Fact Check

Does an American Girl Book Give Children Advice on Gender-Affirming Care?

The book, "Smart Girl's Guide: Body Image," has been the focus of several Fox News segments.

Published Dec. 8, 2022

Updated Dec. 9, 2022
A children's book in an American Girl-branded series of self-help guides gives children advice on gender-affirming care.

In early December 2022, a book in an American Girl company-branded series of self-help guides — "Smart Girl's Guide: Body Image" — drew the ire of anti-trans activists. Published in February 2022, its publisher explains that:

This book will help you understand how internal and external factors such as puberty, media images, social media, and peer pressure contribute to how you see yourself, and it will give you ways to combat the negative feelings and behaviors that come along with negative body image. This book will also help you understand and value all body types, and learn how to be less judgmental and more compassionate toward every body.

Several conservative pundits and media outlets including Fox News, The New York Post, and The Daily Mail, reported negatively on the book because it provided young children advice on gender-affirming care. This book is also the subject of a separate fact check about American Girl's purported advocacy of puberty blockers. 

While the book does not advocate any particular treatment, it does provide advice and tools to help kids discuss gender-related issues — including transitioning — with doctors and others. The relevant section reads:

Being transgender is not an illness or something to be ashamed of. If you're questioning your gender or if you already know for sure that you're trans or nonbinary—talk with an adult you trust, like a parent or school counselor. That person can connect you with a specially trained doctor, who can help you and your family decide what's best for your body. 

At first, you and the doctor might talk about wearing the clothes and using the pronouns (like he, she, or they) that make you feel most like the true you. If you haven't gone through puberty yet, the doctor might offer medicine to delay your body's changes, giving you more time to think about your gender identity. And if you've already gone through puberty, a doctor can still help. Studies show that transgender and nonbinary kids who get help from doctors have much better mental health than those who don't. 

The book also provides a list of resources for children who lack an adult they trust to discuss gender issues. In response to criticism, the American Girl company defended the book, explaining to TMZ that: 

We value the views and feedback of our customers and acknowledge the perspectives on this issue. The content in this book, geared for kids 10+, was developed in partnership with medical and adolescent care professionals and consistently emphasizes the importance of having conversations and discussing any feelings with parents or trusted adults.

Several studies support the assertion that gender-affirming care helps trans and non-binary youth's mental health outcomes. This is, it bears mentioning, a position held by U.S. government health agencies, as well.  

A study published in April 2021 and based on data derived from nearly 20,000 participants, for example, found that "gender-affirming surgeries were associated with a 42% reduction in psychological distress and a 44% reduction in suicidal ideation when compared with transgender and gender-diverse people who had not had gender-affirming surgery but wanted it."

A study published in February 2022 similarly found that "gender-affirming medical interventions," which included puberty blockers, "were associated with lower odds of depression and suicidality over 12 months."  

Because the book provides information and resources about these topics, it is accurate to state that the book, at least in part, gives children advice on how to ask for or receive gender-affirming care. For that reason, the claim is "True."


"A Smart Girl's Guide: Body Image Book." Americangirl.Com, https://www.americangirl.com/products/a-smart-girls-guide-body-image-book-hgv01. Accessed 8 Dec. 2022.

Almazan, Anthony N., and Alex S. Keuroghlian. "Association Between Gender-Affirming Surgeries and Mental Health Outcomes." JAMA Surgery, vol. 156, no. 7, July 2021, pp. 611–18. Silverchair, https://doi.org/10.1001/jamasurg.2021.0952.

American Girl Angers Parents with Book Teaching Kids about Gender Expression. 7 Dec. 2022, https://nypost.com/2022/12/07/american-girl-angers-parents-with-book-teaching-kids-about-gender-expression/.

"American Girl Doubles Down On Kid Book About Gender Transition, Amid Backlash." TMZ, https://www.tmz.com/2022/12/08/american-girl-book-kid-children-gender-transitioning-baclkash/. Accessed 8 Dec. 2022.

"Gender-Affirming Care Saves Lives." Columbia University Department of Psychiatry, 23 June 2021, https://www.columbiapsychiatry.org/news/gender-affirming-care-saves-lives.

Hammer, Alex. "American Girl under Fire for Book That Teaches Girls to Change Gender." Mail Online, 6 Dec. 2022, https://www.dailymail.co.uk/news/article-11509601/American-Girl-accused-stripping-away-innocence-book-teaches-girls-change-gender.html.

Tordoff, Diana M., et al. "Mental Health Outcomes in Transgender and Nonbinary Youths Receiving Gender-Affirming Care." JAMA Network Open, vol. 5, no. 2, Feb. 2022, p. e220978. Silverchair, https://doi.org/10.1001/jamanetworkopen.2022.0978.


UPDATE [Dec. 9, 2022]: The terminology "changing gender" in the title, claim, and text of this fact check have been changed to reference receiving gender-affirming care.

Alex Kasprak is an investigative journalist and science writer reporting on scientific misinformation, online fraud, and financial crime.