State AGs Hold AMA’s Feet to the Fire on Gender Transitions for Children

The once-ironclad defenses of institutions captured by the transgender agenda appear to be crumbling before our eyes. After a recent statement by the American Medical Association (AMA) suggested its defense of gender transition surgeries for minors was shaky, a coalition of state attorneys general committed to defending children has decided to press the point.

On Monday, 20 state AGs wrote a letter to AMA CEO and Executive Vice President Dr. John J. Whyte seeking clarification on the organization’s position with regard to gender transition hormones for minors.

Alabama Attorney General Steve Marshall (R) led the letter, in which he was joined by his Republican counterparts from Arkansas, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Nebraska, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, and West Virginia.

The AGs’ letter responded to a media statement released by the AMA earlier this month. When pressed for a reaction to news that the American Society of Plastic Surgeons (ASPS) released a position statement against gender transition surgeries for minors, the AMA gave media outlets a statement admitting, “In the absence of clear evidence, the A.M.A. agrees with ASPS that surgical interventions in minors should be generally deferred to adulthood.”

“The American Medical Association has finally admitted what many have warned for years: its recommendations for surgeries on children were not grounded in solid evidence, despite telling doctors and families otherwise,” said Attorney General Marshall. “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.”

This line of inquiry was the purpose of Monday’s letter. The attorneys general “read with appreciation” the AMA’s admission about transgender surgeries on children. However, they added, “We thus find it concerning that the AMA continues to support the use of puberty blockers and cross-sex hormones to treat gender dysphoria in minors. The quality of evidence is the same as it is for surgeries: low and very-low quality.”

“So if you agree that there is insufficient evidence to support using surgical interventions to treat gender dysphoria in minors — as your recent statement indicates — we do not understand how you can find that there is sufficient evidence to support using hormonal interventions to treat gender dysphoria in minors,” the letter reasoned. “These interventions have not been shown to be any safer for children than surgeries are, and in fact may be all the more dangerous precisely because they are viewed as not as serious. But hormones can leave a child sterilized just as surely as surgery can.”

The letter cited recent systematic evidence reviews conducted by the U.S. Department of Health and Human Services, as well as by the National Health Service in England. They cited from the HHS review that “the certainty of evidence is very low regarding the effect of surgery on [gender dysphoria] or incongruence, improvement in mental health including suicidality and depression, and long-term outcomes such as sexual function, quality of life, and regret.”

Likewise, “the evidence base is similarly lacking when it comes to the provision of puberty blockers and cross-sex hormones to treat gender dysphoria in minors,” they wrote. Again citing the HHS review, “[t]he certainty of evidence is very low regarding the effect on [gender dysphoria] or incongruence, improvement in mental health, and safety metrics including fertility and bone health” of cross-sex hormones.

In fact, “the rationale for providing the treatments” that Annelou de Vries, a pioneer of the infamous “Dutch studies” that pioneered gender transition procedures for minors, has shifted from arguing for the effectiveness of outcomes to claiming that “effective” outcomes were not necessary.

The attorneys general wanted to know whether the AMA still defends gender transition procedures for minors as its evidentiary basis erodes. In particular, the attorneys general wanted to know where exactly the AMA stood with regard to the “Standards of Care” produced by the World Professional Association for Transgender Health (WPATH), an activist organization whose guidelines were improperly influenced by political considerations brought by the Biden administration.

Marshall, who joined Family Research Council President Tony Perkins on Tuesday’s “Washington Watch,” insisted, “[T]he AMA ultimately needs to be a medical organization that’s not in political advocacy, but defining what’s best medical practice for doctors across our country. … Absent a political agenda on the Left, now they need to be able to step up and recognize [that] what the science also tells us is that there’s no basis for puberty blockers and cross-sex hormones being used to deal with gender affirming care,” the AG argued. “And we’re now giving them the opportunity by this letter to be able to say very clearly what their positions are. Do they stand with science? Do they stand with what we’ve seen [in] the overwhelming trend coming from Europe to identify this as experimental treatment of kids?”

The AMA recently claimed that “medical and surgical treatments for gender dysphoria and gender incongruence … are medically necessary as outlined by generally-accepted standards of medical and surgical practice,” the letter noted, although they decline to officially endorse WPATH’s standards.

The letter asked 14 questions of the AMA, including, “Does the AMA endorse or otherwise recommend the provision of puberty blockers to minors to treat gender dysphoria? If so, what is the basis of that recommendation, and how do you distinguish the evidence base for the provision of surgeries versus the provision of puberty blockers?”

Likewise, “Does the AMA endorse or otherwise recommend the provision of cross-sex hormones to minors to treat gender dysphoria? If so, what is the basis of that recommendation, and how do you distinguish the evidence base for the provision of surgeries versus the provision of cross-sex hormones?”

And, for good measure, “How did the AMA decide to join the amicus briefs in United States v. Skrmetti and other cases in which the AMA told courts that the WPATH and Endocrine Society guidelines were evidence-based and well-accepted and that the provision of transitioning procedures to minors was safe and effective at treating gender dysphoria and improving well-being?”

These are good questions. The letter gives the AMA 30 days (until March 25) to respond. The attorneys general likely suspect they know what the answer is. But politely requesting an explanation is a first step of due process before any potential prosecution — a prospect the letter does raise.

“While we hope to avoid a formal investigation under our consumer protection laws, we do have concerns that the AMA may be violating those laws,” the letter warned. “Under Alabama law, for instance, it is unlawful for an organization to cause ‘confusion or misunderstanding as to the … sponsorship, approval, or certification of goods of services,’” to “represent ‘that goods or services have sponsorship, approval, … uses, benefits, or qualities that they do not have,’” to “represent ‘that goods or services are of a particular standard, quality, or grade … if they are of another,’” or to “engage ‘in any other unconscionable, false, misleading, or deceptive act or practice in the conduct of trade or commerce.’”

To avoid violating these provisions, the AMA would have to both clarify what gender transition procedures it does or does not support and renounce support for gender transition procedures not supported by the evidence.

In fact, no gender transition procedures are well-supported by the evidence. When the ASPS issued its recommendation against gender transition surgeries on February 3, it cited low-quality evidence and a high risk of harm as major reasons not to carry out the procedures on minors.

The state attorneys general aim to induce the AMA to make a similar concession. The ASPS statement against gender transition surgeries for minors came as the result of government scrutiny, as the organization “was participating in an urgent, time-limited process initiated by a federal agency seeking clarification of medical society positions on this topic,” wrote ASPS Executive Vice President Michael Costelloe.

This demonstrated the result that government scrutiny can achieve in keeping medical associations accountable to the truth. Following suit, the coalition of state attorneys general has applied a bit more scrutiny, in hopes of calling the AMA to account.

As Marshall put it, “The AMA has the opportunity to make sure to send a message to physicians that if, in fact, you’re in one of those states that continues to allow this experimentation on children to take place, that they are at great risk … not only financially for themselves — we’ve already seen a verdict come from a detransition — but they’re also clearly harming kids in ways that aren’t validated by science.”

Originally published by the Washington Stand.

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