By Abigail Anthony – September 16, 2025 6:30 AM – National Review

Planned Parenthood’s online “gender affirming care” lesson for students as young as middle-schoolers suggests using “liquid filled condoms” to mimic a penis and provides instructions on how to circumvent safeguards if “you’re looking for hormones without extra gatekeeping.”

Sex Ed To-Go is an online program with free sex-education lessons in Spanish and English developed by Planned Parenthood for teachers and students, ranging from topics like sexually transmitted diseases to “handling break-ups.” The new module titled “Gender Affirming Care,” created by Planned Parenthood of the Pacific Southwest, is designed for students in eighth grade and above. The lesson plan explains gender-related terminology, explores “types of things people can do to help their body and appearance match their gender identity,” directs students on finding “resources,” and details “how to support someone who is transgender, non-binary, or transitioning.”

The course explores four types of “transition”: 1) “Social transition,” meaning non-permanent adjustments such as “changing [your] pronouns, clothing, hairstyle, or name,” 2) “legal transition,” by updating identification documents, 3)  “medical transition” in the form of hormonal interventions, and 4)  “surgical transition” such as “removing breasts or changing external genitals.”

The “social transition” section catalogues a range of “gender-affirming devices” that modify appearance without medical intervention. The guidance includes a description of “tucking the testicles into the body and pulling the penis back between the legs” with either tape or particular underwear to “create a smooth and flat crotch.” The lesson tells students that a “binder” and “tape” can constrict breasts for the appearance of a flatter chest, although it warns that breast-binding can “cause injuries, like broken ribs” and advises that such devices should not be worn for more than eight hours or while sleeping. For those who want the appearance of breasts, the module mentions the options to wear “push-up bras” or “stuffing a normal bra with something soft like socks.”

“Stand-to-pee devices are funnel-like devices that allow people with vaginas to pee standing up. They can help trans men feel safer in restrooms,” says the lesson for eighth-graders and older students:

Packers are penis-shaped devices that help create the appearance of a ‘bulge’ under their clothing, like for a person with a penis. They are usually worn in tight-fitting underwear. It’s possible to buy packers designed for this, or to use rolled up socks or liquid filled condoms.

When discussing “medical and surgical transitions,” the module claims that “puberty blockers are medications that pause puberty” with the aim to “give young people time to explore their gender identity before permanent body changes happen,” and Planned Parenthood suggests that puberty will resume after ceasing such medications. But the lesson then hints that these drugs have long-term consequences, saying they “might change someone’s body permanently, like affecting whether they can get or cause a pregnancy when they are older.”

“To say that puberty blockers ‘pause’ puberty implies a simple, harmless process; it’s not,” Dr. Kurt Miceli, medical director at the organization Do No Harm, told National Review.

Prolonged use of puberty blockers can lead to significant changes in bone density, and even fertility, particularly if cross-sex hormones are started thereafter. Additionally, when a child’s puberty is delayed because of puberty blockers, it can unintentionally increase the gap in development as one’s peers progress through natural puberty with the impacted child remaining in a ‘paused’ state. This may inadvertently add strain to a child’s social and emotional well-being.

Miceli further mentioned that puberty blockers may also negatively affect bone health, growth, and neurocognitive development.

Planned Parenthood’s lesson discusses “gender affirming hormone therapy,” meaning cross-sex hormones administered in the form of injection, pill, patch, or topical gel.

“A person can continue hormone therapy for as long as they want to keep certain physical traits,” the module says. “If they stop taking hormones, some effects will go away while others, like breast growth and voice changes, can stay.”

The lesson further claims that the existing research demonstrates so-called gender-affirming care “improves mental health and reduces risks like depression and suicidal thoughts in transgender youth.” “Gender-affirming surgeries” mentioned in the lesson are facial plastic surgery, phalloplasty, vaginoplasty, and voice-altering surgery. Other interventions discussed are speech therapy and laser hair removal.

“Many of the laws or policies you might hear about that ban, or limit, gender affirming care directly oppose medical guidance and decades of research,” the lesson states.

The Cass Report, an independent review of gender-related medical care for minors and young adults submitted to the United Kingdom’s National Health Services in 2024, found that previous studies on such medical practices are of “poor quality” and that there’s “very limited evidence on the longer-term outcomes” associated with medicalized transition. A report issued by the U.S. Department of Health and Human Services in 2025 similarly found that there is not strong evidence that “gender-affirming care” for minors is effective for treating gender dysphoria or improving mental health.

“Systematic reviews — which represent the highest level of evidence — have found the quality of evidence related to psychological outcomes in so-called ‘gender-affirming care’ for minors to be very low,” Miceli told National Review. “Compelling evidence to support these life-altering interventions in children does not exist. Yet, the risks are significant.”

In the “Taking Care of Yourself” section, Planned Parenthood says that “there’s no right or wrong time” tell someone that you identify as either “transgender” or “nonbinary.” The lesson instructs students to prioritize their safety because “not everyone is safe to come out to,” and therefore questions can serve to “test” a person’s views.

“If you’re unsure how someone feels about trans people, bring up LGBTQ+ topics casually and see how they react,” says Planned Parenthood. “If they use respectful language or seem open-minded, it might be a safer space to disclose.”

Shortly after describing hormonal therapies and surgeries, Planned Parenthood tells students in a section on “dating and safer sex” that “you deserve love and respect” and “the right person will accept you for who you are.”

“If they don’t respect your identity or boundaries, they aren’t the right person for you,” the lesson says. “If someone claims to be supportive but makes transphobic jokes or dismisses your feelings, they may not be as accepting as they seem.”

The module also alludes to sexual contact, even though the lesson is designed for students as young as eighth grade — usually age 13 or 14 — and thus below the lowest age of consent in the United States.

“Share the words you want to use for your body parts (like using ‘chest’ instead of ‘breast’) and if any body parts are off limits for touching or seeing,” says the lesson.

The final section in the lesson plan mentions therapy — but it suggests that “good therapists” are those who affirm a child’s self-declared gender.

“A good therapist creates a space where you can talk about your gender identity without fear of being judged or invalidated. They respect your pronouns, chosen name, and experiences, and can be a great support for navigating stress that can come with being a teenager and figuring out life,” says the lesson. It also notes that a “gender-affirming therapist” can produce letters required for some medical interventions, such as hormonal therapy or surgeries.

Planned Parenthood’s instructions for “finding non-judgmental services and providers” directs students to online directories such as Planned Parenthood, World Professional Association for Transgender Health (WPATH), Health Professionals Advancing LGBTQ+ Equality (GLMA), and the Trevor Project’s Resource Finder. Planned Parenthood suggests that, before booking a medical appointment, you can call the office and ask questions including, “Do you use patients’ chosen names and pronouns in medical records?”

Planned Parenthood encourages seeking “informed consent” clinics that remove guardrails for obtaining medical services, such as by not requiring certain forms of documentation.

“Some places (like Planned Parenthood) offer hormone therapy without requiring therapy letters,” says the lesson. “They go over all of the available options and try to present an accurate overview of the pros and cons of each, so that you can make an informed decision about what is best for you. This is called informed consent. Search for ‘informed consent HRT clinics’ in your area if you’re looking for hormones without extra gatekeeping.”

The educational module encourages students to “advocate” for themselves and switch to “gender-affirming providers.”

“If a provider misgenders you, correct them. A good one will listen and apologize. If they seem judgmental, you don’t have to stay—find someone better. You deserve respectful care!” the lesson states. “It might take a little searching, but don’t be discouraged if this process takes more time than expected — there are gender-affirming providers who will respect and support you. Don’t settle for less!”

Planned Parenthood’s lesson concludes with a video listing tips for being a supportive friend or family member to someone who is pursuing gender-related transition. The suggestions include deferring to “the right name and pronouns,” listening without “interrupting or judging,” and avoiding “assumptions” about an individual’s identity.

Another lesson offered by Planned Parenthood, titled “Gender & Sexual Orientation Basics,” is designed for students in sixth grade and above. It tells students that there are “traditionally three sexes,” namely male, female, and “intersex.”

Students begin the lesson with an online worksheet that prompts them to reflect on their “beliefs and values” by marking whether they agree, disagree, or are unsure about certain statements, such as 1) “I don’t make jokes about people who are gay, bisexual, or transgender,” 2) “I’d be okay if someone thought I was gay or a different gender, even if I’m not,” and 3) “I know that just because someone is gay, it doesn’t mean they want to hook up with me.”

The section on sexual orientation mentions non-monogamy, saying that “people can choose what they want their relationships to look like,” which might be “a committed relationship, dating multiple people, or keeping things casual and not wanting to label anything.”

A video titled “What Makes It Hard to be LGBTQ+” tells students that “homophobia” and “transphobia” are defined as “being afraid of, not liking, or being mean to someone just because they’re gay, lesbian, or love someone of the same gender” or “just because they are transgender,” either of which can manifest as “rude words, unfair treatment, or bullying.” An example given of LGBTQ-identifying people being treated unequally to “straight and cisgender people” is not getting “a spot on a sports team that they are qualified for.”

“We want to be very clear that being gay or transgender or non-binary isn’t what puts someone at risk,” the lesson tells students. “The real danger comes from how others treat them, and the hate and stereotypes in our society.”

Planned Parenthood did not respond to a request for comment.

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