Transgender Surgery Debate Intensifies as Attorneys General Question AMA

The previously unassailable support for gender transition procedures among institutions is increasingly under scrutiny. Following a recent statement from the American Medical Association (AMA), suggesting doubts about its stance on gender surgeries for minors, a group of state attorneys general focused on protecting children has decided to take action.

On Monday, twenty state AGs sent a letter to AMA CEO Dr. John J. Whyte, asking for clarification on the organization’s views regarding gender transition hormones for minors.

The letter was spearheaded by Alabama Attorney General Steve Marshall (R), who was joined by his Republican colleagues from various states including Arkansas, Georgia, Indiana, Louisiana, and West Virginia.

The AGs’ inquiry was a direct response to a media statement from the AMA earlier this month. When asked about the American Society of Plastic Surgeons’ (ASPS) recent opposition to gender surgeries for minors, the AMA acknowledged that, “In the absence of clear evidence, the AMA agrees with ASPS that surgical interventions in minors should be generally deferred to adulthood.”

Attorney General Marshall pointed out, “The AMA has finally admitted something we’ve been warning about for years: its recommendations for child surgeries lacked solid evidence, despite previous assertions to the contrary.” He added, “Yet, the same questionable science underlies the use of puberty blockers and cross-sex hormones. You can’t dismiss one as unsupported and still advocate for the others. When it comes to children’s lives, scientific honesty is crucial.”

This inquiry was the main goal of the letter. The attorneys general expressed appreciation for the AMA’s admission regarding surgeries on minors but expressed concern that the AMA still supports the use of puberty blockers and hormones to treat gender dysphoria. They argued that the evidence quality remains low for both interventions, much like that for surgeries.

The letter emphasized, “If you agree there’s insufficient evidence to support surgical interventions for minors, how can you endorse hormonal treatments? These interventions pose similar risks, and in some cases, can be even more dangerous due to their perception as less serious.”

The AGs cited recent reviews from the U.S. Department of Health and Human Services and the National Health Service in England, highlighting the uncertainty surrounding surgeries and hormone treatments related to gender dysphoria.

“The evidence supporting these treatments is notably lacking,” they wrote. They referred to the HHS review, stating that “certainty of evidence is very low” for both surgical and hormonal interventions concerning mental health outcomes and safety.

The AGs questioned whether the AMA still endorses gender transition procedures for minors considering the shaky evidentiary foundation. They also sought clarification on the AMA’s stance regarding the “Standards of Care” by the World Professional Association for Transgender Health (WPATH), which they believe has been swayed by political agendas.

Marshall, discussing this on a podcast, asserted, “[The AMA] should focus on defining medical best practices, free from political influence. If they strip away the political agenda, the scientific consensus shows there’s insufficient grounding for puberty blockers or cross-sex hormones in gender-affirming care.”

The AMA previously stated that “medical and surgical treatments for gender dysphoria … are medically necessary,” although they did not officially endorse WPATH’s standards.

The letter posed several questions for the AMA, such as whether it supports puberty blockers or cross-sex hormones for minors and the basis for those recommendations.

They even asked how the AMA justified joining amicus briefs in legal cases where they claimed the transitioning procedures were both evidence-based and effective for minors.

The AGs gave the AMA 30 days to respond, likely anticipating they know what the answers will be. However, requesting a formal explanation is a necessary due process step before any potential legal actions—though the letter hints at such actions being a possibility.

“We hope to avoid a formal investigation, but we are concerned the AMA may be violating consumer protection laws,” they stated in the letter. “Alabama law, for instance, forbids organizations from causing confusion about endorsements of services.”

To avoid legal pitfalls, the AMA must clarify its support for various gender transition procedures and retract support for any unsupported practices.

As it stands, no gender transition procedures are robustly supported by evidence. The recent ASPS recommendation against surgeries for minors highlighted low-quality evidence and significant associated risks.

The state attorneys general aim to prompt the AMA to make a similar acknowledgment. Government oversight has a proven impact on maintaining accountability in medical associations, and the coalition seeks to intensify that scrutiny on the AMA.

As Marshall emphasized, “The AMA has the chance to convey to physicians that those involved in transitioning minors are at significant risk—financially and ethically—especially given the growing trend in Europe to deem these practices as experimental.”