This is Part 2 of a multi-part investigative series.
Part 1 investigated the Sexual Minority Youth Assistance League (SMYAL)'s trail of government grants, leading to SMYAL's taxpayer-funded LGBTQ youth program aimed at influencing kids as young as six-years-old to identify as "transgender." This sequel follows the next (un)natural step in childhood "gender-transitioning," providing a raw and intimately close peek under the hood of pediatric "gender care." Meet the physicians who practice it, the parents who willfully sacrifice their children on the altar of gender ideology, and the activists who marshal them there.
WASHINGTON, DC — Pro tip: When medically mutilating your young son, you should consider actually allowing him to undergo puberty beforehand, thereby letting his penis grow to a sufficient length, long enough so that the surgeons have ample material to work with when it's ultimately inverted into a neo-vagina. You see, the surgically constructed cavity ought to be of optimal depth, cavernous for coitus.
Those were the words, in essence, of Dr. Rebecca Wood Persky, a pediatric endocrinologist at Children's National Hospital and the medical director of "Gender Care Services" there.
"Trans girls might have a change in their bottom-surgery option, if they choose to do bottom surgery, from being on puberty blockers," she said, specifically. Of course, by "trans girls," she means biological boys, and "bottom surgery" is a euphemistic expression for genital disfigurement.
Via penile-inversion vaginoplasty, Persky explained nonchalantly, the skin of the penis creates the vaginal canal, and the scrotum, after the testicles are taken out, becomes the labia majora.
"But that requires enough tissue there to make the vagina — to make a vagina with enough depth for sexual intercourse," Persky cautioned.
"And so," she continued, "if kids — or adolescents — are starting on puberty blockers at the very early stages of puberty and really not having penile growth or testicular growth or scrotal growth, then these options change, and you might have to do a more invasive option than the inversion vaginoplasty, which would have some more recovery time or complications. So that's just an important thing to understand when making these decisions about timing and whether or not to start puberty blockers."
Whereas in the case of "transgender boys" (i.e. biological girls) who take puberty-suppressing drugs early on, they may avoid "top surgery," a.k.a. mastectomies, altogether, given there's little to no natural breast development, Persky advised.
"This is something that they really wanted us to be sharing and talking about with families and patients before starting puberty blockers," Persky, citing the conclusions of an American Academy of Pediatrics article that studied the "surgical implications" of pubertal suppression medication, disclosed during her hour-and-a-half lecture.
Listening intently to Persky's medical guidance were parents of "transgender" children, tuning in virtually from various quarters around the DMV area, predominantly D.C. They — and I, joining via the publicly posted link — were attending a workshop on "Gender-Affirming Puberty," presented by the Sexual Minority Youth Assistance League (SMYAL), a federally funded non-profit nestled on the outskirts of Capitol Hill.
Most of the caregivers, gathered over Zoom to learn about "navigating puberty" and exploring "gender-related care approaches," have enrolled their children in Little SMYALs, the organization's LGBTQ after-school program for kids in kindergarten through eighth grade. As Townhall's initial exposé uncovered in disturbing detail, Little SMYALs conditions these children (ages six to 13) to identify as "transgender" — or, at least, induces a state of gender dysphoria — and coaches them through "transitioning" socially. This socialization process, which Little SMYALs ushers along within a matter of weeks, entails adopting a new name, using pronouns of the opposite sex, changing their clothes, cutting or growing out their hair, and even "coming out" in the classroom, all to assume this newfound "gender identity."
And that's how the program's participants (well, their parents, acting on their behalf) ended up here, turning to medical means, either as a way of physically completing such outwardly changes or pausing puberty to give them (the children, ostensibly) time to decide what to do in the interim, that is while their bodies no longer naturally mature.
It was the evening of July 9, and many of the titular Little SMYALs were supposedly "hoping to transition at school this fall." Persky spoke, "talk[ing] all things puberty, through a gender-affirming lens," as part of SMYAL's monthly caregiver conversation series in partnership with Children's National.
Pediatric neuropsychologist Dr. John F. Strang ("flexible" pronouns), the director of the hospital's "Gender and Autism Program," the only gender clinic in the country specializing in special-needs children, was also in attendance that Tuesday. "A strong proponent of autistic Pride," he had held his own SMYAL workshop in April on the "Intersections of Neurodivergence and Gender-Diversity." Strang's springtime session similarly helped parents "plan for the future."
Chiming in, Taryn "Ty" Kitchen ("they/them"), the bearded biological woman who manages the Little SMYALs program and the night's moderator, mentioned that the children's hospital — its "Gender Development Program," in particular — is "a wonderful source of connection for us."
"Children's National has referred so many youth to our programs," Kitchen said. Likewise, the Little SMYALs manager added, "We love sending youth their way for all their gender-development work and all the services that they provide."
"I'm sure that there are some people here whom I have met or I've seen their kids before. So if that's the case, it's nice to see you again," Persky, seated in some sort of examination room, said at the start of the "training" session.
Persky prefaced the PowerPoint presentation with a disclaimer slide stipulating that any recording, photographing, reproducing, or otherwise capturing its contents without prior written consent is prohibited. "Any unauthorized sharing, distribution, or dissemination of the content is a violation of intellectual property rights," the slide read. A logo bearing the official branding of Children's National Hospital remained in the lower-right corner of the screen throughout the rest of Persky's slideshow.
Also at the outset, Persky announced she'll be using the abbreviations AMAB ("assigned male at birth") and AFAB ("assigned female at birth") to refer to biological males and females, respectively. "I'm trying to use neutral, anatomical terms if possible," the medical professional said.
Asked "how to explain puberty to gender-diverse children," Persky pushed "The Every Body Book," her "favorite puberty book for kids." Kitchen, who's licensed to teach elementary education, quickly retrieved a copy of the LGBTQ literature off her bookshelf in the background of the conference call and displayed it proudly for the attendees to see. Persky's recommended reading material, which the physician also keeps at her home office, teaches "Pregnancy isn't just for women" and "Trans men and non-binary people with uteruses can get pregnant too!"
"What I really like about it is that it's very inclusive, has very gender-neutral language, talks about body parts, but is also anatomically correct and doesn't sugar coat things," Persky said. The children's picture book includes absurd illustrations like one of "a pregnant man." Other excerpts claim "Penises...can also belong to people who are transgender girls and women."
As a general overview of sexual maturation, she broke down how puberty presents itself differently in boys and girls, based on "sex assigned at birth," as Persky phrased it. First, she showed a graph chronicling the stages of puberty in girls as they age. "I apologize again for the terms that say 'in girls' [...] I wasn't able to change that," Persky stated matter-of-factly. "This is people assigned female at birth."
On the subsequent slide about pubertal development in boys, again she acted apologetic for leaving the word "boys" in the title card. "Oh, sorry I didn't change this," Persky said. "We're talking about people assigned male at birth. That should say AMAB, not boys."
She showed a similar graph corresponding to male puberty, spanning from age eight to 18. "I think this graph is really helpful when thinking about fertility preservation," such as "saving sperm," Persky said. "People always ask, 'Well, when will that happen? When will my kid be mature enough to produce sperm?' And it's a really tricky thing to say for sure."
She pointed to the line graph plotting pubertal growth over time. 14.5 years is the average age that spermarche, the start of sperm production, typically takes place. "That is a long time especially if you have a child who you're waiting to initiate puberty blockers for sperm preservation," Persky remarked.
Persky caveated the conversation, acknowledging that the drugs discussed are not FDA-approved to treat gender dysphoria. Some puberty-pausing drugs like leuprolide acetate (Lupron Depot) and triptorelin (Triptodur), which lower testosterone levels, are commonly used to chemically castrate sex offenders and treat deviant sexual disorders.
Occasionally, a few kids popped into frame, the stars of the show, serving as a visual reminder of who's on the receiving end of this so-called "care." The children's on-camera cameos prompted Kitchen, a familiar face to them, to tease an upcoming Little SMYALs project. "I will see so many of you on Monday and Tuesday and Wednesday and Thursday and Friday!" at Camp Free2Be, the Little SMYALs manager said. (We were about a week away from the first day of Camp Free2Be, an LGBTQ summer day camp in Arlington, Virginia, designed for "transgender, nonbinary, and gender-diverse youth" ages six to 14.)
Sharing her screen, Persky laid out a "Roadmap" showing a pathway progressing from "Puberty Blockers" to "Gender-Affirming Hormones" and finally arriving at "Gender-Affirming Surgery," though "it does not have to be in this order and you don't have to do all of these things," she clarified.
Puberty blockers are generally administered as injections in the muscle or as implants in the upper arm, buried right under the skin. Persky said they are often used to allow children "time to explore [their] gender identity," contemplate cross-sex hormones, and weigh whether or not "they want to do a full transition." More commonly, though, puberty blockers are taken to prevent "undesired irreversible cisgender secondary sex characteristics" that "don't align with their gender," Persky said.
Persky put an asterisk beside the bullet point on "reversibility" when describing the "benefits" of puberty blockers.
"We don't know everything about all the effects and if they are totally reversible, so I don't actually really like to use that term for them," Persky said. "But when you think about just the effect on puberty, then yes, it's reversible, meaning when you take the medication and puberty stops; if you stop the medication, puberty will come back. So in that respect, it is reversible on your puberty development." Puberty resumes where it left off, Persky reiterated.
She also claimed that puberty blockers pose no "significant" long-term effects on fertility potential. While puberty is being suppressed, the patient will not ovulate or produce sperm. Thus, if the patient stops puberty blockers, fertility is technically restored, Persky said.
"So what are the risks? What would we worry about? Why is there an asterisk?" Persky addressed, after a handful of parents asked about any negative side effects of puberty blockers. Short-term, she mentioned hot flashes, mood changes, headaches, body pains, and the risks associated with the physical procedures. "So infection, abscess, just normal things" with the intramuscular injection and subcutaneous implant, Persky said.
Long-term, puberty blockers decrease bone density development. "So, it's not like your bones are weakening. It sounds scarier sometimes than it is in reality," Persky said. "But it's [bone density] just not increasing as quickly." Data in the field of pediatric endocrinology shows that when puberty is permitted to resume at a typical time, then those kids catch up eventually as adults, Persky said. However, she noted that those subjects were experiencing precocious puberty (sexually maturing too early, before the age of eight). Applying this to the pubescent patients they're "treating" now, e.g. kickstarting puberty at age 14 after pausing the production of hormones for two years, there's not enough long-term data to come to a solid conclusion, Persky acknowledged.
Persky inserted a question mark next to "neurocognitive effects" since sex hormones have activational effects on the human brain. "Also could be neuroprotective if it reduces stress for kids. We don't know but that could equally be true," Strang interjected. Persky then skipped a slide studying its impact on cognitive function. "I don't think this study is very good or adds to our understanding," Persky said.
One parent asked if they should be concerned about special-needs children, who have pre-existing learning disabilities, being on puberty blockers. "I think the short answer is no, not necessarily," Persky said. Strang, weighing in, said, "I think that it's a question that can't be answered because it's just a theoretical question at this point and nobody has studied this."
At another point, Persky pushed an oft-repeated narrative among gender ideologues, one that emotionally blackmails parents into acquiescing by essentially telling them that these services are "life-saving." She cited a 2020 study that surveyed "transgender" adults and asked them which ones had wanted to be on puberty blockers versus who actually took them. The researchers compared these percentages to suicidality rates and concluded that the odds ratio was lower when the puberty blockers were prescribed. "So in conclusion, what this article is arguing is that receiving puberty suppression decreases the risk of suicidal ideation..." Persky said. "I think this one was a pretty big deal."
Piling on, Persky spotlighted a qualitative study out of the Netherlands of only 13 "trans" teens, in which "a majority" said they understood there may be long-term consequences they'd suffer, yet "this is still something they'd choose" despite the dangers. "So that's an important thing to keep in mind when we talk so much about risks," Persky said.
"Puberty blockers I hope I convinced you they aren't super scary, but they're also not risk-free," Persky said towards the end of the webinar. "There's always a risk-benefit ratio, and it seems like the benefits really outweigh it."
Kitchen, noting the number of lingering questions about "legal implications" and insurance coverage, announced that Perky will return for a second session on cross-sex hormones. "Our community is right in that age sweet spot of six- to 14-year-olds," Kitchen said. "A lot" of them are considering puberty blockers while the other half are focused on hormones, she said.
One father, a primary care physician who's certified in family medicine, spoke speculatively about his son, who wants to "start female puberty as soon as possible." The parent asked if Aldactone, a testosterone-blocker, could be a cheaper alternative to puberty blockers, if taken in conjunction with pumping him full of estrogen.
Persky recited a medley of testosterone blockers such as spironolactone, a diuretic used to treat heart failure; bicalutamide, a type of hormone therapy used to treat prostate cancer, though it has led to severe and even fatal liver failure among adults; finasteride, which is prescribed to shrink an enlarged prostate in adult men; and cyproterone acetate, which is not approved for use in the U.S.
Persky listed off other options for blocking hormones like birth control pills to stop menstruation; IUDs, which Children's National can insert in children under sedation; and a Depo-Provera shot (contraceptive injection).
Another parent asked if they'd be "stuck in phase 2 [the second Tanner stage of puberty] for the long haul," to which Persky said they'd then "transition to T" (testosterone), and the short overlap should simultaneously suppress estrogen production. This switch from puberty blockers to hormone replacement "therapy" (HRT) simulates whichever puberty the patient "identifies with."
What if the child "comes off of T," would puberty presume, a third parent pressed. "I guess maybe when someone goes through puberty later in life, that could be a concern as far as psychosocially," Persky said. She showed some hesitance in keeping a child in a puberty-blocked physiological state at an unusual age while his or her peers grow up without them.
Venturing further, Persky wrestled with the idea that kids could simply be confused whilst in the throes of adolescence, that they're pathologizing puberty and, in accordance, seeking to medicate it away. "Is this truly gender-related or is this just a fear of puberty?" Persky alluded to this phenomenon.
During the discussion, Persky did offer non-medical options to "affirm" one's "gender identity" like electrolysis (laser-hair removal) and voice-deepening lessons or vocal feminization training. If a male patient is already post-puberty, Persky said, hormonal medication cannot change a man's pitch at this point or reverse this normal part of puberty. "Unfortunately," the physician said, then caught herself. "Well, I shouldn't say unfortunately."
She additionally recommended cross-dressing devices that could harm the human body, such as chest binders, which girls wear to flatten their breasts. These girdle-like garments can cause bone breakage, bruising, difficulty breathing leading to lung build-up, heat exhaustion, and skin damage. Persky shared some "safety tips" when chest-binding to "avoid skin breakdown and infections." For example, you should be able to fit two fingers beneath the binder, Persky explained. "It's supposed to be compressive, but we don't want it to be so compressive that people are getting rib fractures or having trouble breathing," she said.
"For people with a penis and testicles," Persky said they (boys who want to look like girls) should try "tucking and taping," a technique to hide the appearance of a bulge so it's not conspicuous through tight clothing. According to the wikiHow tutorial Persky shared, to make a smooth "crotch contour," shove your testes back inside the body (into the inguinal canals), wrap your penis with the now-empty scrotum, and tuck the package between your butt cheeks, securing it with tape.
Persky failed to mention the risks of this method, which include urinary tract infections, issues with urine flow, urinary trauma, twisting of or inflammation in the testicles, and cut-off blood circulation. Some studies found that since tucking for prolonged periods can increase the temperature of the testes, heat stress could impair spermatogenesis and cause fertility problems.
"For people who want that bulge," Persky suggested that girls "pack" their pants by padding them with an artificial penis "packer," a penile prosthesis or other phallic object placed in the front of the underwear. Plus, Persky added, there are "stand-to-pee" (STP) devices that allow girls to urinate while standing upright, "which can be affirming for some."
"There's no one right way to transition. There's not one right way to be transgender or express yourself. I see a whole variety..." Persky said. "Some people might really feel like puberty blockers and hormones are very important and crucial to their transition, but that's not true for everyone. And so, I always like to just emphasize that there's not a right path, a wrong path, and it's really individualized based on the patient's needs and family discussion."
Kitchen agreed. "Medical options are not the only options. There are just so many possibilities," she added.
However, Persky's presentation concluded with a "Contact Us" page, providing an entry point for participating parents to get connected with the gender clinic at Children's National Hospital.
"We see patients any age three and up at Children's," Persky said.
"Usually the young, younger kids are seeing our gender development specialists in psychiatry, but I see patients as a pediatric endocrinologist even as young as six or seven who just want to start talking about puberty or their families want to start having these conversations, even though we're not, you know, prescribing medications," Persky said, clarifying that she does have clinical visits with families that don't automatically "end in a prescription." Sometimes, children can see a medical provider for general "counseling," she said.
"There's really not a 'too early' if this is helpful for you. But we do officially accept people into our gender program as early as three," Persky recapitulated.
Persky named points of contact to guide the children on their "gender journey" at Children's National Hospital: Joshua Murphy ("they/them"), the program coordinator for "Gender Care Services" within the Division of Adolescent and Young Adult Medicine, and Shane Henise ("he/him"), the "transgender" program manager.
"Shane is amazing," one of the parents remarked. Adding on, Kitchen said, "I know lots of our families have worked with your team, and I just hear positive feedback all the time." Strang, reciprocating, said: "Thanks to Ty and amazing SMYAL!"
Kitchen praised Persky for her deep dive into puberty blockers. "But I definitely encourage you all to connect directly with Children's as well," Kitchen urged.
So I dialed the direct line Persky provided and reached Murphy, saying I was the parent of a 10-year-old "trans" child who had attended the SMYAL workshop. On a 20-minute patient navigation consultation call, Murphy said, "This is the best possible thing that you can do. I have nothing but admiration for parents who call us and seek out care for their children, especially so early in their journey! It's never too early to have a conversation. It's never too early to learn your options."
"Children are always the expert when it comes to their gender," Murphy, formerly a substitute middle school teacher at D.C. Public Schools, said.
The hospital staffer subsequently asked if my "trans son" had her first period yet. "Has he begun to menstruate?" Murphy asked.
Afterward, Murphy instructed me to complete an intake form for the endocrinology clinic, which currently has a two- to four-week wait for new patient appointments.
Over email, Murphy forwarded the hospital's handouts on puberty blockers and testosterone treatment. Similar to Persky's top-secret presentation, a "Confidentiality Notice" was attached to the message, saying that any unauthorized use, disclosure, or distribution of the attachments potentially containing "privileged information" is prohibited.
The documents on taking testosterone said some bodily changes are irreversible like growth of the clitoris and hair loss, such as male-pattern baldness, which cannot regrow. Testosterone can increase a patient's risk of heart disease and diabetes, the paperwork noted, as well as ramp up the amount of red blood cells and hemoglobin, the protein that carries oxygen to the organs. If the latter levels are too elevated, it raises the risk of blood clots and strokes.
"A lot of patients believe, 'I'm gonna start taking shots of testosterone and I'm gonna feel affirmed physically in my gender!' But, really, it takes months, if not years, to see changes physically in your body when you begin hormone replacement therapy," Murphy said of managing expectations.
During the virtual meeting, Murphy confirmed that Children's National performs hysterectomies through the gynecology unit.
The gynecology program's since-scrubbed website used to list "gender-affirming hysterectomy," which surgically removes the uterus, under its menu of surgical offerings. When I asked in a follow-up email if the hospital has a hysterectomy handout, Murphy replied, "I apologize for any misunderstanding; the hospital does not have any handouts about hysterectomies or top surgeries (as they are not performed at Children's National Hospital). As I mentioned in our phone call, please speak to your Endocrinology provider regarding those options who can recommend speaking to our Gynecology clinic regarding those options."
"However, we are going to keep a finger on the pulse about [legislative] changes that are developing," Murphy said on the phone. "The White House has stated that they always look to providers, patients, and families as experts in their care."
Chaya Raichik of Libs of TikTok caught Children's National admitting in an audio recording that a 16-year-old would be eligible for a hysterectomy at the gender clinic. A hospital spokesperson told friendly media that none of the telephone workers Raichik spoke to deliver "care" directly, declaring categorically: "We do not and have never performed gender-affirming hysterectomies for anyone under the age of 18."
In 2022, the year of Raichik's viral video, Townhall had inquired with the gender clinic at Children's National about whether they "treat" children without parental consent or prior knowledge. "I reached out to our team to see what their recommendations are," Henise said, handling the case of a 13-year-old "trans" child seeking services by herself. "Since you are not already an established patient, it gets a little tricky with getting you registered without a parent contact. We're brainstorming on our end and I'll get back to you as soon as we have a plan."
After consulting with the "gender development" team, Henise said they have "some options for moving forward."
In the past five years, Children's Hospital has only had two kids who decided to de-transition. "We're establishing this network to support those two patients," Murphy said. The majority of their patients, though, are 10- or 11-year-olds starting puberty blockers, Murphy said.
Children's National is ranked No. 5 nationally, named on U.S. News & World Report's Best Children's Hospitals Honor Roll for the seventh straight year. Its endocrinology department, where Persky's employed, is No. 7 in the nation.
At the time of publication, Children's National has acknowledged but not responded to Townhall's request for comment. Hours after Part 1 was published, previewing Part 2, SMYAL deleted their Facebook posts advertising the workshops with Persky and Strang. Camp Free2Be also expunged its webpages.
Tune in tomorrow, Wednesday, August 7, for the third and final installment of Townhall's investigation as we turn our attention to a SMYAL-tied, federally funded clinical study actively recruiting "trans" children for the apparent purpose of influencing public policy on pediatric "transgender healthcare."
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