with the amount that you’re injecting.” Added the doctor, “I don’t know why the other doctors kept giving you this.” 

Barnes said she received six or seven blood draws from the other Planned Parenthood facility, and “no one called me and told me that my levels were off; they just kept giving it to me.”

 

‘Informed Consent’

Lahl told the Register that while Planned Parenthood claims its facilities operate under an “informed-consent model,” their process “is not informed consent when you're dealing with people that are under mental duress, as often is the case.” 

A copy of Planned Parenthood of Southern New England’s 2017 informed-consent form was obtained by the Register. Describing testosterone hormone therapy, the New Haven, Connecticut-based organization lists among the benefits that “your voice will become deeper,” and “hair on your body will be thicker and grow faster,” while also noting that “you will notice less fat on your buttocks, hips and thighs and more on your belly.” 

Among the side effects were acne, mood changes and male-pattern baldness. The risks listed include that the drug can “increase your red blood cell count” and “increase the chance of getting diabetes”; it also acknowledged that “there may be long-term risks that we don’t know about.” 

By contrast, the Mayo Clinic provides a longer list of risks involving the long-term use of testosterone, including the fact that “the risk of permanent infertility increases with long-term use of hormones, especially when hormone therapy is initiated before puberty. Even after stopping hormone therapy, ovarian and uterine function might not recover well enough to ensure that you can become pregnant without reproductive technology assistance.”

The media office of Planned Parenthood of America did not respond to the Register’s query about whether the organization believed its informed-consent model adequately informed patients of the risks and screened for mental-health issues. 

Erica Anderson, a transgender individual who was formerly president of the United States Professional Association for Transgender Health, is another critic of the group’s approach. 

Anderson wrote in a recent column in the San Francisco Examiner, “the student health centers and Planned Parenthoods operate under the informed consent model, which casts aside mental health screening requirements. Yet parents frequently tell me aghast that their young adult withheld from the medical provider a history of mental health challenges, including in some cases self harm or suicidal thoughts. Other college-age students gloss over details of their mental health history, dismissing further inquiry or accusing providers of ‘gatekeeping,’ which in gender affirming circles is akin to being called out for racism by a person of color.” 

Anderson warned that “absent an individualized comprehensive evaluation prior to initiating gender affirming medicine, a gender transition may be premature or, worse, inappropriate.” 

 

Erin Brewer’s Experience

Erin Brewer, co-founder of Advocates Protecting Children, told the Register that “Planned Parenthood's model of informed consent is giving people a very limited idea of what the hormones are going to do. The fact is, we don't really know what the long-term consequences are of these hormones.” She added that “the detransitioners that I've talked to have said that they don't even read the form. They just sign it because they want the drugs.”

Brewer’s work helping young people and parents navigate the transgender ideology comes from having what “would now be considered a transgender identity” when she was young. Her insistence that she was a boy when she was a young girl, she said, came from “a sexual assault that occurred. My brother and I were both together, and two men sexually assaulted me and they didn’t sexually assault him, and so, as a creative coping mechanism, I just was going to be a boy, in my mind.”

“According to trans-rights activists, if a child is insistent, consistent or persistent that they are the opposite sex, then they are transgender,” she said. “I know that if I were a child now that I would have been medicalized.” 

Indeed, Planned Parenthood lists these criteria on its website, advising that “if your kid’s actions and words are consistent, insistent, and persistent when it comes to their gender identity, talking with a counselor or therapist who’s familiar and supportive of LGBTQ identities is a good idea.” 

Brewer received help from therapists and worked through those issues, but she worries about children today with similar backgrounds who are “not getting the help that they need to address the underlying issue, and then they’re being damaged with these medical interventions, and, oftentimes, permanently.” 

 

Other Side Effects

Quentin Van Meter, a pediatric endocrinologist and president of the American College of Pediatricians, told the Register that providing young women with testosterone shots means “a very rapid and irreversible change in voice, body hair,” adding that “they make themselves vulnerable then for an elevation in hemoglobin, which their bodies are not ready to tolerate.” 

One recent study noted, “after taking testosterone, transgender men will often see increases in their hemoglobin or hematocrit levels beyond the laboratory's normal range for cisgender men and women, but the implications of this erythrocytosis are unclear.”

Van Meter said that for biological men going on estrogen, “the risk for clotting disorders and stroke is way higher.” A recent study found that among biological men taking estrogen, there was “a higher risk of stroke and blood clots than nontransgender women and nontransgender men. The highest risk differences were found several years after starting estrogen.”

He said that because of the permanence and severity of the changes and side effects, “the first thing that needs to be done is an extensive psychological screening to say, ‘Well, if you feel you’re in the wrong body, why is that?’ And none of that’s done in the Planned Parenthood 45-minute appointment.”