A Gender Doctor’s Descent Into Medical Extremism

I almost joined Johanna Olson-Kennedy’s team of gender doctors. I’m glad I didn’t.

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About the Author

Dr. Erica Li is a pediatrician in Washington State. She went to medical school at UC Davis and trained in general pediatrics in Los Angeles. She currently teaches medical students from three medical schools and interns from four residency programs. Certified in Pediatric Hospital Medicine by the American Board of Pediatrics, Dr. Li is a subspecialist who identifies as a generalist. She is passionate about helping trainees approach clinical problems by mapping out a chain of cause-and-effect, such that each node in the chain can be examined as a potential opportunity to interrupt pathology. 

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Reading my recent article, “A Pediatrician’s Manifesto for the Modernization of Gender Medicine,” some might assume that I’ve always been skeptical of the Gender Ideology movement. This isn’t the case. In 2014, as a senior pediatrics resident in Los Angeles, I had the opportunity to attend a grand round talk on gender medicine presented by Dr. Johanna Olson (now Olson-Kennedy). For those unfamiliar, a grand round is a lecture presented to a medical department, focusing on a subject where the speaker holds expertise. Concluding her talk, Dr. Olson mentioned that those interested in her field could shadow her at her clinic.

At that point, still uncertain about my career path, I decided to take her up on that offer. I spent four hours at CHLA’s gender clinic, contemplating a potential career in pediatric gender medicine.

From the discourse on X (formerly Twitter), one might form the impression that Dr. Olson-Kennedy is ideologically possessed and insistent on harming children through hormones and surgery. However, meeting her in person dispelled that notion. She was charismatic and personable. I was instantly drawn to her confidence, poise, and persuasive manner.

In her grand round presentation, she shared the story of a pre-pubescent male child who identified as a girl. This child had been prescribed multiple psychoactive medications to manage psychiatric and behavioral problems. Unfortunately, these medications’ side effects began damaging organs and led to severe metabolic disease. He also had a tic disorder, learning difficulties, and anxiety that were difficult to manage. The most compelling part of Dr. Olson’s presentation was her revelation that, upon social affirmation of the child’s cross-sex gender identity, it became possible to gradually discontinue the medications. Over the course of several months, the patient was able to stop taking most of the medications that were causing iatrogenic harm. His mood improved dramatically, and he appeared to thrive. Dr. Olson emphasized that by validating the child’s cross-sex gender identity, she was able to circumvent the dangers of polypharmacy, improving his quality of life and overall function.

Another point that Dr. Olson made was that at the time, in 2014, there was no perceived social benefit to coming out as trans. She effectively explained the “handicap principle,” also known as Zahavian signaling, often encapsulated in the adage, “a costly signal must be honest.” For instance, to test Abraham’s loyalty, God asked him to sacrifice his only son. Dr. Olson posited that if someone is willing to risk social ostracization, parental rejection, and increased exposure to violence to live as their authentic self, they must be honest. Therefore, we must honor and support them. This perspective on the Zahavian signal deeply resonated with me.

In her presentation in 2014, Dr. Olson emphasized that no surgeries were offered to minors under 18. She said that the standard treatment for children at the time was to start out with careful and intensive psychotherapy used in conjunction with social affirmation. While puberty suppression and cross-sex hormones were available to pubertal adolescents, surgeries, she said, were reserved for adults.

A few months later, I reached out to Dr. Olson to express my interest in her field, and she graciously invited me to shadow her for an afternoon in her gender clinic at in CHLA. The first patient I met was a 17-year-old male who identified as a young woman. He had been undergoing hormone treatment and presented as unambiguously feminine. He was impressively mature and well-informed. He was excited about becoming an adult soon to be eligible for genital surgery. The patient was very happy with the care Dr. Olson had been providing, and giddy at the prospect of vaginoplasty. He said he wanted a vagina that that resembled a “rosebud.” Throughout the consultation, Dr. Olson treated the patient with respect and empathy, inquiring about sexual orientation and acknowledging the challenges transgender individuals often face in the dating world, irrespective of their attraction to men or women.

After the patient left, Dr. Olson expressed her concerns to me. She thought the patient had unrealistic expectations about the outcome of vaginoplasty and planned to manage those expectations in follow-up. However, she was pleased that the cross-sex hormone therapy was helpful. “If you’re a girl,” she remarked, “your brain would feel better if you’re getting estrogen.” In private, she seemed to truly believe that the brain is the primary sex-determining organ, and that transgender patients’ brains are biologically destined to function better in the presence of cross-sex hormones. The evidentiary basis of this belief, as Colin Wright has repeatedly explained, is extremely flimsy. 

The next patients we saw together were less mature and self-assured than the first. Most were females approaching puberty who recently began identifying as boys. On further interview, it was clear they had other psychiatric issues unrelated to gender. Dr. Olson acknowledged this candidly, noting that managing co-morbidities alongside gender dysphoria is a routine aspect of her work. Spending time with her in the clinic allowed me to witness how desperate and entangled the social and psychiatric conditions of her patients can be, and how tempting it is to look for an easier way out. 

I left the CHLA gender clinic with a favorable impression. Dr. Olson seemed to provide a service to a population that, at the time, had limited access to compassionate care. She treated her patients with understanding, while also appearing realistic about co-morbidities and prognosis. I knew that she was right about two things—we should always attempt to reduce iatrogenic harm from psychiatric polypharmacy, and we should heed Zahavian signaling. For me, the prospect of using new hormonal and surgical technologies to improve lives seemed very attractive and elegant. I had briefly been a patient at a reproductive endocrinology clinic, and experienced firsthand how the careful control of hormones can produce almost miraculous and desired effects. Working with a vulnerable population and doing something unique appealed to me. 

Fortunately (in retrospect) for me, the clinic was not expanding at that time, so there was no job opportunity for me. After about a week, I decided to move on and pursue my original plan of becoming a general pediatrician. 

Over the next few years, I centered my intellectual growth on the core principles of liberty, truth, and the necessity of grounding important beliefs in high-quality evidence. My current gender-critical stance is not rooted in any a priori opposition to medical sex-trait modification. In fact, I was open to practicing it in 2015 and would still support it today if robust clinical and scientific evidence demonstrated its overwhelming benefits. While I don’t support the inclusion of males in women’s sports and changing rooms, I don’t have any issue with adults choosing to present and live in a manner that aligns more with what’s more typical of the opposite sex, if it enhances their well-being without imposing a serious cost on other people. For me, an indicator of this “enhanced well-being” would be a substantial reduction in patients’ obsession with their sex traits, allowing them to draw more of their identity from their abilities, values, experiences, and relationships.

I now think back about Dr. Olson emphasizing the prevention of iatrogenic harm from psychiatric medications as a major motivation behind her work. What a tragic, ironic twist. Now, Dr. Olson-Kennedy nonchalantly speaks about teenage girls being able to consent to having their healthy breasts removed, and that if they later came to regret such a permanent decision, they could just get breast implants. Her charismatic personality and gift for persuasion hasn’t changed, but I find her increasing mental gymnastics chilling and macabre. She has also married an avowed Critical Theorist named Aydin Olson-Kennedy, a female person who identifies as a man, whose praxis is in social work. Describing clinical partnership with Johanna, Aydin Olson-Kennedy writes “I am an anti-racist, anti-oppressive clinical social worker. I address intersectionality, systems of power, and privilege in my work with clients.” This quote clearly illustrates what I have previously written in Manifesto: contemporary gender medicine is fully in the realm of postmodern praxis and is as far removed from reality-based modern medicine as witch-burning. 

I am also re-thinking Dr. Olson-Kennedy’s invocation of the Zahavian signal. Given that gender ideology is essentially an anti-reality cult ideology, the costly signal of committing to dramatically and permanently alter one’s body through puberty suppression, cross-sex hormones, and surgery may be a type of initiation ritual—a large, non-refundable deposit used to signal loyalty. While social transition already makes it very difficult for a teen who would otherwise desist to succeed in desistance, drastic medical interventions make it impossible for one to detransition unscathed and return to a pre-transition state of health.

The time I spent with Dr. Olson-Kennedy helped me view pediatric gender medicine doctors with more nuance and humanity. Doctors like Johanna Olson-Kennedy, Jack Turban, and Jason Rafferty do not have horns and tails. Like avowed martyrdom-seeking jihadi who have written poetry about brotherhood, art, and living in the desert, they are human. I believe that unlike them, I’m simply fortunate not to have my empathy and capacity to reason parasitized by a pernicious ideology disguised as righteousness. I do believe that doctors who have zealously advocated for invasive treatments that caused widespread iatrogenic harm, like jihadi who have decided to maim children in order to martyr them and save their souls from a sinful world, must be held fully accountable and made to confront the enormity of their actions. However, I do not have the luxury of feeling smug about it. 

I’d like to end on a hopeful note. As a fledgling doctor uncertain about my career path, I was invited to join the gender ideology cult by a charismatic recruiter with a message about victimhood and a gift for invoking moral sympathy. But ultimately, my commitment to truth and responsibility steered me away from practicing non-evidence-based, postmodern gender medicine. It’s vital that these values be relentlessly championed in medical education to avoid repeating such grave and avoidable horrors.

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