Calling Out Scientific Misinformation
and Protecting Transgender Youth
AMSA Endorses an Expert Report: “Biased Science: The Texas and Alabama Measures Criminalizing Treatment for Transgender Children and Adolescents Rely on Innacurate and Misleading Scientific Claims”
By: Kyle Gavulic, Shamik Bhat, and Bassel Shanab
2021 set a dismal record: states across the country collectively introduced a total of 147 anti-transgender laws, with many of these targeting transgender youth. A record 13 bills against transgender youth became law, starting with Arkansas’ “Save Adolescents From Experimentation (SAFE) Act” that prohibited physicians from providing medically necessary, gender-affirming care to youth on the false basis that gender-affirming care possesses greater risks than benefits.
Unfortunately, in 2022, the Human Rights Campaign is tracking an even larger number of anti-LGBTQ bills, a number of which persistently target transgender youth. Most notably, in February 2022, the Texas Attorney General introduced an interpretation of state law that defines gender-affirming care as child abuse (the AG Opinion), and, in April 2022, the Governor of Alabama signed the “Vulnerable Child Compassion and Protection Act” (the Alabama Law) banning physicians from providing medically necessary, gender-affirming care to youth. Similar to Arkansas’ “SAFE Act,” the AG Opinion and the Alabama law are grounded in scientific misinformation that subject transgender youth to inequitable medical treatment and severely threatens their livelihood.
In response to these inhumane state-sponsored attacks on transgender youth, a group of medical and law faculty members from the Yale School of Medicine, Yale Law School, and University of Texas Southwestern joined to examine the claims made in the recent AG Opinion and Alabama legislation. In their report, “Biased Science: The Texas and Alabama Measures Criminalizing Treatment for Transgender Children and Adolescents Rely on Inaccurate and Misleading Scientific Claims,” this team of medical and legal experts expose the multitude of errors in these two recent high profile anti-transgender policies.
As medical students and future physicians, we, the Yale Chapter of AMSA, join with AMSA National to commend these medical and law leaders who have assembled this scientifically well-informed report. A large body of literature shows that transgender youth endure higher risks of bullying, depression, and suicidality, not to mention greater barriers to accessing health care. Out of consideration for the additional harms that these systemic acts of hate and scientific misinformation impose on transgender youth and their families, as well as on our ability as future physicians to properly care for them, AMSA endorses the report published by faculty members of the Yale Law School faculty, Yale School of Medicine, University of Texas Southwestern, and condemns the AG Opinion, Alabama Law, and similar attempts to limit and attack gender-affirming care.
As described in their report, the AG Opinion and Alabama Law falsely assert that providers of gender-affirming care prescribe puberty blockers, sterilization procedures, and high doses of testosterone and estrogen to prepubertal children. These claims, if true, would run counter to the medical guidelines from the World Professional Association for Transgender Health and the Endocrine Society that physicians follow. For instance, surgical treatments for gender dysphoria can only be considered after the age of majority. Meanwhile, medical treatments such as puberty blockers are only permitted for adolescents (once puberty has begun). As in most pediatric settings, a parent or guardian must consent to these treatments as well, and gender-affirming drug therapy is provided after thorough discussions and assessments by physicians and mental health professionals.
Moreover, the authors of the report describe how the AG Opinion and Alabama Law fail to accept scientific consensus by the world’s leading professional associations of pediatricians, psychologists, and adolescent and children psychiatrists as well as that of Texas and Alabama (e.g. Texas Medical Society and Alabama Psychological Association) by neglecting to correctly acknowledge and understand gender dysphoria. By denying and misstating established scientific evidence in the assessment and treatment of gender dysphoria, the AG Opinion and Alabama Law place transgender people’s lives at risk through the denial of timely life-saving gender-affirming care.
Finally, the authors emphasize the overstatement of the risks of gender-affirming drug therapy in both the AG Opinion and Alabama Law. Both falsely claim that puberty blockers cause irreversible infertility and loss of bone mineral density. These claims are contradicted by the scientific consensus: puberty blockers temporarily stall the development of puberty and reduce fertility, yet puberty resumes normally and their effects on fertility are reversed if the medications are halted. Meanwhile, the benefits of puberty blockers, and gender-affirming care more broadly, are invaluable to adolescents with gender dysphoria. By misrepresenting and exaggerating the effects of these medications, the AG Opinion and Alabama Law will make gender-affirming care harder to access; care that serves an important role in lowering the odds of depression and suicidality.
The full extent of anti-LGBTQ governance threatening rights to health care in 2022 is still yet to come; just earlier this month, Florida signaled its intent to no longer allow Medicaid to cover gender-affirming care, with a public hearing expected in early July. Yet, there are many tangible, effective ways to counter these acts of hate that behold such harmful medical consequences. First, as members of the medical community, we can inform our peers, family members, medical institutions, and policy makers of the scientific consensus on gender-affirming care by referring them to the report: Biased Science: The Texas and Alabama Measures Criminalizing Treatment for Transgender Children and Adolescents Rely on Inaccurate and Misleading Scientific Claims, among other expert sources. Already, last month, in Alabama, we witnessed the powerful voice of physicians when Judge Burke, after reviewing the scientifically sound medical guidance, blocked the Alabama ban on physicians providing age-appropriate gender-affirming care.
Second, we call on all medical students, especially those within and from Alabama, Texas, Florida, and any other state that has introduced or signed an anti-LGBTQ bill into law to call, email, or write to your state and federal congressional offices about the harmful consequences on the health and well-being of transgender youth and the dangers of the discredited claims within the AG Opinion, the Alabama Law, and other copy/paste anti-transgender policies.
Third, until the Equality Act is passed, universal nondiscrimination protections for all members of the LGBTQ community will not be achieved. While calling and writing to your state and federal representatives, we ask that you as medical students and physicians also signal your support for the passage of the Equality Act, which would amend the Civil Rights Act of 1964 to also include sexual orientation and gender identity among other personal characteristics, such as race, color, religion, sex, and national origin, by which discrimination is illegal.
Fourth, we encourage medical students around the country to work with peer and faculty allies to identify gaps in the education and training of physicians in LGBTQ health, including gender-affirming care for transgender individuals, and to develop new curricula that will train the next generation of physicians how to better care for transgender individuals, as well as other gender and sexual minorities. Similar to the cross-sector effort and leadership of the medical, mental health, and legal experts that wrote the report that we endorse in this post, we advocate for collaborations across disciplines and institutions, including with our own Yale Chapter of AMSA.
As this year’s Pride month comes to an end, we remind you how dangerous hateful governance and scientific information are for transgender youth and other members of the LGBTQ community and to remain vigilant to the dynamic policy environment. Our voices, as well as our trust and understanding of science, are powerful. We must use them to promise equitable health care for all.
For more information, once again, the full report can be found here.
This is an official statement from the American Medical Student Association, written by Kyle Gavulic, Shamik Bhat, Bassel Shanab. Gavulic, Bhat, and Shanab are second year medical students at Yale School of Medicine and co-leaders of the Yale Chapter of AMSA.
This statement was reviewed and endorsed by Michael Walls DO MPH, AMSA President.
We would also like to thank Meredithe McNamara, MD, MS, FAAP, Assistant Professor of Pediatrics (Adolescent Medicine) at Yale School of Medicine and co-author of “Biased Science: The Texas and Alabama Measures Criminalizing Treatment for Transgender Children and Adolescents Rely on Innacurate and Misleading Scientific Claims,” for her thoughtful feedback and comments.