Ted Hudacko’s fate was sealed when his son’s court-appointed counsel, Daniel Harkins, wrote in his notes, “[t]hese parents have a choice, they can either continue to believe that they should be in total control of their child’s life or they can come to an understanding that those days are past . . . and give their children some independence and the ability to make some of their own decisions.”

The decisions in question? Whether to start Hudacko’s trans-identified 16-year-old son on a puberty-blocker regimen, followed by a course of estrogen.

As Abigail Shrier recounted in a 2022 City Journal investigative report, shortly after returning from a trip to New York with their two sons, Hudacko’s wife, Christine, told him that she wanted a divorce—and that their oldest son identified as transgender. During divorce proceedings, the presiding judge, Joni Hiramoto, granted Hudacko shared legal and physical custody of his youngest, but stripped him of all custody of his trans-identified son. Hudacko was concerned about administering experimental drugs and preferred to wait and see if his son’s gender issues might resolve on their own, as usually happens in such cases. To the California judge, this confirmed his unfitness as a father.

Hiramoto’s view is shared by a growing social movement bent on deeming parents “abusive” for declining to “affirm” their child’s “gender identity.” The idea that failing to endorse a child’s identity constitutes psychological abuse has spread across major American institutions and power centers and is reflected in recent court precedent, school “social transition” policies, journal publications, and several proposed state laws. Illinois’s House Bill 4876, for example, would redefine child abuse to include denying minors “necessary medical . . . gender-affirming services,” meaning parents who take a more cautious approach to their child’s dysphoria—an approach endorsed by a growing number of European countries—could become targets of investigation by the Illinois Department of Children and Families, with some even losing custody.

The Biden administration is seeking to entrench this redefinition of “abuse” with its recently published foster-care regulations. Guided by misleading characterizations and omissions of existing research, the new rules from the Administration for Children and Families (ACF) enshrine activist talking points about what constitutes a child’s “best interest,” with dire implications for foster children and parents alike.

Under the new rules, state agencies must follow specific protocols when placing “LGBTQI+” foster children in residential settings. Given what the ACF describes as the “specific needs” of these children, the agency requires federally funded providers to qualify as “Designated Placements” to serve such youth. To obtain this designation, providers must undergo specialized gender-identity and sexual-orientation training, facilitate access to “age- or developmentally appropriate resources, services, and activities that support the [child’s] health and well-being,” and “commit to establishing an environment that supports the child’s LGBTQI+ status or identity.” State foster agencies, to get federal funds, must develop and submit to the ACF case plans that ensure each child is placed in the most “appropriate setting available.”

Repeating popular activist talking points, the ACF claims that refusing to use a child’s chosen name and pronouns is linked with poor mental-health outcomes. The agency then follows a familiar pattern of citing self-reported survey data to show a supposed connection between “gender affirmation” and positive mental-health outcomes in trans-identifying kids. Surveys of this kind, however, cannot support the ACF’s conclusion that “significant mental health disparities” facing “LGBTQI+” youth “result from experiences of stigma and discrimination.”

One of the ACF’s sources, a research brief from the Trevor Project, claims that “LGBTQ youth” who say they have been in foster care had nearly three times greater odds than non-foster youth of reporting a past-year suicide attempt (notably, the final rules incorrectly cite the wrong Trevor Project survey for this claim instead of the correct survey cited in the proposed rules). The agency’s purpose in citing this study is to imply that youth suicidality is driven by how foster parents deal with the “gender identity” of those in their care. But the correlation has an alternative explanation: Youth who enter the foster system have more adverse childhood experiences (ACEs) than do non-foster children, a fact linked to increased suicidality. It’s possible that foster youth with more ACEs and higher suicidality are also more likely to adopt a transgender identity as a maladaptive coping mechanism. This makes sense, given the weakness of the “minority stress” hypothesis and the mounting evidence of elevated rates of co-occurring, suicidality-linked conditions in trans-identified populations that predate their trans-identification.

The U.K.’s recent Cass report bolsters this view. In that review, foster youth were overrepresented in the first clinical cohort seen at the nation’s gender-identity clinic, with nearly a quarter of referrals having spent time in foster care. A systematic review cited in the report found that among children referred to gender clinics, maternal mental illness (53 percent) and substance abuse (49 percent), paternal mental illness (38 percent) and substance use (38 percent), and combined neglect and abuse (11 percent to 67 percent), were very common—meaning that kids at the clinic likely had a higher-than-average number of ACEs, and may have identified as transgender as a coping mechanism.

A different survey question in the same ACF-cited brief tries to establish that trans-identified foster youth are “kicked out, abandoned, or run away” at disproportionate rates because of their “gender identity.” The survey question, though, conflates running away with being kicked out or abandoned; the actual reason for running away is not specified, and the results are not reported separately for each item. The group even disclaimed that its “data isn’t [sic] able to establish whether youth were kicked out, abandoned, or ran away prior to, during, or after being in foster care.” All we can conclude from this survey is that youth in foster care, who, for whatever reason, experience dissociation from their bodies or their sex are more likely to report negative family experiences compared with their peers.

Apparently unphased by these issues, the ACF used another Trevor Project survey to justify the agency’s claim that living in supportive homes results in fewer suicide attempts among trans-identified youth. Significantly, though, the Trevor Project report does not define the term “support,” effectively leaving it up to the child respondents to define it for themselves. Based on the most common ways youth in a separate item self-reported feeling supported—having parents use the correct names and pronouns, and supporting their gender expression—however, it seems reasonable to conclude that the respondents often conceive of “support” as affirming their identity. “Un-supportive” parents could therefore refer to anything—parents who are actually neglectful, or those who refuse to use their children’s preferred pronouns, or even those who do something as banal as not letting their children buy cell phones. Given the muddled inputs, the data are unpersuasive. Elsewhere in the document, the authors disclose that the self-reported suicide-attempt rate didn’t change much between youth who reported living in an a “gender-affirming” home (14 percent) compared to those who lived in a “not gender-affirming” home (20 percent).

Further, a child’s perceptions of “support” may be conditioned by his mental-health history, independent of his trans-identification status. A study by the Family Acceptance Project, for example, concedes that, “Independent of levels of family acceptance, transgender young adults reported lower social support and general health.” This is one weakness of the “minority stress” theory and the associated research, as noted by J. Michael Bailey: it never empirically tests for the possibility that the group in question has greater sensitivity to stressors to begin with, trading on the classic correlation/causation confusion. It is possible, therefore, that youth with more severe psychiatric issues are both more likely to identify as trans and to perceive and report familial situations as unsupportive.

The ACF later asserts that “research consistently shows that when LGBTQI+ youth experience supportive environments and services, they experience the same positive mental health outcomes as other youth.” It cites a Substance Abuse and Mental Health Administration (SAMHSA) report to justify this claim.

The citations SAMHSA uses to support its view that “access to gender affirmation can reduce gender dysphoria and improve mental and physical health outcomes among transgender and gender diverse people,” however, are two “conceptual framework” papers, not rigorous empirical studies. These documents cannot possibly provide the required evidence. Meantime, so-called social transition—publicly recognizing a trans-identifying child’s chosen identity, a practice the SAMSHA report endorses—has not been shown to be necessary in improving mental health in high-quality research. A 2023 study from the U.K., for example, found “no significant effects of social transition or name change on mental health status.” That finding is corroborated by a new systematic assessment published as part of the final Cass Review, which found no credible evidence that social transition is either helpful or harmful. Other emerging evidence suggests that “social transition” may interfere with the natural resolution of gender dysphoria and greatly increase the chances that a passing phase becomes the basis for lifelong and potentially harmful medical interventions.

The Cass Review alludes to this possibility, emphasizing that social transition is “an active intervention because it may have significant effects on the child or young person in terms of their psychological functioning and longer-term outcomes.” The Review recommends consulting a clinician when deciding whether or how to facilitate social transition for children. The Biden administration’s ACF, in contrast, instructs state recipients to ensure social transition on demand, no clinical input required.

The SAMHSA report—which, as mentioned, also endorses social transition—claims that “[e]xtensive research indicates that even just one supportive adult, such as a family member, teacher, or mental health provider, can have a positive impact on the mental health of youth of diverse sexual orientation and/or gender identity; such support can reduce adverse mental health impacts including suicide.” However, the research SAMHSA cites in support of this claim looked only at acceptance of sexual orientation, not of “gender identity.”

This points to another concern about social transition: the most common outcome of dysphoria is not a transgender identity, but homosexuality. As the DSM-5 observes, among childhood “desisters”—people who once identified as transgender or experienced dysphoria but later revert to identifying as their biological sex or cease having dysphoria—63 percent to 100 percent of natal males and 32 percent to 50 percent of natal females turn out to be gay.

The ACF guidance compares objections to child gender transition with “conversion practices” and claims that multiple professional organizations agree that gender-identity conversion efforts have been “rejected as harmful.” This comparison is spurious, however, and has been addressed by psychologist James Cantor in response to an American Academy of Pediatrics’ policy statement on “gender-affirming care,” which made the same argument. Cantor said that the AAP’s claim about “conversion” practices “struck me as odd because there are no studies of conversion therapy for gender identity. Studies of conversion therapy have been limited to sexual orientation, and, moreover, to the sexual orientation of adults, not to gender identity and not of children in any case.” He added, “it simply makes no sense to refer to externally induced conversion. The majority of children ‘convert’ to cisgender or ‘desist’ from transgender regardless of any attempt to change them.”

The ACF’s rules treat “LGBTQI+” youth as a monolith. They assume that research done on gay and lesbian youth applies seamlessly to youth who identify as transgender. This is a well-known strategy of transgender activism: to exploit the ignorance of well-meaning Americans about the differences between sexual orientation and gender dysphoria. 

The finalized rules also fail to address the actual problems in the U.S. foster system. Data on foster-care capacity show a critical shortage of available homes. State foster systems remain generally underfunded, and the average annual turnover rate at U.S. child welfare agencies is almost 30 percent. The ACF could have endeavored to solve these problems.

Instead, the Biden administration seeks to use federal policy to cajole foster families and agencies into affirming a child’s mistaken gender identity, entrenching the idea that failing to do so constitutes abuse. The policy will compound the challenges facing some of the nation’s most vulnerable children.

Photo: bombermoon/iStock/Getty Images Plus


City Journal is a publication of the Manhattan Institute for Policy Research (MI), a leading free-market think tank. Are you interested in supporting the magazine? As a 501(c)(3) nonprofit, donations in support of MI and City Journal are fully tax-deductible as provided by law (EIN #13-2912529).

Further Reading

Up Next