I have obtained 12 hours of videos of top pediatric-gender-clinic physician Dr. Johanna Olson-Kennedy and her colleagues, including her husband, providing training to mental-health providers on how to treat minors who have gender dysphoria or otherwise identify as transgender or nonbinary.
This is the first of 12 installments I will post during the coming weeks of these videos. Subscribe to receive them as I publish them:
A 19-year veteran of the pediatric gender medicine field and one of its leading physician-researchers and advocates, Dr. Olson-Kennedy is the medical director of the gender clinic at Children’s Hospital Los Angeles. According to figures she provided during this particular video, annual referrals to her clinic surged from just 25 in 2010 to 436 in 2022—following a similar pattern seen in clinics throughout the Western world.
The past six months have been challenging for Dr. Olson-Kennedy, to say the least.
Dr. Olson-Kennedy is the principal investigator on a National Institutes of Health grant for a long-running research project concerning pediatric gender-transition treatment, one that has received over $10 million to date. In October, The New York Times reported that she has withheld null findings from a study of puberty blockers funded by this grant, doing so for political reasons. The grant is now the subject of a probe by congressional Republicans. In November, however, she asserted in a sworn deposition in a civil case that the Times had mischaracterized her words.
In December, Dr. Olson-Kennedy was sued by a former patient, Clementine Breen, who reported that the gender doctor prescribed her puberty blockers at age 12—on her first appointment, without a psychological assessment—and testosterone at age 13, and then referred her to receive a double mastectomy at age 14. Ms. Breen, now 20, has since detransitioned, reverting to presenting and identifying as a woman.
The Trump administration has unleashed an onslaught against the field of pediatric gender medicine, seeking to wipe it off the map. In recent weeks, the NIH has been canceling research grants related to transgender people, including those conducted with animal models. There is currently a preliminary injunction in place to block the president’s executive order that would freeze federal funds to hospitals that provide gender-transition interventions to those under age 19. Prior to the injunction, Dr. Olson-Kennedy’s clinic had “paused” new cross-sex hormone treatments for youth, only to lift the pause a couple of weeks later.
It remains unclear whether the grant for which Dr. Olson-Kennedy is the top investigator has been canceled. But it is no longer listed on the NIH site where active grants are described.
I reached out to Dr. Olson-Kennedy and her co-principal investigators on the grant to ask about its status. I did not hear back.
Dr. Olson-Kennedy is also newly the president of USPATH, the U.S. branch of the medical-activist group the World Professional Association for Transgender Health. WPATH, which despite is name is largely a U.S.-based organization, has been besieged by damaging publicity over the past year, in particular after internal documents subpoenaed by Alabama’s attorney general revealed that its leadership was aware that the evidence behind pediatric gender medicine was weak and sought to paper over this fact.
Prior to the October Times article, Dr. Olson-Kennedy was perhaps best known by the general public for a previous leaked video in which she was giving a training in 2018 to mental health care providers on how to write referral letters for minors seeking gender-transition surgeries. In the video, she expresses exasperation with what she sees as hand wringing over whether natal girls will later regret having their breast removed during adolescence. (At least 1,000 such surgeries have been conducted annually in recent years.)
She says: “What we do know is that adolescents actually have the capacity to make a reasonable, logical decision. And here’s the other thing about chest surgery. If you want breasts at a later point in your life, you can go and get them!”
Ms. Breen recently reported that she was undergoing reconstructive surgery to provide herself with new breasts. However, it is very unlikely she will ever be able to breastfeed should she have children.
12 hours of leaked Olson-Kennedy training videos
The 12-hour training in what is known as the gender-affirming care method for minors who identify as trans or nonbinary took place in late April 2024—a few weeks after Britain published the Cass Review, which found that this medical field is based on “remarkably weak evidence.” The training was led by Dr. Olson-Kennedy; her husband, Aydin Olson-Kennedy, who has a doctorate in social work and is a transgender man; and licensed clinical social worker Darlene Tando.
I obtained the videos a few months ago.
The training videos are a window into not just the methods of these individuals, but their overall attitudes about gender dysphoria and transgender and nonbinary identification in children. A prevailing attitude they share is one of indignation and irritation with a medical system that demands that children betray a substantial level of distress before they are granted gender-transition medications. Overall, these three favor less gatekeeping and less pathologizing of the mental states and internal lives of the children in their care. If a gender-incongruent child arrives in their care absent any particular distress about their identification as the opposite sex, they believe that that child should be granted the opportunity to medically transition by taking puberty blockers and cross-sex hormones if the family wishes.
I have edited the videos to snip or crop out images that would identify the participants in the training, whether because of Zoom-chat questions that pop up in the right-hand corner of the screen, or moments when a matrix of the participants is visible. You can watch the video at the beginning of this Substack. Otherwise, I wrote a summary below:
Video number 1: Johanna Olson-Kennedy on the gender basics
Dr. Olson-Kennedy opens the video by charting the recent shift in transgender visibility in popular media, which she says has improved dramatically in recent years. Previously, transgender people were frequently presented as sex workers, according to at GLAAD analysis. But these days, TV has benefited from the likes of Jazz Jennings and shows like Transparent and Pose that center on the transgender experience, Dr. Olson-Kennedy says. Having stories about youth in the media in particular, she says, has influenced the seeking of gender-transition treatment by young people.
She expresses concern that the trans kids whose stories have been told in the media are generally white. This is reflective, she says, of the disproportionately white patient population at gender clinics in the U.S. and Europe. “It is important for all of us to think about what those barriers to care are for other communities and work really hard to dismantle those barriers.”
This remark speaks to a common dichotomy among advocates in this medical field: They will at once characterize the number of children receiving these treatments as low (as Dr. Olson-Kennedy does a bit later in the video), emphasizing that the political firestorm over this population is disproportionate to its size, while also decrying how few kids are receiving the treatment.
Since 2021, Dr. Olson-Kennedy says, we’ve seen a “problematic” visibility of trans youth as states have moved to ban these treatments. She shows a Google search she conducted of “transgender youth care” the night before. “All of these six headlines, and there’s many more,” she says, “are negative, and they speak to moves being made to ban access to care.”
Dr. Olson-Kennedy generally avoids using the words “child,” “children” or “kids.” This is apparently quite intentional. If you watch the other video from 2018 in which she instructs professionals on how to write the referral letters (see below), she tells them to avoid such words and instead to call the patient a “young person,” or just to use their preferred name. The purpose of this is evidently to de-emphasize the patient’s youth as they seek life-altering surgery.
She and Aydin also routinely use the term “young person” in this lengthy interview:
In the 2024 training video, Dr. Olson-Kennedy does, however, use the word “kiddos” on occasion. (I have found this word is quite commonly in use by professionals who work with children these days. It was frequently used by the American Academy of Pediatrics members whose emails I obtained through a public-records request for my investigation about the tumultuous lead-up to the AAP’s recent conference.) But Dr. Olson-Kennedy tends to favor “young person.”
Referrals to her gender clinic in Los Angeles, she notes, took off in 2015. After that time, the sex ratio inverted, with more natal girls than natal boys presenting to the clinic. Nonbinary identification has also increased, she says.
She is keen to emphasize that the numbers they have seen have nevertheless been small. “In the largest clinic in the county, we are still not seeing thousands and thousands of people every year,” she says.
Language is important when talking with these patients, she says. She asks her patients which language for their body parts feels most comfortable to them.
In her office, Dr. Olson Kennedy says, she has a “gender abacus” for anatomy, gender identity, gender expression and sexual/romantic attraction, which she provides to her patients to help them express where they believe they lie on these respective spectrums. She does this because she found that families were conflating gender identity with gender expression. “I actually don’t think that female and male are the ends, like some sort of linear relationship to each other,” she says. But for “non-community members,” she says, this is how they think about gender.
Designated, or registered, sex at birth, is based on whether a baby comes out and either has testes (registered male) or not (female), she says. She says she doesn’t have time to get into differences in sex development, or intersex conditions, as that would take too long.
Gender identity, she says, is “both a label and an experience.” It is: “A person’s basic sense of being male, female, both, neither, or something else entirely; especially as it is experienced in self-awareness and behavior.”
She goes through the basics of what gender identity is and how we all have one. The majority of those who are registered as male at birth identify as male, and same for females, she says. Gender expression doesn’t just include hair, clothing and name. There are myriad other ways of expressing gender that give people around us cues.
Then she walks through the beginning of gender-transition treatments with synthetic hormones in the 1930s. However, “Trans people have existed since people,” she says. In the old days, people expressed their trans identity through clothing and their occupation.
Today, clothing and toys are highly gendered, she notes with withering disapproval. These differences signal to children what is expected of them based on what she calls their assigned sex at birth.
She is keen to note that shoe-wear for girls and women is often not comfortable—the dreaded heels.
She goes through physical differences in faces that are typical for men vs. women. She refers to men as “people with XY chromosomes” and points out that, for example, they tend to have an Adam’s apple.
Sexual and romantic attraction is often conflated with gender identity, she says.
“Mostly, gender is like an onion,” she says. “It has all of these layers.”
“Sometimes gender makes us cry and sometimes we cut it up and put it in spaghetti sauce,” she says.
“Gender essentialism,” meaning “sex equals genitals,” which often starts when parents learn the sex of a baby in the womb, she says, is wrong. “It erases trans experience and trans people,” she asserts. “It creates a chronic environment that’s skeptical and, now, increasingly hostile, that creates a scenario whereby people have to prove their gender before they can be affirmed either socially, legally and certainly medically.” And it supports a hierarchy in which cisgender people (non-trans people) hold supremacy.
She is no fan of gender-reveal parties. Nor does she care for providing “a person with a penis” with one kind of bedroom with a bunch of stereotypically masculine décor, and “a person without a penis” with another—all those pink shag carpets. “These cues that are in people’s rooms,” she says, “give babies and children messages about how to perform their gender. This is a ubiquitous situation!”
Gendering can be traumatic to everyone, she says. The gender-affirming care bans (which today have swept through half the states) are only “adding to the trauma for trans youths,” she says.
She charts the neural development of children, noting how by age six there is a surfeit of neural pathways in children’s brains. (I had to cut out this part due to sounds that might reveal the identity of the person who taped the session.) Then, during adolescence, synaptic pruning pares them back—the use-it-or-lose-it phenomenon at play. Trans kids, she says, have neural pathways that are established vis-à-vis the trans experience—from being told, overtly or covertly, that they are not okay.
“This is a chronic experience of trauma,” she says.
She goes through case studies of children presenting as transgender at very young ages, including one natal boy who was so adamant about being a girl and frustrated about being denied this reality that the child would fly into rages at night, destroying things around the nursery.
Then she shows a cartoon—a true story—about a mother coming to terms with her young natal boy identifying as a girl. “Now I have a daughter,” the mom says. “A really happy one. I do miss my baby boy. Sometimes I wonder where he is. He is like a dream I had.”
Not everyone who has this experience of gender dysphoria or incongruence during childhood is going to stay transgender, Dr. Olson-Kennedy says. There are lots of males who like dresses and dolls.
The next section is relevant to the lawsuit against Dr. Olson-Kennedy. The plaintiff, Ms. Breen, has asserted that when she first saw Dr. Olson-Kennedy at age 12, she had been concerned about her gender identity for less than six months. And yet in this video, Dr. Olson-Kennedy makes clear that she knows that the DSM—the bible of mental disorders—stipulates that to have a diagnosis of gender dysphoria in childhood, the patient has to have had the outcomes in question for at least six months.
“In some ways, whether people meet these diagnostic criteria in childhood is not super relevant for me as a medical provider,” she says. “Because there are no medical interventions for people not yet in puberty. But there is this definition and there is some issues with it.”
These criteria, Dr. Olson-Kennedy notes, include a:
1. Strong desire to be the other gender.
2. Strong cross-dressing desire. On this point, Dr. Olson-Kennedy expresses profound disdain, saying that the cross-dressing question is different for masculine- and feminine-presenting people, because of the patriarchy and misogyny and our feelings about people who perceived as men wearing women’s clothing. She scoffs at the fact that natal males are referred to as cross-dressers but natal females are not.
3. Strong preference for cross-gender roles in make-believe play or fantasy play. A lot of times kids will tell her about the video-game avatars that they use, through which they explore their questions about their gender. Back in the day, this was about playing house.
4. Strong preference for toys, games or activities of the other gender.
5. Strong preference for playmates of the other gender.
6. For boys, a strong avoidance of typically masculine toys and activities and rough-and-tumble play—which Dr. Olson-Kennedy says is very 50s.
7. Strong dislike of one’s sexual anatomy. Dr. Olson-Kennedy objects, saying, “Your brain is actually the biggest sexual organ in your body.” She says that there are many problems with these diagnostic criteria, but that observing them becomes a necessity to obtain insurance coverage.
8. Strong desire for primary or secondary sex characteristics of the opposite sex.
Gender dysphoria, according to the DSM, must be associated with clinically significant distress or impairment in school or other areas of functioning.
For pre-pubertal children, Dr. Olson-Kennedy says, “these diagnostic criteria are not super useful.”
In later videos, she and her colleagues will express their disapproval of the requirement that the child be distressed to qualify as gender dysphoric and therefore for gender-transition treatment.
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I am an independent journalist, specializing in science and health care coverage. I contribute to The New York Times, The Guardian, NBC Newsand The New York Sun. I have also written for the Washington Post, The Atlantic and The Nation. Follow me on Twitter: @benryanwriter and Bluesky: @benryanwriter.bsky.social. Visit my website: benryan.net
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