How Did Planned Parenthood Become One of the Country’s Largest Suppliers of Testosterone?

For Cristina Hineman, the situation felt urgent: the 17-year-old needed treatment at Planned Parenthood, where she knew she wouldn’t be subjected to humiliating questions, or an unnecessary waiting period, or lectures, or prying about her certainty. But it wasn’t an abortion she sought. It was testosterone.

Planned Parenthood was founded a century ago to promote birth control. Today, its nearly 600 clinics nationwide make it the largest single provider of abortion, contraception, reproductive care, and sex education in the U.S. 

It has also, in less than a decade, become the country’s leading provider of gender transition hormones for young adults, according to insurance claim data. In 2015, around two dozen of their clinics began offering this service. Now it’s available at nearly 450 locations. Insurance claim information provided to The Free Press by the Manhattan Institute shows that at least 40,000 patients went to Planned Parenthood for this purpose last year alone, a number that has risen tenfold since 2017. The largest proportion, about 40 percent, were 18- to 22-year-olds.

Faced with her parents’ skepticism, Hineman waited to make an appointment for just after her 18th birthday in November 2021 at the Planned Parenthood in Hudson, NY. Some clinics offer hormones starting at age 16 with parental approval, but as a legal adult Hineman wouldn’t need their consent.

After she filled out forms in the Planned Parenthood waiting room, a nurse led her to an exam room and handed her a consent form for “masculinizing hormone therapy.” 

Records show that a nurse practitioner asked about Hineman’s identity and desires; she noted that “patient has consulted with a mental health provider”—meaning Hineman had previously talked to therapists. The two discussed the “expected changes” related to testosterone—growing a beard and body hair, deepening voice, and that “changes to fertility may be permanent or reversible.” 

Then the first nurse took Hineman’s blood, and she was given a prescription for testosterone gel. She remembers all this taking under 30 minutes. 

Like many others in the rising wave of female teens seeking to masculinize, she had been battling a cluster of mental health problems: self-harm, depression, and anxiety. Also like many of these teens, Hineman has autism. The Covid lockdown exacerbated her troubles. She told me, “I couldn’t see my friends, I couldn’t see my girlfriend. I was depressed and scared, in my room ruminating all the time.” 

The viral YouTubers she was watching convinced her that gender was the problem. “I was like, oh my god, trans includes all the things I’ve been feeling—my discomfort with my chest, my discomfort with being called ‘young woman,’ not being sure of who I was or what I wanted to be,” she said. 

Just over a year into treatment, Hineman realized she had made a terrible mistake, and that gender was not the source of her problems. “I was brainwashed,” she says now. “A lot of people say that adults should be able to do whatever they want. But if you have mental illness that’s clouding your view, or you’re so misinformed about what gender dysphoria even means, then you cannot consent to such invasive treatments.”

Hineman, who went from identifying as “nonbinary” to “agender” to “trans” over the course of a year, now considers herself a “detransitioner”—someone who, if possible, has returned to living as their birth sex, often with medical side effects. 

Today, reported exclusively in The Free Press, she is a plaintiff in the first detransitioner lawsuit against Planned Parenthood Federation of America. In the medical malpractice suit, filed in April, she’s seeking unspecified damages for negligence and failure to obtain informed consent from all the health providers—including those at Planned Parenthood—who facilitated her medical transition: from therapists who “encouraged” her desire to change genders, to the plastic surgeon who removed her breasts after a superficial consult when she turned 19, to the nurse practitioner at Planned Parenthood who wrote Hineman the prescription for testosterone. (In June, Planned Parenthood filed its answer to the complaint, disputing Hineman’s claims.)

Hineman, who went from “nonbinary” to “agender” to “trans” over the course of a year, now considers herself a “detransitioner”—someone has returned to living as their birth sex, often with medical side effects. Above, Hineman walks with her mother, Naomi, at Poets’ Walk Park in Red Hook, NY. (Cindy Schultz for The Free Press)

She joins more than a dozen young people who, in separate lawsuits across the country, are alleging medical malpractice by institutions such as Kaiser Permanente as well as individual practitioners, and are seeking compensation for the harm they claim has been done to them. 

Her suit comes as the U.S. is increasingly alone in championing hormonal and surgical interventions to swiftly transition gender-distressed young people. A growing list of European countries, including Sweden, Finland, and the UK, are restricting these sometimes irreversible treatments for young people and favoring an approach that encourages therapy to address all the causes of a patient’s distress. 

In 2020 a young British detransitioner, Keira Bell, was a claimant in a case against the government clinic that supervised her transition. Like Hineman, Bell asserted she was a troubled young person who needed psychological counseling, not medical transition. Her case caused a firestorm that helped lead to the comprehensive Cass Review, released in April, which delivered a scathing indictment of the “gender-affirming” model. 

The distinguished English pediatrician Dr. Hilary Cass, who led the review, has said, “I can’t think of another area of pediatric care where we give young people a potentially irreversible treatment and have no idea what happens to them in adulthood.” Meanwhile, new revelations show that the purported evidence of the benefits of medical transition cited by advocates has been manipulated for political purposes. 

But in the U.S., major medical associations from the American Academy of Pediatrics to the Endocrine Society continue to back gender-affirming care. In response, about two dozen Republican-led states have passed laws restricting this treatment for minors. 

If malpractice lawsuits like Hineman’s are successful, they have the potential to reshape the currently accepted medical standard of gender care. This can be summarized as setting children on a path to medical transition, and treatment on demand for adults. This applies even when these adults are still teenagers and legally restricted from activities such as buying alcohol or renting a car. 

“Treatment without a competent evaluation shouldn’t be foisted on you whether you’re 15 or 30,” says Kevin Keller, an attorney who is consulting pro bono on several detransitioner cases brought by firms across the country. “Vulnerability is the issue. If there’s no comprehensive screening in place before a medical intervention that’s going to have permanent effects,” that’s a breach of duty, he argues.

Hineman describes herself as politically to the left. She supports the right to abortion and does not want to hamper women’s access to that at Planned Parenthood. 

Her attorneys may have different political leanings, but Jordan Campbell, who left commercial litigation two years ago to exclusively represent detransitioners, tells me the firm is apolitical. He was motivated to “do something” after hearing a detransitioner’s harrowing experience on a podcast, and law school friends joined the cause. (In 2022, the conservative Independent Women’s Forum launched a series of documentaries about gender medicine, focusing on detransitioners. Four of the dozen people profiled so far are Campbell’s clients, including Hineman. The documentary on her is debuting with this article.) 

Keller told me, “There’s a real belief among these plaintiffs and lawyers that this is the great medical scandal of our times.” 

Watch the documentary from the IWF about Hineman and her suit against Planned Parenthood here:  

There is another civil suit against a Planned Parenthood affiliate, filed in February by a different law firm, representing a detransitioner in the Midwest. She spoke to me on condition that she not be identified by name in this story. I’ll call her Anna. 

Two years ago, Anna made an appointment for her 19th birthday at a Planned Parenthood clinic a thousand miles away from Hineman’s. Yet her experience unfolded so identically it’s as if the Planned Parenthood clinician was following a script. And essentially, she was. Planned Parenthood medical guidelines are made by the national headquarters. “Like any franchise, you know what to expect in whatever affiliate you go to because they’re all practicing by the same standards and guidelines,” Dr. Paul Blumenthal, an emeritus professor of obstetrics and gynecology at Stanford and former subcommittee chair of Planned Parenthood’s National Medical Committee, told me.

These guidelines allow for speedy access to life-altering hormones. As evident in one affiliate’s Gender Affirming Hormone Therapy Patient Handbook: “Most of our patients can get a hormone prescription at the end of their first visit with us.”

Anna, who is now 22 years old, tells me she was a tomboy as a kid, which led to a lonely adolescence in which she struggled with depression, anxiety, ADHD, and was “hating puberty because I’m getting these huge boobs and period that’s horribly uncomfortable.” She was also discovering that she was attracted to girls. When she started dating, many of the females she was interested in had started to identify as male, and Anna describes herself as having been “young and impressionable.”

Anna took testosterone for seven months, which was enough to drop her voice and thicken her body hair. Now, she says she experiences constant vocal pain, joint pain, and frustrating and sometimes painful sexual dysfunction. She says that none of these distressing side effects were discussed at that first Planned Parenthood appointment, one that resulted in a prescription for testosterone. 

In her suit, Anna is asking for a minimum of $50,000 in damages and coverage of her legal costs. The suit alleges that Planned Parenthood’s care was so negligent that Anna “has suffered great pain and anguish” and “has experienced a substantial loss of her normal life.”

She’s grateful for a lab mix-up that stopped her refills and led her to abandon transition before she started to look more masculine. She tells me she occasionally gets “sir’d” now, mostly on the phone, or maybe because she “presents a bit dykeish.”

She’s doing her best to move on, and has a satisfying part-time job and her own apartment, though she tells me every day is still a struggle. “I just have a lot of regret.” She’s suing because “I don’t want people to get hurt like I did,” she tells me, and she wants Planned Parenthood to stop treating patients “like they’re on a conveyor belt.” Many of her friends are trans—she’s not trying to take away their care. “I want them to be healthy and fully informed.”

Hineman, who is now 20 years old, has permanent effects from testosterone, like hair on the backs of her hands and side of her face. Her clitoris, which she had once hoped would come to resemble “a small penis” under the effects of testosterone, is now permanently enlarged and so uncomfortable that it’s difficult to wear fitted pants or jeans. Her sexual response has been dulled. “I was very sensitive down there before. Now it’s harder to have a satisfying experience,” she tells me with embarrassment. 

Talking about the double mastectomy is even more difficult: her chest is concave, scarred, and alternately numb and raw. She didn’t think about breastfeeding when she was seeking to transition, but now is haunted by the fact she’ll never be able to. 

For Hineman, the whole project of gender identity was “kind of like a punk thing,” she says. But rather than sex, drugs, and rock and roll, it was just drugs. And surgery. “It’s a medicalized version of normal teen rebellion. And I got completely sucked into that.”

Hineman tells me all this from her parents’ home in the Hudson Valley—she’s living there saving money while she works at a convenience store selling cigarettes she’s still not legally old enough to buy until she turns 21 in October. She’s articulate and shy, with braces that make her seem younger than she is. The testosterone somewhat lowered her voice, but her hair and overall style helps her present as female. Occasionally people assume she’s male, but she’s made a conscious decision to shrug it off because getting “emotionally bogged down about being misgendered” is what led to transition in the first place, she tells me. “I had the realization that I can’t continue to let this bother me in any direction.”

“I was brainwashed,” says Cristina Hineman. “A lot of people say that adults should be able to do whatever they want. But if you have mental illness that’s clouding your view, or you’re so misinformed about what gender dysphoria even means, then you cannot consent to such invasive treatments.” (Cindy Schultz for The Free Press)

How did Planned Parenthood transform itself from an organization devoted to women’s health into one of the country’s largest suppliers of testosterone?

Planned Parenthood traces its origins to the opening of a birth control clinic in New York in 1916 by a nurse named Margaret Sanger. It was swiftly shut down and Sanger was arrested because, at the time, distributing birth control—even distributing information on birth control—was illegal. Sanger persevered in her mission of bringing contraception to the masses, infamously making an alliance with the eugenics movement. 

Today, the organization serves more than two million patients a year, and has for decades provided affordable gynecological care for women who can’t find it elsewhere. It has revenues of around $2 billion, of which nearly $700 million comes from publicly funded programs such as Medicaid. Its motto is “Care, no matter what.” 

In 2005, a northern California affiliate expanded that care to a pilot program in Santa Cruz intended mainly for male-to-female transsexuals, as they were then commonly called. This was long before de rigueur pronouns, before puberty blockers were a culture war weapon, and a full decade before the still-unexplained spike in female teens across the Western world identifying as trans.

Dr. Jen Hastings, a Santa Cruz family physician working at Planned Parenthood, spearheaded the program. There she saw how estrogen—a hormone her clinic prescribed for menopausal women—could help an underserved, marginalized population of trans-identified adults who were born male.

Hastings then focused her career on expanding transgender services throughout Planned Parenthood. At a 2015 conference of reproductive health clinicians, Hastings led a session titled “Transgender health care in your affiliate: You can do it!” (Hastings did not respond to requests for an interview.)

It was around that time that two physicians active in expanding access to hormonal treatments started advising Planned Parenthood. Both have advocated against what’s derisively known as “gatekeeping”—that is, requiring a mental health evaluation, or a certain number of therapy sessions, or a referral letter to initiate treatment. They supported early intervention, at the cusp of puberty, based on the argument that doing so spared gender dysphoric young people the trauma of a “wrong” puberty. 

These physicians are Dr. Madeline Deutsch, director of the Gender Affirming Health Program at the University of California, San Francisco, and Dr. Johanna Olson-Kennedy, the medical director of The Center for Transyouth Health and Development at Children’s Hospital Los Angeles. Both were subject matter experts on transgender care for Planned Parenthood; Olson-Kennedy joined the national medical committee in 2017. The guidelines increasingly reflected a “patient-led” approach, with protocols added for minors. (Some clinics limit gender treatment to 18-plus, others 16-plus.) An internal slide presentation shows that Planned Parenthood gender services more than quadrupled between 2016 and 2021. 

The organization would not give specific numbers, or respond to multiple requests for comment, but the insurance claim data (estimates that do not include patients who pay out of pocket) suggest that 1 in 6 U.S. teens and young adults who sought gender hormones last year were seen at Planned Parenthood. Between 2017 and 2023, affiliated clinics filed gender-related insurance claims for 12,000 youths aged 12–17.

There were plans to bring in even younger patients. In 2022, the Planned Parenthood in Santa Cruz launched another pilot, this time offering puberty blockers and hormones for teens aged 15 and under. The goal was to expand the program, but only “a small handful” of families came, an affiliate spokesperson told me, and it was shuttered. Meanwhile, the St. Louis affiliate is under investigation by the state attorney general for allegedly eliding parental consent when providing gender-transition care to minors.

Dr. Nicole Chaisson, associate medical director of Planned Parenthood North Central States, told me easy access to appointments and treatment for young people seeking transition is precisely the point. Chaisson defends a quick consult that allows a teenager to “leave the clinic with their prescription.” She told me that “otherwise healthy patients” who have been living as trans for some time tend to have already given sufficient thought to making irreversible changes. 

Chiasson says the gender treatments come under an “informed consent” model. “Gatekeeping is not necessary. People are the experts of their own body and of their own journey, and as long as they can make decisions, they should be the agent of their own healthcare.”

A Planned Parenthood video shared on social media tells teens: “Your gender identity is real. You should be the one to decide what changes you want to make to your body.” Olson-Kennedy told colleagues in 2018 that teens can consent to what she called “chest surgery” or breast removal. She added, “If you want breasts at a later point in your life, you can go and get them.” She did not respond to requests for comment.

Dr. Vanessa Cullins was Planned Parenthood’s VP of Medical Affairs when it wrote transgender services into the national guidelines, allowing the program to expand nationally. Originally, the impetus was facilitating bodily autonomy in a small population of mostly male adults seeking to transition. 

I reached Cullins in Florida, where she’s resided since retiring from her position and medicine generally in 2016. She told me she was “proud” to have started the transgender services program. But when I shared the updated guidelines with her and told her about what Hineman and Anna have gone through, she expressed concern. “We have to be vigilant when we’re giving powerful medications to young people, and these are powerful medications,” Cullins told me, which must necessarily involve side effects. If someone is not fully informed and prepared, “it could be a nightmare.” 

During her tenure, gender treatment was for adults only and based on a “team model” of care, Cullins explained, in which clinic staff coordinated with outside mental health and primary care. She added of the typical visit under today’s guidelines, “I would suggest that 30 minutes is not enough.” 

Cristina Hineman tells The Free Press that the last time she went to Planned Parenthood in March 2023, she held back tears as she told the nurse practitioner she realized that it all had been a mistake. (Cindy Schultz for The Free Press)

Trading one biological sex hormone for the other has a multitude of profound impacts: on metabolism, on risk of cardiovascular disease and stroke, on bone health, on mood stability, on cognition, and on sexual function and fertility. Female sex organs thrive on estrogen, which the ovaries cease to produce under the sway of testosterone. After a few years, atrophy may affect the entire reproductive tract. 

Planned Parenthood’s materials for clinicians state atrophy can begin within just 3–6 months of exposure. But on the brief patient consent form—it’s about three pages long—that both Hineman and Anna signed, this was referred to only as “genital dryness.” 

I spoke with a former Planned Parenthood clinic employee who, trans-identified himself, has been taking testosterone for nearly a decade and knows its effects intimately. He became concerned that the information wasn’t being shared with new patients, and asked the chief medical officer why. He was told that protocols were set by the national office, and in any case, informing patients of lesser-known side effects “would scare them.” He has since obtained legal whistleblower protection.

Hineman says of her experience, “There was no conversation about the actual process of what the hormones are going to do in your body; it’s just you take the shot and start becoming more male,” she says. Both she and Anna are alleging that clinicians did not explain the treatment sufficiently to meet the legal standard of informed consent. This requires that a patient must fully understand the risks and benefits of the treatment or medication they are considering as well as being presented with the alternatives.

Dr. Nicole Chaisson said that side effects are part of the conversation, but acknowledged that some may go unmentioned, saying it would be wrong to point patients to things that might happen 10 or 20 years down the road when “they’re having lifesaving care right now.”

Chaisson is referring to a claim often repeated by gender practitioners: that without access to “affirming” treatments, young people will commit suicide. This is a threat that’s been commonly held over parents reluctant to approve transition for their child. 

Fortunately, there is now good evidence to refute this dire claim. Researchers in Finland recently published the largest study to date looking at suicide in gender-distressed patients and found that suicide is rare, and the greatest predictor of it is previously diagnosed psychiatric conditions. Lead author Dr. Riittakerttu Kaltiala has called it “dishonest and extremely unethical” for clinicians to exaggerate risk. Dr. Hilary Cass was also clear in her review: “the evidence does not adequately support the claim that gender-affirming treatment reduces suicide risk.”

After the 2016 presidential election of Donald Trump—and the promised threat to abortion rights that came to pass—record donations funded many new hires at Planned Parenthood’s national office. I spoke to several physicians who served in high-level positions within the organization who expressed frustration with the national office for pouring more resources into advocacy than medical services. 

“Planned Parenthood became the place to work if you wanted to be on the front lines of the anti-Trump resistance,” a former high-level executive who agreed to speak on the condition of anonymity told me. 

Many of the new staffers in the national office “believed in every so-called progressive issue, and at that time the forefront was gender-affirming care. That one issue became everything.”

And this required new language. “There was this huge push to cancel the word woman,” the former executive told me. “Women’s health or female were edited out constantly to reflect gender-neutral language.” For example, people with uteruses began appearing. Chestfeeding became a synonym for breastfeeding. And front hole as a word for vagina was added to the glossary.

The last time she went to Planned Parenthood in March of 2023, Hineman, then 19, held back tears as she told the nurse practitioner she had come to realize, with horror that still grips her, that it all had been a mistake. The consent form Hineman had signed stated, “You can choose to stop taking testosterone at any time. If you decide to do that, talk to your doctor or nurse.” But Hineman discovered there was no protocol for stopping, no handout. Her clinician had no advice except to contact a gender therapist. Hineman left a voicemail but said she never got a return call. 

The week before, she’d had her final post-op appointment with the surgeon who removed her breasts. When the bandages came off, she hated what she saw. She had sought surgery believing this was “the only way” to make the “crippling feeling” of suicidal depression go away. It’s what she’d been told “over and over and over again” on the internet, by medical professionals and YouTubers alike.

But the next night she had “the biggest anxiety attack of my entire life.” She called for her mother to comfort her, and cried so hard she threw up. “I regretted everything,” she tells me. She was overwhelmed with the thought that “I’m never going to look like a woman again, I’m never going to have feeling back in my chest.” 

The next day was a scheduled testosterone “injection day,” but instead of plunging a needle in her belly, she shaved her legs and put on a red dress with long sleeves that hid her biceps. She announced the change in an Instagram post that said, “I’m going by she/her pronouns again.” 

Anna also looks back with bafflement that her depression and other medical factors didn’t give providers pause. “I was lost. I was hurting. I was a fucked-up teen who needed help,” she told me. 

Hineman now regrets that she put off college to transition, and spent her life savings, about $9,000, on a mastectomy. She has gone public because she wants young people like herself, their parents, and the providers who are pushing ideology over good care to know that there are safe and humane ways to address the kind of distress she suffered. “The answers are not just transition or suicide. There are ways to work through these feelings without altering your body,” she says.

As for Planned Parenthood, she says, “Honestly, I want them to focus on women’s health. That’s what they exist for.”

Jennifer Block is a journalist and author, often writing about contested areas of medicine. She got her start contributing to outlets including The Village Voice, The Nation, and Ms. magazine. She was most recently an investigations reporter at The BMJ. Follow her on X @writingblock.

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