Dr. Erica Anderson, 71, who transitioned at age 45, told the L.A. Times the rise in the those numbers could be the result of peer pressure.

“For a while, we were all happy that society was becoming more accepting and more families than ever were embracing children that were gender variant,” Anderson told the Times.

“I think it’s gone too far. Now it’s got to the point where there are kids presenting at clinics whose parents say, ‘This just doesn’t make sense.’ To flatly say there couldn’t be any social influence in formation of gender identity flies in the face of reality. Teenagers influence each other.”

Anderson, who has helped hundreds of teens transition, questions whether there are thorough enough mental health evaluations being done before hormones or surgeries are recommended to youths unsure about transitioning.