Last August, the American Academy of Pediatrics renewed its guidance supporting the use of puberty blockers, hormone therapy, and other medical care for transgender children and teens. At a time when trans issues have moved to the center of the culture wars, the AAP—the main medical association representing US pediatricians, with 67,000 members—said its action was aimed at supporting trans minors amid new waves of anti-trans laws.
Now, Republican officials from 21 states have accused the medical group of violating state consumer protection laws by supporting gender-affirming care for trans youth. More ominously, they’re demanding that the AAP turn over extensive records about how it developed its policy.
In a letter signed by Idaho Attorney General Raúl Labrador and sent to the medical group this week, the GOP officials claim that the AAP is misleading parents and the public about the reversibility of puberty blockers and hormone therapy. The letter calls gender-affirming care “medical experimentation” and demands the AAP produce years’ worth of communications and documents related to its guidance for treating trans youth.
“It is without question that anti-transgender policies, and the dangerous rhetoric surrounding them, take a measurable toll on the health and safety of transgender and nonbinary young people all across the country.”
The letter was signed by the usual array of Republican suspects, including the top lawyers of Texas, Ohio, Florida, and nearly every state with laws restricting gender-affirming care. As state bans face legal challenges and injunctions, these attorneys general appear to be laying the groundwork for a new strategy to further their ideological agendas over the objections of medical experts.
The AAP is the leading US authority on pediatric health care, regularly releasing policy statements on a slew of topics, including medical treatment of LGBTQ youth. Last year, in addition to reaffirming its 2018 guidance on gender-affirming care, the AAP board of directors also authorized a systematic review of existing research to develop an “expanded set of guidance” for pediatricians. The 2018 policy statement supports a “collaborative, multidisciplinary approach” to treating gender dysphoria in trans youth that includes the ongoing, informed consent of the child and parents.
The GOP officials’ latest salvo disregards the AAP’s expertise and presents a bad-faith interpretation of the association’s gender-care policy. “Children with gender dysphoria need and deserve love, support, and medical care rooted in biological reality,” Labrador asserted in a statement announcing the letter. “Parents should be able to trust that a doctor’s medical guidance isn’t just the latest talking point from a dangerous and discredited activist agenda.”
Labrador’s letter leans heavily on a dispute over whether puberty blockers are reversible, citing the UK-commissioned Cass Review, issued this past April, which experts have criticized for its methodology and biased assertions about gender identity. “Telling parents and children that puberty blockers are ‘reversible’ at the very least conveys assurance that no permanent harm or change will occur,” the letter reads. “But that claim cannot be made in the face of the unstudied and ‘novel’ use of puberty blockers to treat gender dysphoria.”
In fact, AAP itself emphasizes that there are risks associated with the use of puberty blockers to treat gender dysphoria—mostly the potential for distress caused by social stigma. Research on long-term effects is limited and varied, with some studies suggesting impacts on bone density and fertility. As the Mayo Clinic points out, bone density concerns are typically addressed with calcium and vitamin D supplements. Meanwhile, organizations including AAP and the World Professional Association for Transgender Health (WPATH) recommend that before initiating treatments, providers and patients extensively discuss the fertility implications and options. Indeed, the gap in long-term research on gender-affirming care is precisely why AAP and other experts advocate for the continued study of evidence-based practices.
The Republican officials gave the AAP until October 8 to hand over all its communications with WPATH related to standards of care, dating back to 2020; all communications with the White House regarding gender-affirming care, and “substantiation” for many aspects of the AAP’s 2018 guidance. That policy statement already includes nearly 100 citations, including systematic reviews, AAP committee findings, and other organizations’ standards of care.
The AAP did not respond to Mother Jones’ request for comment.
Twenty-six states have passed laws restricting gender-affirming care for trans youth, according to the health policy think tank KFF. In Idaho—where Labrador is the top law enforcement official—medical providers face felony charges and up to 10 years in prison for prescribing puberty blockers and hormone therapy to trans minors. Most state bans, including Idaho’s, are facing legal challenges, but so far, only Arkansas’ law has been permanently blocked. (Florida’s ban, which also restricts care for trans adults, is in effect while the state appeals.) The US Supreme Court will hear a case this term regarding the constitutionality of Tennessee’s ban on the use of puberty blockers and hormones in trans youth.
Meanwhile, the effect of laws targeting transgender youth and adults is becoming increasingly evident. A new study by researchers from The Trevor Project, published in the journal Nature Human Behavior, suggests a causal link between anti-trans laws and suicide attempts in trans people. The study of 61,000 transgender and nonbinary kids and young adults, conducted from 2018 to 2022, found that attempted suicide among trans children increased by as much as 72 percent in states that passed restrictions on gender-affirming care.
“It is without question that anti-transgender policies, and the dangerous rhetoric surrounding them, take a measurable toll on the health and safety of transgender and nonbinary young people all across the country,” says Jaymes Black, CEO of The Trevor Project. “It’s not necessary to fully understand their experience to acknowledge that they—like all young people—deserve dignity, respect, and the ability to lead healthy and full lives.”
