Clementine Breen’s Journey
Clementine Breen faced a life-altering path at just 14 when she underwent a double mastectomy. She began taking puberty blockers at 12, feeling uneasy about the changes in her body and questioning her gender identity.
By 13, with assistance from the Trans Youth Health Development Center at Children’s Hospital Los Angeles, she started testosterone treatments to physically transition to male. The mastectomy at 14 seemed like a necessary next step on her journey, a journey she embarked on before truly understanding the implications or long-term consequences.
At 18, after receiving therapy for past sexual abuse, she decided to detransition back to her biological sex. Yet, seeking help for her detransition was met with skepticism rather than compassion. Consultations for breast reconstruction were tainted with questions about her mental health—questions she hadn’t faced when she requested her mastectomy at 14. In fact, one doctor severed ties with her upon learning of her return.
Now, Breen grapples with health issues stemming from her earlier medical interventions. She experiences irregular menstrual cycles, intense cramps, hormonal imbalances, breast pain during menstruation, and vaginal atrophy that requires estrogen therapy. One gynecologist noted the absence of a standard care plan for someone with her medical background.
Her experience isn’t an isolated one; many children have been subjected to similar medical decisions, believing they would find relief from their struggles. Instead, they were left to deal with the consequences of their medicalized treatment alone.
As healthcare professionals, we can’t reflect on Breen’s story without recalling our initial commitment to do no harm. This principle is supposed to inform all treatment decisions, especially for patients who are still too young to grasp the complexity of their choices.
However, failing to prioritize a patient’s well-being goes beyond mere influence or pressure.
A recent report from the Department of Health and Human Services’ Office of the Assistant Secretary for Health, titled “Wolves in White Coats: How Doctors and Hospitals Promoted and Profited from the ‘Gendered Medicine’ Fraud,” suggests a troubling trend. It reveals how medical professionals financially benefited from procedures involving vulnerable children, placing them on a lifelong trajectory of medical dependence.
This issue wasn’t confined to a handful of perpetrators. The report highlights various clinics within major medical centers and children’s hospitals across multiple states participating in programs like Medicaid and Medicare.
The economic incentives for doctors and medical institutions were substantial. For instance, a single mastectomy can yield over $12,000 for an insurance provider, while more complex surgeries can exceed $100,000, including associated follow-up care.
Since 2019, nearly $120 million in claims have been submitted for surgeries, puberty blockers, and hormonal treatments for minors, according to a tracking service for such claims.
Some institutions, notably Mount Sinai Medical Center in New York and Boston Children’s Hospital, have reportedly profited significantly, billing more than $8 million and $6.5 million respectively for these procedures from 2019 to 2023.
Moreover, evidence suggests insurance companies frequently diagnosed minors with conditions they did not have, enabling them to secure coverage for surgeries and therapies that would typically be denied.
Claims made to insurers for puberty blockers prescribed to children aged 9 to 17, with diagnoses of endocrine disorders, totaled nearly $50 million from 2015 to 2025. One notable analysis found a 30% increase in such diagnoses among minors from 2020 to 2022.
The discrepancies became apparent in instances of precocious puberty, where insurers, including Medicaid and Medicare, billed nearly $11 million for drugs prescribed to patients between the ages of 13 and 17 despite definitions stating that no one over 13 can develop this condition. Such findings suggest potential civil and criminal liabilities for the involved providers.
These troubling practices continued unchallenged until President Joe Biden, shortly after taking office in 2021, signed an executive order to combat discrimination based on “gender identity,” pushing federal agencies to align with this stance.
The Health Department followed suit, indicating a refusal by medical professionals to provide gender-affirming procedures would be deemed illegal sex discrimination.
This pressure was echoed by medical organizations like the World Professional Association for Transgender Health, which, lacking solid scientific backing, established guidelines that risked casting doubt on physicians seeking to exercise caution for fear of professional backlash.
As healthcare providers, our commitment should prioritize the patient’s well-being, not simply alignment with prevailing political views. It’s time to assess the extent of the trust that has been compromised within our profession and to hold responsible parties accountable.
Clementine Breen might not regain her original self, but countless children before her deserve a healthcare system that prioritizes their health and safety over profit and ideology. To initiate real change, we must honestly confront past actions and begin the process of rebuilding trust—starting now.
