In late March, before Arkansas lawmakers officially blocked minors from obtaining gender-affirming medical care, Willow Breshears, an 18-year-old trans woman in Little Rock, spoke of her fears to a local news outlet: “The people who are legislating [against] these trans kids have no grasp of what a trans experience is.”
Most in the medical community would agree with her.
As similar bills are introduced and debated across the country, transgender children and their families have gone public to explain that treatments like puberty-blocking hormones and gender-affirming hormone therapy are medically necessary and potentially lifesaving. But they’re not the only ones speaking out. Every major medical association in the United States — including the American Medical Association, the Endocrine Society, the Pediatric Endocrine Society, the American Academy of Pediatrics, the American Psychiatric Association, and the American Academy of Child and Adolescent Psychiatry — has issued statements supporting gender-affirming care for youth that have met specific diagnostic criteria (the World Professional Association for Transgender Health, for example, says adolescents are only eligible for puberty blockers if they’ve demonstrated “a long-lasting and intense pattern of gender nonconformity or gender dysphoria,” have the ability to understand the benefits and risks of the medication, and have parental consent). Many of the same groups have issued explicit statements opposing the bills or testified against them in state hearings.
Yet while opposition in the medical field has been overwhelming, it has not been unanimous. A small number of highly controversial doctors and researchers have been pushing these anti-trans bills. Representing organizations with seemingly professional names like the American College of Pediatricians or the Society for Evidence-Based Gender Medicine, they have effectively accomplished for gender dysphoria what anti-vaxxer medical professionals have sought to do for their cause: give credence to the notion that no scientific or medical consensus exists regarding the relative safety and efficacy of a given treatment, despite the clear and growing evidence to the contrary.
“The policy debates about banning gender-affirming medical care have been really hard to watch because every major medical organization is opposed to these bills,” said Jack Turban, a fellow in child and adolescent psychiatry at Stanford University School of Medicine who focuses on transgender youth. With no support from the mainstream medical community, conservative legislators have gone and found “this handful of people who have ‘MD’ after their name” but lack the research, experience, and evidence to back their claims, he said.
“Proponents of these bills claim that they are advocating in the interests of transgender children, which is actually ludicrous,” said Hannah Willard, the vice president of government affairs at Freedom for All Americans, a bipartisan group pushing for protections against LGTBQ discrimination nationwide. “These fringe extremists are trying to push a narrative that transgender people need saving from the medical experts.”
The last few years have brought an onslaught of anti-trans legislation; most recently, these proposed laws are attempting to ban trans children from playing in sports leagues that match their gender identity. One wave of legislation, which peaked in 2017 and 2018, aimed to limit trans kids’ ability to use the bathroom or locker room that corresponds to their gender identity. But last year, perhaps prompted by sensationalist and inaccurate right-wing media coverage of a Texas custody case involving parents who disagreed over treatments for their trans child, a new set of bills began appearing in legislatures across the country aimed at prohibiting or even criminalizing giving puberty blockers and gender-affirming hormones to minors. In the 2019–2020 legislative year, at least 15 states introduced bills prohibiting healthcare for trans youth. This year, at least 13 states have introduced similar bills. Arkansas is the first state to ban gender-affirming healthcare. On Monday, a committee in the Texas Senate heard testimony on a bill that would make it a felony for parents to provide their children with puberty blockers, hormones, or other gender-affirming care.
At least on the surface, proponents of these bills have framed their need in medical terms. The Arkansas bill, for example, makes a host of pseudoscientific claims: that the majority of gender-nonconforming children “come to identify with their biological sex in adolescence or adulthood,” that puberty blockers are being prescribed “despite the lack of any long-term longitudinal studies evaluating the risks and benefits of using these drugs,” and that “the risks of gender transition procedures far outweigh any benefit.”
But these assertions are either misleading or verifiably false, according to experts in the field. Studies have consistently shown that providing gender-affirming care to gender-diverse children — which includes allowing them to socially transition and access puberty blockers and gender-affirming hormones — is correlated with lower rates of suicide and mental illness. Studies have also shown that children who aren’t supported, such as those who undergo therapy with the aim of eliminating their trans identity, have worse health outcomes and are more likely to have thoughts of suicide.
Proponents of the anti-trans healthcare bills often distort the findings of these studies, experts told BuzzFeed News. Kristina Olson, a professor of psychology at Princeton University who in 2018 received a MacArthur grant to study the social and cognitive development of trans and gender-nonconforming youth, said the claim that children eventually identify with their birth gender as they enter adulthood is a misinterpretation of an outdated study, as other scientists have explained elsewhere.
More recently, critics of gender-affirming care have promoted a widely criticized and methodologically flawed study that appeared to indicate that gender dysphoria was being spread through social circles. In reality, this misconception was from parents of gender-nonconforming children.
Heron Greenesmith, a senior analyst at Political Research Associates, a progressive think tank dedicated to studying the American right, told BuzzFeed News that the widely accepted studies into best practices for trans youth have been undermined by a few physicians and mental health providers who espouse right-wing or explicitly anti-LGBTQ views. “People tend not to question folks with a medical degree,” Greenesmith said.
Brennan Suen, the LGBTQ program director at Media Matters for America who has tracked the anti-trans legislation and its media coverage, said “the anti-LGBT right” goes to great lengths to highlight the few medical professionals who agree with them because they give a “veneer of credibility” to the supposed dangers posed by gender-affirming treatment.
One organization has played an especially significant role in boosting the claims behind the bill, including by talking with lawmakers and submitting expert testimony during legislative hearings. According to Willard with Freedom for All Americans, the American College of Pediatricians has helped shape the debate in “nearly every state legislature pushing these bills,” including Georgia, where the first anti-trans healthcare bill was introduced, as well as Pennsylvania, Alabama, and Utah. ACP has also supported the federal bill that Republicans recently introduced into Congress. Quentin Van Meter, the ACP president, is the "foremost person being cited by anti-trans advocates,” Greenesmith said.
Turban, the Stanford researcher, has described ACP as a “small but clever anti-LGBT group [that] created a legit-sounding name.” He told BuzzFeed News that ACP is not the country’s leading organization for US pediatricians; that group is known as the American Academy of Pediatrics. In 2002, the AAP issued a statement in support of parents of the same sex, prompting a small number of socially conservative physicians to leave the group and found ACP. Since then, ACP has issued many controversial anti-abortion and anti-LGBTQ statements. It is currently designated as an anti-LGBTQ hate group by the Southern Poverty Law Center.
Newer groups are also playing a role, including the Society for Evidence-Based Gender Medicine. Last year, SEGM was cited in an Idaho bill barring trans people from changing the sex on their birth certificate. A federal court has since struck down the law. (In an email, a SEGM spokesperson said they never expressed support for the Idaho bill and that they “object to the politicization of healthcare.”) SEGM member William Malone told a Christian news site in 2019: "No child is born in the wrong body, but for a variety of reasons some children and adolescents become convinced that they were."
Media coverage has also confused matters. After initially gaining traction in the right-wing press, ACP is now routinely quoted in prominent news outlets. “We are basically being blackmailed (into providing hormone treatments) by that adolescent who’s emotionally troubled into doing something that they don’t understand,” Van Meter told Reuters last month in an article about the Arkansas law. Although the article notes that ACP belongs to a “minority of dissenters” within the medical community, it mentions neither the organization’s history of promoting anti-LGBTQ claims nor its certification by the Southern Poverty Law Center as a hate group. “It is completely irresponsible for the media to cite an extreme anti-LGBTQ group with an innocuous-sounding name like American College of Pediatricians,” said Brianna January, an LGBTQ researcher at Media Matters for America. “Placing its dangerous disinformation next to credible sources makes it falsely appear that this is a debatable topic, skewing how the public and policymakers understand the issue.
In statements to BuzzFeed News, both ACP and SEGM denied that they were promoting misinformation. Michelle Cretella, ACP’s executive director, called pediatric transition “an atrocity, not healthcare” and said that “society is being lied to and bullied by a medical establishment driven by a dangerous ideology and economic opportunity, not science and sound medical ethics.”
SEGM member Roberto D’Angelo said the group was concerned with the “low quality of evidence” in gender-affirming treatment. “The key issue under consideration is how to weigh the low-certainty findings of improvements in mental health associated with medical interventions against the many known and many more as-yet-unknown long-term health risks,” he said.
Opponents, including members of ACP and SEGM, have called for “hypothesis-driven randomized controlled clinical trials” to evaluate care models for treating gender dysphoria in children, but those techniques aren’t realistic or ethical, said Turban. Given the existing evidence for providing trans youth with gender-affirming care, and the fact that it’s already widely accepted in the medical field, no institutional review board would permit a randomized trial of puberty blockers or gender-affirming hormones, he said. Moreover, the study could never remain blind, since the effects of being given the medication would be impossible to hide.
Given the statements from every major medical association in the country, there is a clear and inarguable consensus supporting gender-affirming care. But that doesn’t mean these treatments carry no risk, Turban said. Regardless of the population or the medical issue at play, physicians are trained to weigh a treatment’s potential benefits against its risks. The same is true in caring for trans youth.
Medical providers and researchers still want more data to better understand various treatments, despite an established consensus. “We all agree that we need more data and that we wish there was more research,” said Olson, the Princeton researcher. But providers should still use the existing body of data to determine the best treatment for a trans child, she said: “I think it’s an unfair bar that we’ve created for trans healthcare.”
But for now, all eyes are focused on the legislation being pushed in states across the country. And the fear in the trans community is very real.
Casey Pick, a senior fellow for advocacy and government affairs at the Trevor Project, which operates a crisis intervention and suicide prevention helpline for LGBTQ youth, said their counselors have reported trans children and their families calling to ask what these bills are and when they’ll go into effect. Callers are distressed that the legislation will prevent them from getting the care they need, Pick said.
“This should not be treated as a philosophical debate,” she said. “This is a real concrete concern to real, actual LGBT youth.” ●