Irreversible Damage: The Transgender Craze Seducing Our Daughters [Book Review]

According to her mother, Lucy had always been a “girly girl”. She loved frilly dresses, her Beanie Babies, and an array of little critters she tended to. Her favorite movies were Disney Princess movies, and later the Twilight saga.

Lucy was bright, with advanced reading skills and early artistic promise, but as she reached middle school, her anxiety spiked. Her parents took her to psychiatrists and therapists for treatment and medication, but no amount of therapy or drugs leveled her social obstacles or got her into the female cliques that didn’t want her.

Lucy’s older sister fell into a drug addiction which consumed much of her parents’ attention. Lucy’s ups and downs eventually resolved in a bipolar II diagnosis.

Upon graduating, Lucy began studying at a Liberal Arts college in the Northeast. When her anxiety flared up later in the semester, she decided, with several of her friends, that their angst had a cause: “gender dysphoria.”

Within a year Lucy had begun a course of testosterone, shaved her head, started wearing boys’ clothes, and took on a new name. The next step was “top surgery,” a euphemism for a voluntary double mastectomy.1

Lucy’s is just one of many stories author Abigail Shrier tells in her book Irreversible Damage: The Transgender Craze Seducing Our Daughters. Although not a Christian book, Shrier analyzes a problem facing a segment of our population Across My Heart Ministries cares deeply about: teenage girls. In her book, she unpacks the gender identity crisis seizing today’s adolescent girls like a viral contagion. For this reason, I read the book, and I am so glad I did!

Irreversible Damage Book Review


Gender dysphoria, characterized by a severe and persistent discomfort in one’s biological sex,2 historically begins in early childhood, with nearly 70 percent of childhood gender dysphoria resolving.3 In recent years however, the demographics of those affected by gender dysphoria has seen a dramatic shift from predominately pre-school aged boys to now predominately adolescent girls.4 This striking change in the affected is made even more alarming by the fact that before 2012, there was no scientific literature on 11-21 year old girls ever developing gender dysphoria. Scientists weren’t studying it because it just wasn’t a thing. 

So what’s the deal? One public health researcher, Dr. Lisa Littman, has given this unique form of gender dysphoria its own name, “Rapid-Onset Gender Dysphoria”, with the primary propagation being peer contagion.

Just like any contagion, it’s spreading fast.

According to the latest edition of the Diagnostic and Statistical Manual (DSM-5) the expected incidence of gender dysphoria amongst females is .002-.003 percent. Lower than the .005-.014 percent expected for males.5 This means we should see less than 1 in 10,000 people experiencing gender dysphoria. However, in recent years the prevalence in the U.S. has escalated by over 1,000 percent6 with 2 percent of students in some large, urban high schools identifying as transgender.7 And, it’s not only happening in the United States. In 2018, the UK reported a 4,400 percent rise over the previous decade in teenage girls seeking gender treatments.8

So what are some factors that put a girl at higher risk of developing Rapid-Onset Gender Dysphoria? Abigail Shrier analyzes many, but the prominent ones include:

  1. Mental Distress: Social anxiety, history of self-harm, or a previously diagnosed (or undiagnosed) mental illness. At alarmingly high rates, more and more teens are being diagnosed with depression and anxiety or participating in self-harm9.
  2. Social Media: Specifically, prolonged periods of exposure. The fact that deteriorating mental health of teens coincides directly with increased social media is a noteworthy correlation. Offering up false realities of glamorous, curated lifestyles, while also romanticizing mental illness and self-harm, social media reminds teenage girls of all the ways they fall short of perfection while simultaneously creating a toxic environment that celebrates certain faults. And, mental illness has indeed become a powerful online identity. Posting one’s vulnerable personal experience with anxiety, eating disorders, gender confusion, etc. can cultivate tons of popularity.10 It shouldn’t be a surprise then that 65% of adolescent girls come out as transgender after prolonged social media use.11 
  3. Peer Contagion: Gender dysphoria is something that has historically manifested itself in isolation but is now showing up in groups of teenage girls with the prevalence in some friend groups more than 70x the expected rate.12 In addition to friend groups, the peer contagion can propagate through online communities as well.
  4. Anime: Anime itself is not automatically a trigger, but many of the online sites where people post their content (like DeviantArt) are places where gender ideology is rampant, particularly transgender ideology and influence. 13
  5. Porn: With 13 percent of sexually active girls ages 14 to 17 reporting having experienced a violent sexual act14, violent porn is turning girls off to desiring sexual encounters with men. And, potentially contributing to young women deciding they don’t want to be women.  

So how is it that girls suffering from Rapid Onset Gender Dysphoria seem to be falling between the cracks? How is this trend amongst teenage girls not national news? Why aren’t psychologist and psychiatrists digging into this phenomenon and helping these girls? I will say, some are, and they are featured in Shrier’s book. But, rather than receiving praise for trying to solve the mysteries behind this atypical gender dysphoria, many are making headlines as transphobic and getting cancelled. In fact culture is embracing a radical gender ideology that will sacrifice these girls’ gender identities to appease the transgender agenda, rather than help them.


The unsettling reality is, the two common places these girls would turn to for help, schools and mental health professionals, are often complicit in the girls’ identity crisis.

Schools in New York, New Jersey, Colorado, Illinois, Northern Virginia, and Oregon will change a student’s name, use their preferred pronouns, allow them to use preferred sex facilities, bunk with their preferred sex on class trips, and even help them obtain cross-sex hormones all without ever notifying parents. Many progressive schools see it as their responsibility to affirm transgender students and protect them from any harassment they may receive at home. In addition, these “gender inclusive” schools integrate gender ideology into their education k-12. And, rather than receive training from healthcare professionals and/or mental health professionals on how to handle these topics, administrators and teachers are coached by activists.

If that is disappointing, consider what is occurring in mental healthcare. Many mental health professionals have replaced an extremely effective form of therapy known as “watchful waiting” for the “affirmative care” model. The primary difference between “watchful waiting” and “affirmative care” is how the professional treats the patient on the basis of the patient’s self-diagnosed “gender dysphoria”. In “watchful waiting” the patient’s self-diagnosis is taken into consideration while looking for other underlying mental health issues BEFORE recommending the patient take social or medical steps to gender transition. In “affirmative-care” the patient’s self-diagnosis is affirmed, and the professional helps the patient figure out how to best alleviate their “gender dysphoria” (new name, pronouns, hormones, surgery, etc.). Additionally they will work on other mental health issues.

The affirmative-care model is troubling. You cannot go to any other medical professional and have them affirm your self-diagnosis BEFORE they run tests or take a look at you to confirm it, yet this has become the primary method of treating “gender dysphoria”.

In defense of many mental health professionals, there are a few things that make watchful-waiting more challenging, and in some cases possibly illegal, to practice. Affirmative-care is now the standard for treating patients who self-identify as “transgender” or self-diagnose as “gender dysphoric” and has been adopted by the American Medical Association, the American College of Physicians, the American Academy of Pediatrics, the American Psychological Association, and the Pediatric Endocrine Society. For mental health professionals that rely on the expertise of these organizations to inform the treatment for their patients, it is disappointing that these national organizations are kowtowing to identity politics and the transgender activists vs. science and best care practices.

In addition, in 20 states (New Jersey, California, Oregon, Illinois, Vermont, New Mexico, Connecticut, Rhode Island, Nevada, Washington, Hawaii, Delaware, Maryland, New Hampshire, New York, Massachusetts, Colorado, Maine, Utah, Virginia) and many counties in other states (usually counties with large urban centers) watchful-waiting could be considered illegal, since it is sometimes viewed as a form of conversion therapy, and converstion therarpy is illegal in those 20 states. Historically conversion therapy was a method used to “cure” someone of their same-sex attraction. It was often psychologically and/or physically grueling, with some methods being straight up unethical. In addition, it had little to no success in changing a person’s sexual orientation. Today, conversion therapy has expanded to include gender identity. Even though watchful-waiting does not necessarily seek to correct a person’s gender dysphoria, but rather determine whether it is truly gender dysphoria or something else, transgender activists still see this as a form of conversion therapy. If a mental health professional in one of these states uses the watchful-waiting model they could possibly find themselves in court.

Perhaps the most disturbing advice I read in the book was given to parents by gender therapists. In an attempt to keep gender dysphoric children from experiencing the trauma of the wrong puberty, the gender therapists recommend pausing puberty with the use of puberty blockers. They claim this will give the child time to sort out whether the gender dysphoria is real or just a phase. What they don’t tell parents is that in children studied who went on puberty blockers 100 percent of them proceeded to cross-sex hormones15. Lupron is the most common puberty blocker prescribed. Although an FDA approved drug, formerly used to treat prostate cancer, chemically castrate sex offenders, and halt early onset puberty, it has not been approved by the FDA for use to halt normal puberty. Finally, when a child goes from puberty blockers to cross-sex hormones, they are sterilized. The gametes (egg or sperm) never fully developed due to their stunted puberty.16 If this strikes you as devastating, that’s because it is! The fact doctors can administer medications to physically healthy children that will sterilize them, all on the basis of a condition that resolves in 70% of children affected by it 3 is unethical. 


The most important lesson I learned in this book is this: Parents are their child’s gatekeeper. They need to keep close tabs on what their teens are looking at on the internet. Monitor their social media use and consumption. Call the school. Find out what they teach about gender identity and what their policies are on keeping information about transgender students from their parents. If a child sees a mental health professional, parents need to make sure they know what models of therapy are being used. Research any medication a healthcare professional recommends. Know who their daughter’s friends are and if any of them are having a gender identity crisis. They must be diligent. And, most importantly they must combat the lies of this world by making sure God’s Truth is being taught in the home. 

“You shall teach them diligently to your children, and shall talk of them when you sit in your house, and when you walk by the way, and when you lie down, and when you rise.” Deuteronomy 6:7

In conclusion, I would recommend reading this book if you are a parent of a teen or will be, or if you work with teens. I wouldn’t recommend this book for teens without first being screened by a parent as it does contain mature content. As a Christian, you won’t walk away with any theological insight into how to handle transgenderism, but you will have some tools to help you understand and respond to rapid onset gender dysphoria, as well as a general understanding of other transgender issues.

At the end of the book, Shrier gives an update on Lucy and the other girls. Some have abandoned their transgender lifestyles, some have alienated their families, some fall somewhere between those two extremes, nonetheless, not any of the families emerge without some scars. 

After three months on testosterone, Lucy quit. It had altered her voice for good, but it made her feel horrible enough to want to be done with it. Since dropping out of school to pursue life as a “trans man” and living with a biologically female “boyfriend,” she has broken off that relationship, gone back to school, and no longer identifies as a “trans man.” Her interactions with her parents are less combative than when she was pursing her trans life, as long as they avoid discussing gender with her. She is still a member of a “queer” community on campus. For now, her parents hope she will keep her grades up and refrain from trying to transition again.17

If this topic is important to you, keep an eye out for future blogs as I work my way through Preston Sprinkle’s new book Embodied: Transgender Identities, the Church, and What the Bible Has to Say.

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1. Shrier, Abigail. “Irreversible Damage: the Transgender Craze Seducing Our Daughters.” Irreversible Damage: The Transgender Craze Seducing Our Daughters, Regnery Publishing, 2020, pp. xvii-xviii.

2. Diagnostic and Statistical Manuel of Mental Disorders, 4th Edition, text revision (DSM-IV-TR) (Washington, D.C.: American Psychiatric Association, 2000), 579.

3. Kenneth J. Zucker, “the Myth of Persistence: Response to ‘A Critical Commentary on Follow-UP Studies and ‘Desistance’ Theories about Transgender and Gender Non-Conforming Children’ by Temple Newhoook et al. (2018),” International Journal of Transgenderism (May 2018); See also J. Ristori and T.D. Steensma, “Gender Dysphoria in Childhood,” International Review of Social Psychiatry 28, no. 1 (2016): 13-20.

4. Nastasja M de Graaf et al., “Sex Ratio in Children and Adolescents Referred to the Gender Identity Development Service in the UK”; “Referrals to GIDS, 2014-15 to 2018-19,” Gender Identity Development Service, June 25, 2019,; Madison Aitken et al., “Evidence for an Altered Sex Ratio Clinic-Referred Adolescents with Gender Dysphoria,” Journal of Sexual Medicine 12, no. 3 (January 2015), 756-63.

5. Diagnostic and Statistical Manuel of Mental Disorders, 5th ed., (Washington, D.C.: American Psychiatric Association, 2013).

6. M. Goodman and R.Nash, Examining Health Outcomes for People Who Are Transgender (Washington, D.C.: Patient-Centered Outcomes Research Institute, 2019),

7. Michelle M. Johns et al., “Transgender Identity and Experiences of Violence Victimization, Substance Use, Suicide Risk, and Sexual Risk Behaviors among High School Students – 19 States and Large Urban School Districts, 2017,” Morbidity and Mortality Weekly Report 68, no 3(January 25, 2019): 67-71,

8. Gordan Rayner, “Minister Orders Inquiry into 4,000 Percent Rise in Children Wanting to Change Sex,” The Telegraph, September 16, 2018,

9. JRE Clips, “Joe Rogan & Jonathan Haidt – Social Media Is Giving Kids Anxiety,” YouTube, January 7, 2019,; See also Greg Lukianoff and Jonathan Haidt, The Coddling of the American Mind: How Good Intentions and Bad Ideas Are Setting Up a Generation for Failure (New York, NY: Penguin Press, 2018), 160-61.

10. Helena, “How Mental Illness Becomes Identity: Tumblr, a Callout Post, Part 2,” 4thWaveNow, March 20, 2019,

11. L. Littman, “Parent Reports of Adolescents and Young Adults Perceived to Show Signs of Rapid Onset of Gender Dysphoria,” PLoS ONE, no. 3 (August 16, 2018),

12. Littman, “Parent Reports of Adolescents and Young Adults,” 17. (“The expected prevalence of transgender young adult individuals is 0.7%” [This, according to a 2016 estimate]. “Yet more than a third of the friendship groups described in this study had 50% or more AYAs [adolescent and young adults] in the group becoming transgender-identified in a similar time frame, a localized increase to more than 70 times expected prevalence rate.”]

13. “Why Is DevianArt So in Favour of the Transgender Community?” DevianArt Forum, November 26, 2016,

14. Olga Khazan, “The Startling Rise of Choking during Sex,” The Atlantic, June 24, 2019,

15. A. L. de Vries et al., “Puberty Suppression in Adolescents with Gender Identity Disorder: A Prospective Follow-Up Study,” Journal of Sexual Medicine 8, no. 8 (August 2011): 2276-83,

16. Brandon Showalter, “Puberty Blockers and Cross-Sex Hormones Do Sterilize Children, Hospital Consent Docs Show,” The Christian Post, August 19, 2020,

17. Shrier, Abigail. “Irreversible Damage: the Transgender Craze Seducing Our Daughters.” Irreversible Damage: The Transgender Craze Seducing Our Daughters, Regnery Publishing, 2020, pp. 223-224.                    

One thought on “Irreversible Damage: The Transgender Craze Seducing Our Daughters [Book Review]

  1. Thank you for this very well written review. It’s heartbreaking, but necessary to know about.

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