[1] Shrier states that there was a "sudden, severe spike in transgender identification among adolescent girls" in the 2010s, referring to teenagers assigned female at birth.

[4][1] She attributes this to a social contagion among "high-anxiety, depressive (mostly white) girls who, in previous decades, fell prey to anorexia and bulimia or multiple personality disorder".

[12] She critiques the gender-affirming model of care[13] and profiles its critics: Kenneth Zucker, Ray Blanchard, J. Michael Bailey, Lisa Marchiano, and Paul R.

[18][19] The contentious concept of rapid-onset gender dysphoria (ROGD), which Irreversible Damage endorses, was first proposed in a 2018 paper by Lisa Littman.

[22] In a July 2020 interview on The Joe Rogan Experience, Shrier called the desire to transition a "contagion" and compared it with eating disorders and self-harm.

[34] Chase Strangio, an attorney for the American Civil Liberties Union (ACLU), tweeted that "stopping the circulation of this book and these ideas is 100% a hill I will die on."

[35] The book has been translated into multiple languages and foreign-language versions have been released in other countries such as Spain,[36] France, Hungary[37] and Israel where a speech by Shrier drew protesters.

[47] It received mixed reviews from the theologian Tina Beattie in The Tablet[22] and the psychologist Christopher Ferguson in a Psychology Today blogpost.

[5] Science-Based Medicine retracted a positive review by their co-editor the physician Harriet Hall[50] and subsequently published a series of articles criticizing the book.

[53] The Economist called the book "one of the first accessible treatments of a subject that has generated much fascinated coverage" but remarked it had not received many reviews in mainstream papers.

It credited Shrier with "[telling] the stories of those she interviews with great care", but suggested that she might have overstated the extent to which teenagers were receiving medical interventions.

[44] Naomi Schaefer Riley wrote that Shrier was correct to ask "what's ailing" adolescents who appeared to suddenly begin identifying as transgender.

[49] Historian Ben Miller compared the cover's design, "with the little white girl's reproductive organs obliterated by a black hole," to that of Nazi propaganda posters.

[54][55] Psychiatrist Jack Turban accused Shrier of promoting the denial of gender-affirming medical care from transgender youth, which he called a fringe position rejected by several professional societies.

He also accused Shrier of misinterpreting and omitting scientific evidence to support her book's claims and criticized her for portraying transgender youth based on interviews with parents, and for "crass and offensive language.

"[5] Skeptic and physician Harriet Hall published a positive review of the book on the website Science-Based Medicine in June 2021, stating that Shrier "brings up some alarming facts that desperately need to be looked into", that care centered on gender affirmation "is a mistake and a dereliction of duty", and that the current political climate has made scientific study of these matters nearly impossible.