On Tuesday, a group of 22 Republican attorneys general, led by Idaho Attorney General Raúl Labrador, sent a letter to the president and vice president of the American Academy of Pediatrics, accusing the organization of violating laws on consumer protection by approving the use of puberty blockers. . The letter also demands answers to 14 in-depth questions and expanded access to internal documents. Although the letter has no legal authority, states are increasingly using vague and broad consumer protection laws to investigate the records of gender-affirming health care and abortion providers, often with little or no judicial review.
The letter, bearing the seal of the Idaho Attorney General’s Office, seeks to bar the American Academy of Pediatrics (AAP) from endorsing puberty blockers as a form of reversible gender-affirming care for adolescents transgender people, using consumer protection laws as a basis. “Statements made by medical professional organizations, such as the AAP, are subject to state consumer protection laws…misleading and deceptive statements by medical professional associations are related to commerce and reach consumers,” the letter states, asserting the authority of Republican-controlled states. challenge the AAP’s endorsement of puberty blockers and justify further investigations into the organization’s documents.
The letter relies on flawed science and blockbuster articles from far-right, anti-transgender think tanks that have struggled to gain credibility in the scientific and medical communities. It criticizes the organization for describing puberty blockers as “reversible,” a position supported by several medical and scientific organizations, backed by studies and decades of use in treating precocious puberty and other conditions. A study from the Sax Institute found that “two systematic reviews have indicated that puberty suppression treatment is reversible” and that the treatment is “effective, safe, well tolerated, and reversible.”
The letter makes extensive reference to the Cass Review. On the second page, for example, he claims that the claim that puberty blockers are reversible is false, “beyond medical debate.” To support this claim, he cites the Cass Review, which identifies several “possible” irreversible consequences, such as interference with neurocognitive development, bone density, and “blocking of normal pubertal experience and experimentation.”
These claims, however, are not well supported by evidence. For example, the claim regarding neurocognitive development in the Cass Review is entirely speculative. In contrast, the Sax Review found that transgender youth who received gender-affirming hormone therapy demonstrated better cognitive development than those who did not receive it, meaning that gender-affirming care has actually improved the cognitive development of many trans youth through a reduction in negative psychological symptoms. It also states that a study making this claim did not take into account ASD and anxiety, which have proven effects on cognitive development. Other studies of brain development focus primarily on sheep or young people experiencing early puberty.
Similarly, bone density issues are frequently cited as reasons to ban puberty blockers. However, the Sax Review notes that reductions in bone density are “within one standard deviation of normal” and that bone density is restored once puberty resumes. Additionally, according to the Sax Review, most young people in studies showing reduced bone density were vitamin D deficient. That’s why the informed consent form for puberty blockers addresses this risk and its mitigation, stating, “It is important that patients taking Lupron Depot® take other steps to protect their bones: staying active and ensuring a good intake of calcium and vitamin D.”
The last claim, that puberty blockers “block normal pubertal experience and experimentation,” is also entirely speculative. Proponents of this position often point to the high rate of continuation of gender-affirming hormone treatment (as does the letter itself). However, this could be seen as evidence of effective treatment protocols rather than evidence of “blocked sexual or identity development”, particularly given the low rates of detransition among young people undergoing hormone treatment.
The letter extensively cites far-right think tanks, fringe newspaper articles and even the New York Times to support his argument that the AAP should not endorse puberty blockers as being well-supported by evidence. For example, he refers to Léor Sapir and City newspaper making inaccurate statements about detransition rates. City newspapernotably, is a conservative online publication run by the Manhattan Institute, an organization that received a large grant from a billionaire donor to oppose transgender care. The letter also relies on misleading files from WPATH, anti-trans expert Steven Levine and articles in the New York Times par Azeen Ghorayshi.
After threatening that the AAP could face lawsuits for supporting gender-affirming care for transgender youth, the letter demands answers to 14 probing questions. These include requests for any internal communications regarding WPATH standards of care, any communications with the Biden administration regarding transgender care, and any drafts of its public statements. The letter also asks why the AAP “continues to cite WPATH’s published standards of care even after the release of the WPATH Files,” a highly editorialized and misleading document that contains 216 instances of errors and misrepresentations.
Although these probing questions do not have legal authority, many state attorneys general could use consumer protection laws to attempt to seize cases in a more formal proceeding. This tactic has already been used to target transgender care in Texas and Missouri, as well as in requests targeting Planned Parenthood records. The use of civil investigative requests under consumer protection laws has been controversial because they do not require the same level of judicial review. If the AAP refuses to respond, attorneys general could threaten lawsuits in several states, potentially bankrupting the children’s medical organization in legal fees simply for supporting transgender youth.
The AAP has not yet released a statement on the requests or whether or not it will comply with them.
This article was originally published on Erin in the Morning.
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