Boston’s Fenway Health, a leader in pediatric gender medicine, has announced that it will cease providing cross-sex hormones and puberty blockers to dysphoric patients under 19, in response to the Trump administration’s EO Protecting Children from Chemical and Surgical Harm. According to the Boston Globe, Fenway Health sent a letter to patients explaining the calculus behind its decision and emphasized that if it did not modify its “affirming care” policies, the organization risked running afoul of U.S. Health Resources and Services Administration rules, putting its designation as a Federally Qualified Health Center in jeopardy. “This change in position is a response to a shifting federal landscape that requires us to adapt in order to remain compliant, sustainable, and able to provide healthcare, support, and services to all our patients and the community,” the letter to patients said.
On Monday, the U.S. Supreme Court declined to hear a case involving two Colorado families who allege that their 14th amendment rights were violated when their children discussed “gender identity” and sexual orientation at school sponsored events but were discouraged from informing their parents. A federal district court ultimately dismissed their lawsuit and squashed a later attempt to amend the suit. Subsequently, the U.S. Court of Appeals for the 10th Circuit upheld that decision. Lawyers representing the parents urged the Supreme Court to take up the case and highlighted the stakes. “These policies actively deprive parents of the very information they need to exercise their legal rights and moral obligations to act in their children’s best interests” the lawyers wrote. Notably, despite opting not to hear the case, Justices Alito, Gorsuch and Thomas noted that the “allegations in this case underscore the ‘great and growing national importance’ of the question that these parent petitioners present.”
In a court filing last week, federal prosecutors argued that there is evidence that Boston’s Children’s Hospital may have engaged in fraudulent coding and billing practices to ensure that dysphoric minors received insurance coverage for puberty blockers, which remain unapproved by the FDA for the treatment of gender dysphoria. The crux of the argument is that the hospital has seen an unusual spike in children diagnosed with “central precocious puberty,” which is often treated with puberty blockers. The main red flag, though, is that these diagnoses are often made when children are already in the normal age range for pubertal development, belying the claim that their development is precocious. There remains “no clear explanation for why BCH would go from diagnosing almost no 11-year-olds with CPP for the years 2017-19 to diagnosing 50 11-year-old patients with CPP in 2022,” lawyers for the government argued. They went on to elaborate that the “large scale of these late diagnoses raises suspicion that BCH incorrectly diagnosed certain children with CPP in order to mislead insurance companies or others into covering puberty blockers for older children with gender dysphoria.”
Last week, District Judge Jackson Lofgren upheld North Dakota’s law prohibiting minors from accessing sex-rejecting interventions for the treatment of gender dysphoria. Judge Lofgren determined that there was little evidence that the law was motivated by discriminatory intent. The Judge added that “The evidence establishes there is an ongoing international debate regarding the safety and effectiveness of the medical procedures prohibited by the Health Care Law. Where there is uncertainty, deference is given to the Legislature to decide where the line should be drawn.” Of note, in June the U.S. Supreme Court upheld Tennessee’s law prohibiting minors from accessing sex-rejecting interventions for the treatment of gender dysphoria.
After refusing to sign a commitment to uphold an “LGBTQ Affirmation” policy mandated by the Massachusetts Department of Children and Families (DCF), a Massachusetts couple has lost their foster license. Since 2020, the Marvin family has fostered eight different children under the age of 4, however, in 2022 a new policy required families to uphold a new “affirming” policy. Citing their religious beliefs, the Marvins refused to sign the compact, and their licenses were ultimately revoked. They appealed the decision but lost again. Notably, the Trump administration has reached out to the Massachusetts DCF regarding its affirmation policy and vowed to launch an investigation.
Last week, the Supreme Court heard oral arguments in Chiles v. Salazar, a controversial case involving a licensed professional counselor, Kaley Chiles, who argues that Colorado’s law prohibiting “conversion” therapy for sexual orientation and “gender identity” infringes on her 1st amendment and Free Exercise rights. In recent years, the research on conversion efforts for sexual orientation has been extended to “gender identity” even though they are meaningfully distinct concepts, and both dysphoria and trans-identification remain dynamic attributes that change throughout development. Nevertheless, many states now have laws prohibiting therapists from attempting to change a child’s “gender identity,” although they often leave carve outs for “exploratory psychotherapy” which some critics interpret as a dog whistle for conversion efforts (for more reading on the conceptual problems with the “conversion” therapy charge, see HHS’ subchapter on “psychotherapy and its application to gender dysphoria” or this City Journal piece). During oral arguments, both sides debated the evidence for the alleged harms of “conversion” efforts. Many analysts believe that the court’s conservative majority is likely to ultimately side with Chiles and her free speech claim, which would have major implications for the roughly twenty or so states that have similar laws on the books.
In a new Manhattan Institute report, I draw on dozens of resolutions, policies, and never-before-published internal correspondence to provide an analysis of how medical associations become “institutionally captured” on the issue of pediatric gender medicine. The report uses the Texas Medical Association (TMA) as a case study to chronicle and analyze how and why medical organizations adopt positions on “affirming care” that clash with the principles of evidence-based medicine. The report also briefly considers the implications for reforming medical associations, including enforcing governance structure and conflict of interest and open discourse policies.
Joseph Figliolia
Policy Analyst
