Journalist Jesse Singal writes for the New York Times about the role U.S. medical societies have played in propping up an illusory consensus around pediatric gender medicine. Singal gives Times readers a crash course in how medical association policy statements endorsing so-called “affirming care”—which were not based on evidence reviews—convinced other associations to endorse the practice. In turn, activist organizations were now able to point to the newly established consensus on pediatric gender medicine. At the same time, however, healthcare bodies in countries like the UK, Sweden and Finland were conducting evidence reviews and pivoting away from medical interventions after the reviews generally found only “low certainty” evidence for clinical benefits. Ultimately, Singal conceptualizes the U.S. medical association consensus as an institutional failure that also further erodes public trust. “It’s vital that the organizations that represent mainstream science be open, honest and transparent about politically charged issues. If they aren’t, there’s simply no good reason to trust them” Singal concludes.
Twenty states, spearheaded by Alabama and Attorney General Stephen Marshall, are demanding that the American Medical Association renounce support for hormonal interventions to treat pediatric gender dysphoria after recently conceding that surgical interventions lack strong supporting evidence. After the AMA seemingly reversed its stance endorsing surgical interventions after a new position statement by the American Society of Plastic Surgeons, the Attorneys General have pointed out that that the weak evidence base for surgeries also extends to hormonal interventions, and is now seeking to understand how the AMA reconciles its current position with the findings of evidence reviews. “Yet the same weak science underpins puberty blockers and cross-sex hormones. You cannot dismiss one intervention as unsupported while continuing to push the rest. When children’s lives and futures are at stake, anything less than full scientific honesty is reckless. The AMA must follow the science completely, not selectively” Marshall told the Daily Wire.
A group of one hundred and six senate democrats have penned an open letter to CMS Administrator, Dr. Mehmet Oz, urging the Trump administration to rescind two proposed federal rules which would functionally reduce access to medical transition for gender dysphoric minors. Ironically, the letter posits that the rules “would mark an unprecedented intrusion of partisan politics and ideology into medical decision-making,” even though mainstream support for medical transition is largely the product of partisan and ideological considerations, not evidentiary ones. Despite the findings of HHS’ peer reviewed report, and the recent position statement by the American Society of Plastic Surgeons, the letter writers continue to promote the claim that “affirming care” is “medically necessary, evidence-based care.”
The American Academy of Pediatrics and U.S. Endocrine Society have filed lawsuits against the FTC alleging retaliation and free speech violations after the agency launched consumer protection probes into both associations for potentially misleading statements about the benefits of “affirming care.” Both organizations are seeking to block document requests that are part of the probes. Although the AAP is claiming that the government is retaliating over the organization’s 2018 position statement endorsing “affirming care,” it’s worth noting that the position statement was infamously written by a single pediatrician and was not based on the findings of systematic evidence reviews.
Earlier this week, Congressman Bob Onder reintroduced the Chloe Cole Act, federal legislation which would put in place protections for those harmed by “affirming care” practices. The legislation would place full liability on health care providers and entities that render “affirming care” practices, create a private right of action, and create a lengthy statute of limitations. “This Department of Justice is proud to work hand-in-hand with Rep. Bob Onder on the Chloe Cole Act. This vital legislation will protect our children and give people deeply harmed by so-called ‘gender affirming-care’ the necessary tools to seek the relief they deserve” Attorney General Pam Bondi said in a statement.
Utah’s Senate Business and Labor Committee voted 5-1 last Thursday against HB193, a bill which would prohibit taxpayer funded insurance from covering “affirming care” interventions. The bill would also mandate that public insurance companies pay for any medical interventions associated with “detranstioning” if those same companies paid for the original transition interventions. Although “affirming care” has not been shown to improve mental health or reduce the burden of psychiatric illness in systematic reviews, some critics misleadingly argued that “affirming care” is more cost effective in the long term because “we know that gender-affirming care reduces depression, anxiety and suicidality. Costs from those are also quite high.”
According to Gothamist, Mount Sinai in New York City has begun notifying families that they will no longer provide “affirming care” to existing minor patients or take on new ones. The move comes despite a letter from health officials reminding New York hospitals that state and city law prohibit discriminating against patients based on “gender identity” and sexual orientation. The hospital’s decision likely stems from two proposed rules by the Trump administration, which would prohibit federal funds for paying for “affirming care” and make the receipt of federal funds contingent on not rendering these practices.
Journalist Ben Ryan provides more insight into Fox Varian’s historic malpractice suit, this time focusing on the expert testimony of WPATH president-elect Dr. Loren Schechter. Notably, Schechter testified on behalf of Fox, not the medical provider defendants. Schechter testified that the assessing psychologist was ill equipped to work with trans-identified youth and that the total lack of communication between the referring psychologist and gender surgeon constituted a breach of the legal “standard of care.” Schecter’s review of the case notes makes it seem like both the psychologist and surgeon expected the other to provide a more careful assessment for surgery readiness.
The UK’s planned clinical trial on puberty blockers has been put on hold after ethical and safety concerns were raised by the Medicines and Healthcare Products Regulatory Agency (MHRA). “Since potentially significant and, as yet, unquantified risk of long-term biological harms is present to participants and biological safety has not been definitively demonstrated in this proposed cohort, at the very least, there should be a graded/stepwise approach starting with those aged 14 as the lower limit of eligibility,” a statement by MHRA reads. In addition to raising concerns about the age of eligibility, the MHRA also raised concerns about the informed consent process, and the need for more detailed monitoring of patient bone density. “If you take it line by line, almost paragraph by paragraph, it pretty much throws out the current trial design,” said the investigations editor at the New Stateman, journalist Hannah Barnes. For more coverage, see Barnes’ piece in the New Statesman.
Joseph Figliolia
Policy Analyst
