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Yale medical, legal experts 'appalled' by actions denying gender-affirming care

Yale medical and legal experts issue new report debunking the recent actions denying gender-affirming treatment to children and youth
Sharon McCutcheon
Yale medical and legal experts have issued a new report that aims to debunk recent actions denying gender-affirming treatment to children and youth.

Medical and legal experts at Yale University have weighed in on recent actions to stop gender-affirming procedures for minors.

Thenew report from Yale Law School, the Yale School of Medicine’s Child Study Center and Departments of Psychiatry and Pediatrics, and the University of Texas Southwestern and Children’s Medical Center Dallas raises concerns with the “biased science” behind recent actions in Texas and Alabama to deny gender-affirming care for minors who are transitioning.

In February, the Texas attorney general, Ken Paxton, issued a legal opiniondescribing transgender medical care for youth as “child abuse” under the Texas Family Code. On that basis – in the absence of legislation passed that changes the law – Republican Gov. Greg Abbott instructed the Texas Department of Family and Protective Services to investigate parents offering gender affirming care as potential abusers.

The Texas Supreme Court ruled to resume the investigation of parents and doctors who provide gender-affirming care, after a lower court injunction barred state officials from pursuing Abbott's directive.

Alabama adopted a statute that makes it a felony to provide gender-affirming puberty blockers and hormones to transgender youth, although a federal judge recently blocked the medication ban.

Dr. Meredithe McNamara, assistant professor of pediatrics with Yale School of Medicine, is one of the authors of the Yale report.

“I think that a real win would be to completely strike down a law that illegalizes the standard of care and puts trans youths’ lives in jeopardy,” she said. “That did not happen. However children who are experiencing gender dysphoria and receiving treatment do not have to undergo a forced medical detransition because of this law at this time.”

Teachers in Alabama, however, will remain required to disclose gender dysphoria to parents if a student talks to them about it.

“The fight to protect trans kids is far from over,” McNamara said. “The forced disclosure of a young person’s gender identity to parents against the young person’s will is part of this law, and that’s a real blow to a young person’s autonomy.”

Earlier, Steve Marshall, the Alabama attorney general, said in a statement that "the law reflects a growing international consensus that children suffering from gender dysphoria should not be receiving puberty blockers, cross-sex hormones, and surgeries. Children who take these drugs risk permanent infertility, loss of sexual function, increased risk of heart attack and stroke, bone-density problems, risk of altered brain development, and psycho-social harms from delayed puberty.”

Marshall further stated that “the majority of children who experience dysphoria will have it resolve naturally by adulthood, if not subjected to the interventions above.”

Paxton extended his support and said: “I support any law in any state that protects vulnerable children from the sexual predations of the left.”

Those actions prompted Yale experts, along with others, to author the report Biased Science: The Texas and Alabama Measurers Criminalizing Medical Treatment for Transgender Children and Adolescents Rely on Inaccurate and Misleading Scientific Statements. 

“We were really appalled by the misuse of science in the Texas attorney general’s opinion and in the Alabama law,” said Anne Alstott, professor of law at the Yale Law School, and one of the report’s authors.

Alstott said she considered both of these actions to be an unconstitutional infringement in two ways. One, Alstott said, is that both the Texas and Alabama actions unconstitutionally infringe parents’ rights to provide standard medical care to their children.

“Our big message in our report is that this is standard medical care approved by every major medical organization and so denying parents the right to provide that care is, I think, unconstitutional,” Alstott said. “The second constitutional violation here is that transgender youth are being targeted. These very same medical treatments are administered to cisgender youth.”

“Even here in Connecticut, crisis calls from youth experiencing gender dysphoria are worsening, because this is not a safe country for them to be who they are.”
Dr. Meredithe McNamara, Assistant Professor of Pediatrics (Adolescent Medicine), Yale School of Medicine

McNamara said recent actions in Texas and Alabama “needed to be challenged with science.”

“In Texas and Alabama, from what I understand, it is impossible now to continue gender-affirming care,” McNamara said. “Hormone treatments have had to be stopped completely. Parents in Alabama now are afraid to administer the medications that their doctors have prescribed for fear of incurring felony charges.”

The report states the following:

  • Texas and Alabama officials have incorrectly claimed that doctors are routinely sterilizing children and teenagers with surgical procedures — The authors point out that the authoritative medical protocols for treating transgender young people and prepubertal children do not permit genital surgery before the age of majority. 
  • The Texas and Alabama actions ignore the mainstream scientific evidence on the substantial benefits of gender-affirming care — Recognized scientific studies show that gender dysphoria is real and that gender-affirming care significantly improves mental health outcomes, including reducing rates of suicide. 
  • The Texas and Alabama actions exaggerate the risks of gender-affirming drug therapy –- Puberty blockers and hormonal treatments, which are used in adolescents (and not in prepubertal children), are safe and effective and are used only after a careful, staged process of psychological and medical counseling. These therapies have long been approved by major medical authorities.
  • The Texas and Alabama authorities rely on poor-quality evidence — The Texas Attorney General cites debunked and out-of-date studies and relies on an unvetted website created by political activists with little or no relevant scientific expertise.

At least 12 other states are considering legislation to restrict care for transgender youth.
McNamara said she is concerned about the environment in Connecticut, as well.

“Even here in Connecticut, crisis calls from youth experiencing gender dysphoria are worsening, because this is not a safe country for them to be who they are," she said.

The Associated Press contributed to this report, which has been updated.

Sujata Srinivasan is Connecticut Public Radio’s senior health reporter. Prior to that, she was a senior producer for Where We Live, a newsroom editor, and from 2010-2014, a business reporter for the station.

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