Harley-Davidson was founded in 1903, sixteen years before Berlin’s Institute for Sexual Science opened its doors. The former generated hundreds of patents, tens of thousands of motorcycles, and one of the most recognizable brands in American history. The latter existed for thirteen years before the Nazis burned it down, though not before helping to spawn a transgender ideology that would come to dominate Western discourse a century later.
It is easy for a bad idea to capture the academy. Easier still to capture the media. Easiest of all to capture the Democratic Party. The transgender industry managed all three within a matter of years. But how does a radical European ideology capture Harley Davidson?
By 2023, the answer was visible. The most American of icons had celebrated the Transgender Day of Visibility, endorsed the Equality Act, and joined roughly three-quarters of Fortune 500 companies in covering sex-change procedures. More than 90% satisfied the Human Rights Campaign’s criteria for transgender protections.
Jochen Zeitz, Harley’s first German CEO, made progressive realignment a priority from the moment he took the reins. Pride Rides, rainbow-flagged hogs, an LGBT liaison at the Wisconsin Chamber of Commerce. The rebellious, loud, slightly dangerous American brand—the one that served as a stand-in for James Dean and Dennis Hopper—was being retired in favor of something softer, more inclusive, and visibly anxious about being called a ‘bigot.’ Zeitz, like every C-suite executive of his generation, feared the well-organized activists more than he feared his customers.
He could also read a balance sheet. Harley-Davidson’s U.S. operations generated $3.6 billion in revenue in 2022. Transgender healthcare—from the psychologist’s couch, to the pharmaceutical laboratory, to the surgeon’s table—was a $4 billion enterprise. At the start of the century, transgenderism was a rare condition that most doctors would never encounter. It took less than a decade for the transgender industrial complex to overtake Harley-Davidson.
The profit margins are why medical ethicists have always preached caution across all fields. The gender industrial complex has benefitted from ideological cover that obscures the raw material interests of everyone involved—lawmakers, insurers, pharmaceutical executives, and the physicians and surgeons who peddle their products to vulnerable Americans. Patients, too often, find themselves merely along for the ride.
The Profit Narrative and Clinical Exploitation
The sex-change industry portrays itself as a purely philanthropic enterprise, heroically offering life-saving care to anyone willing to take it. In private, doctors will sometimes concede an additional benefit. “Gender-affirming care,” as one put it, is “a big money maker.” That was the pitch from Dr. Shayne Taylor, a physician at Vanderbilt’s Clinic for Transgender Health, during a 2018 lecture—the year the clinic opened.
Dr. Taylor explained:
“These surgeries make a lot of money. Female-to-male chest reconstruction could bring in $40,000. A patient just on routine hormone treatment, who we’re only seeing a few times a year, can bring in several thousand dollars because it requires lots of visits and labs that actually make money for the hospital. […] I think this has to be an underestimate. Vaginoplasty, they’re quoting roughly around $20,000, but that doesn’t include your hospital stay, that doesn’t include your post-op visits, that doesn’t include your anesthesia, your OR. I think that’s just, like, the surgeon’s piece of it.”
Gender medicine is, in this respect, a uniquely profitable field. Sex-change procedures offer everyone involved the prospect of a quick, simple, and enormously profitable intervention to resolve problems that are, in reality, far more complex. The treatments are almost always irreversible, render patients infertile, and, in some cases, leave them sexually dysfunctional for the rest of their lives. Many of the pharmaceutical and surgical operations routinely performed on transgender-identifying patients were originally developed to treat life-threatening cancers. The hormone “therapies” that became standard of care even for children were developed as a last-resort treatment for testicular cancer or to chemically castrate sex offenders.
The Surgical Surge and Market Maturity
In the first fourteen years of this century, a doctor might have gone an entire career without encountering a transgender patient. A 2018 Johns Hopkins analysis found that American hospitals tallied 37,827 encounters with transgender patients between 2000 and 2014—roughly 2,700 per year. Of those, 4,118 involved sex-change procedures, about 275 annually.
The year 2015 was the inflection point. A Columbia University study of federal data estimates that doctors performed more than 48,000 sex-change procedures between 2016 and 2020—a nearly tenfold increase in annual surgeries compared to the previous period. In four years, the number of patients going under the knife exceeded the total number of transgender-identifying patients who had visited hospitals for any reason in the preceding fourteen years. Most alarmingly, surgeons performed 3,678 procedures on children, at a pace of 750 per year. The authors acknowledged a limitation in their methodology: the COVID pandemic suppressed what would otherwise have been even higher numbers, particularly among minors. There should have been more. Children born in the aftermath of 9/11 were more likely to undergo surgery with lifelong consequences than an adult diagnosed with gender dysphoria at the turn of the century.
On the surgical side, the revenues have been substantial. Grand View Research’s analysis found that the top ten providers of sex-change surgeries made more than $1.2 billion in 2022. Many were clearing more than $100 million each year—among them: Cedars-Sinai ($205.7 million), the Regents of the University of Michigan ($152.9 million), Mount Sinai Health System ($136.5 million), Kaiser Permanente ($120.2 million), and the Mayo Clinic’s transgender-focused branch ($116.3 million). Some of these programs had been running for only a few years.
The initial price tag does not tell the whole story. These surgeries frequently produce complications requiring further intervention, and revision surgeries are common. A study in Plastic and Reconstructive Surgery found that up to a third of patients undergo secondary revision following penile inversion vaginoplasty. A similar study in Aesthetic Plastic Surgery reported frequent revisions for “transfeminine” procedures. Masculinizing surgeries carry comparable complication rates: one study in Microsurgery reported complications as high as 53% for double-flap phalloplasty, while researchers in Current Urology cited studies reporting urethral complications between 25% and 75% following masculinizing surgery.
The Lifetime Revenue of Hormones
Even providers who only offer surgery referrals or hormone therapy find sex-change medicine a low-effort, high-reward proposition. As Dr. Taylor observed, hormone patients need only a few visits per year but generate consistent revenue. Patients are often placed on lifelong cross-sex hormone regimens, with the option of further cosmetic procedures along the way. The average cost of transition has been estimated at around $150,000 per person. The full range of available interventions—genital surgery, body sculpting, hair removal, voice training—can push the total considerably higher. Some estimates place the upper end above $400,000 for male-to-female transitions and $600,000 for female-to-male.
Profits can be further maximized by cutting corners in the prescribing process. Planned Parenthood, the nation’s leading provider of sex-change procedures for young adults, routinely prescribes hormones on the first visit, in a process that typically takes around thirty minutes. No psychological assessment is required. In many cases, patients do not interact with anyone holding actual medical credentials before receiving a prescription.
One whistleblower described prescriptions being rubber-stamped off-site by licensed mental health professionals, with actual treatment decisions made by the clinic manager—”with no prior medical experience,” whose previous job was “managing a Wendy’s.”
At some affiliates, staff involvement extends little further than directing patients to take their own blood pressure readings, conduct visits online, and travel to a LabCorp location for any required blood work—though the blood work is sometimes skipped entirely. Follow-up appointments are available but optional, left to the patient rather than the clinic. As the whistleblower put it: “‘The extent of our intervention’ was to grant ‘their requests to start the hormone therapy.'”
It is easy to see how this generates profit. The hormone market was estimated at $1.6 billion in 2022. Grand View estimates that the top pharmaceutical companies producing hormones and puberty blockers for these procedures are clearing tens of millions of dollars annually from these products alone. Some doctors appear to be deliberately obscuring the purpose of these procedures when billing insurance. In another recorded lecture, Dr. Taylor seemed to recommend exactly that: “For the patient who gets a big bill because their insurance doesn’t cover any transgender-related codes, I usually write ‘endocrine disorder not otherwise specified’ to allow me to order the labs that I want.”
The Investor Boom and Market Expansion
Industry revenue rose around 40% between 2018 and 2022. Grand View Research projects annual revenue will grow from just over $4 billion in 2022 to nearly $8 billion by 2030. The number of gender-affirming surgeries in the United States nearly tripled between 2016 and 2019. The number of children diagnosed with gender dysphoria rose 70% between 2020 and 2021. The Congressional Budget Office estimated that federal Medicaid and CHIP funding for sex-change procedures will double between 2026 and 2030, totaling nearly $2.6 billion over the next decade. Pennsylvania alone reported an 8,200% increase in taxpayer funding for these procedures for children between 2015 and 2022—up to about $14,000 in taxpayer funds every single day in 2022.
The potential market is considerably larger than current figures suggest. The Williams Institute estimates roughly 300,000 Americans between 13 and 17 identify as transgender. At the Philadelphia Center for Transgender Surgery’s minimum estimate of $124,000 for a full transition, the underage market alone could yield revenue exceeding $37 billion. Robbi Katherine Anthony, CEO of the transition-tech company Euphoria, told Forbes that the total sex-change market could reach $200 billion. “That’s larger than the entire film industry,” she said.
Investors have noticed. A number of transgender telemedicine companies have emerged and attracted substantial venture funding. Plume has raised $38 million since launching in 2019. Folx has raised $59.4 million. Carrot Fertility, which covers “gender-affirming care” alongside family planning, has raised $114 million. Euphoria, which bills itself as the “Adobe equivalent” for gender transition, raised more than $250,000 from backers including Chelsea Clinton.
These services are not cheap. Folx charges $39.99 per month. Plume charges $32 per month for insured patients and $99 per month for those without—membership fees that exclude the cost of prescriptions and clinical visits. Estradiol through Folx ranges from $175 to $582 every 90 days.
All of the above likely understates the full picture. Many estimates rely on insurance claims data, which misses cash-pay patients and providers—like Planned Parenthood—that no longer require a formal diagnosis before prescribing.
Bad Medicine and Scientific Negligence
Recent experience and study have shown that these treatments do not work as claimed. There is no good evidence that these interventions improve health outcomes and ample evidence that they cause significant harm—particularly to children subjected to hormone regimens and surgical procedures before their bodies have matured. The profit motives for everyone involved make abuse not merely possible but likely. What the psychiatrist William Gaylin said of the lobotomy applies equally here: “The urgent hope for the dramatic and the magical in patients; the seductiveness of the facile and quick procedure for the psychiatrist; the exploitation of the easy and the profitable by the least competent therapist led to a sickening abuse of this procedure.”
Political change, when backed by overwhelming and bipartisan support, can remind medical providers of their obligations. The aftermath of the 2024 election suggests this is already happening. In February 2026—two months after Harley-Davidson ousted Jochen Zeitz—the American Society of Plastic Surgeons (ASPS), the nation’s leading trade organization representing more than 11,000 board-certified plastic surgeons, released a position statement urging surgeons to delay breast/chest, genital, and facial sex-change procedures until patients are at least age nineteen.
This is not a minor policy adjustment. It is the first time a major American medical body has decisively broken with the consensus that has driven this industry. The statement cited low-certainty evidence, insufficient proof of long-term mental health benefits, and growing concerns about irreversible harm—including the recognition that adolescents’ brains are still developing, and that desistance and comorbidities like autism, trauma, and mental illness are common among this population. It referenced the Cass Review directly. The WPATH, Endocrine Society, and AAP guidelines that it implicitly rebukes were never purely scientific documents—they were shaped by ideology as much as evidence. Rushing children into irreversible procedures before these questions are resolved violates the most basic principle in medicine: first, do no harm.
The ideology that captured both Harley-Davidson and the ASPS in the same decade appears to be losing its grip on both in the same season. More than half of the US states have already banned these procedures for minors. The Trump administration’s HHS has praised the ASPS statement. What remains is the question of accountability—for the providers who performed irreversible procedures on children they knew could not meaningfully consent, for the pharmaceutical companies that cultivated a patient pipeline, and for the medical organizations that dressed ideology in the language of evidence. The gender industrial complex did not emerge from nowhere. It was built deliberately, by people who knew what they were doing and who profited from it. That reckoning must follow.