In our qualitative, community-based, Canadian study we asked girls, young women, and girl-serving professionals to reflect on the current state of girls’ mental health, the causes of mental health erosion, and what must change. They revealed that the mental load of contradictory gendered expectations, social surveillance, internalized body criticism, and constant pressure and judgement create unyielding fear and emotional distress. We highlight the social contributors to girls’ mental health, illuminating how gender-based expectations and misogyny collude to create impossible situations from which there is little chance of escaping. Gender-transformative structural change that disrupts gender norms, affirms girls’ rights to mental health, and challenges the ubiquity of gendered oppression of the world's girls and young women is crucial.