When someone says
"American professional associations support gender affirmation-on-demand,"
what I hear is
"International health care boards oppose gender-affirmation-on-demand in favour of much more conservative approaches."

What makes the American system so different? Australia: medscape.com/viewarticle/96…

The inability of psychotherapists to challenge clients' beliefs about themselves caused some of the greatest disasters of mental health.

Recovered memories, satanic panic, multiple personalities...All from therapists failing to challenge easy assumptions.

Now transgenderism. Lehmann, K., et al. (2021). Dramaturgical Accounts of Transgender Individuals: Impression Management in the Presentation of Self to Specialist Gender Services. Archives of Sexual Behavior, 50, 3539–3549. doi.org/10.1007/s10508…

This fact-check seems more relevant now even than it did then:
tandfonline.com/doi/abs/10.108… [The] suggestion that the prevalence of intersex might be as high as 1.7% has attracted wide attention in both the scholarly press and the popular media. Many reviewers are not aware that this figure includes conditions which most clinicians do not recognize as intersex, [2/4]

Just published in the Journal of Sexual Medicine:
"Surgical outcomes following gender affirming penile reconstruction"
jsm.jsexmed.org/article/S1743-… "129 patients underwent genital reconstruction surgery... Patients reported 281 complications requiring 142 revisions."

The most common complications were:
urethrocutaneous fistula (40%)
urethral stricture (32%)
worsened mental health (19%).

All Turban's new study says is:

"If you redefine 'desistance' to include people who transitioned part-time before going full-time, then you inflate the seeming number of 'detransitioners'." And, as others have already observed about the source of the data: If you survey members of activist groups, you get results remarkably similar to the groups agenda.