by Orion Rumler19th, this story was originally published 19th
This is the story Originally reported by Orion Rumler 19th. Visit Orion and read more of their reporting on gender, politics and policy.
The largest medical association in the United States supports gender-affirming care — a position it has reiterated in several ways over the past 10 years. But as Republicans press leading medical organizations over health care for transgender youth, the American Medical Association (AMA) is the latest group caught between political rhetoric and the complex reality of specialized care that few receive.
As patients, families and doctors navigate this care in an increasingly confusing and hostile landscape, what medical groups say matters. But lately, what they have to say — and how politicians interpret it — has only caused more uncertainty.
The AMA’s position was already in question after a meeting in January between leaders of major medical groups and Dr. Mehmet Oz, head of the Centers for Medicare and Medicaid Services. After that meeting, which was first reported by The The New York Times, a group present – the American Society of Plastic Surgeons (ASPS) — muddies the waters on whether it has taken a more restrictive stance on gender-affirming care.
Questions soon followed for the AMA, the nation’s most prominent organization representing doctors.
Twenty Republican state attorneys general are pushing for the AMA to oppose gender-affirming care for minors in response to news coverage of their recommendations on youth surgeries. Attorneys suggest the AMA may be violating state consumer protection laws by misleading or even misleading medical providers and patients about their position. They cited wanting to “avoid formal investigation” into the issue.
Attorneys led by Steve Marshall in Alabama wrote one the letter February asked whether the group recommends hormone therapy or puberty blockers to treat gender dysphoria in minors.
“If you agree that there is insufficient evidence to support the use of surgical interventions to treat gender dysphoria in minors — as your recent statement indicates — we do not understand how you can find sufficient evidence to support the use of hormonal interventions to treat gender dysphoria in minors,” their letter reads.
This is an escalation of a familiar strategy, said Khadijah Silver, director of gender justice and health equity at Lawyers for Good Government. And if it works, it will be a major weapon in the political fight to legitimize gender-affirming care, they said.
“If you can convince the public that they’ve changed positions, that’s very powerful,” they said, referring to the AMA.
In some ways, that impact is already being felt.
At a recent congressional hearing on rising health care costs, the chair of the American Medical Association’s board of trustees was asked about how patients across the country are struggling to find doctors. Two hours in the hearingHe was also asked about gender-affirming care for trans youth — an issue that affects very few Americans, but takes on a lot of political air.
Rep. Erin Houchin, a Republican from Indiana, asked why the medical group changed its position on surgery for trans youth.
But the AMA maintains that it has not changed its position.
“For surgery and minors, our belief is that it should generally be deferred until adulthood. But, we respect the physician-patient-family relationship in making that decision,” Dr. David H. Aizus responded in response to the Congresswoman’s question.
The exchange took just a few minutes of a hearing that spanned the crisis facing the US health care system, e.g Skyrocketing insurance premiums and a growing physician shortage. But it represents growing tension between Republicans and medical groups, as elected officials who oppose gender-affirming care push major health care organizations to do the same.
The American Medical Association declined to comment on the attorney general’s letter, which sought a response by March 25. In a broad statement, the medical group said it supports gender-affirming care.
“We support evidence-based treatment for medical care, including gender affirming care,” an AMA spokesperson said in an email. “At present, the evidence for surgical interventions in minors is insufficient for us to make a definitive statement. In the absence of clear evidence, surgical interventions in minors should generally be deferred until adulthood. Treatment decisions should be made between the physician and the patient (and family) based on the best medical evidence and clinical judgment.”
This position is aligned with the World Professional Association for Transgender Health (WPATH), an authority on medical care for trans people. WPATH by recommending Patients who typically wait until adulthood before undergoing surgery. Trans youth rarely undergo any type of surgery; Performed on a small number of teenagers, the majority are mastectomies.
If a teenager needs surgery, WPATH recommends they meet broad criteria — full understanding of reproductive side effects, a year’s worth of hormone therapy, persistent gender nonconformity, as well as emotional and cognitive maturity.
Questions about the surgery come on the heels of the American Society of Plastic Surgeons’ response to a January meeting with Oz. In what the Times described as an “exciting” meeting, Oz pressed leaders of organizations including the AMA and ASPS on why they recommend gender-affirming care for trans youth. At that meeting, the surgeon group said it would change its position, according to the Times.
A few weeks after the meeting, ASPS published a nine-page statement states that gender-affirming surgery for minors should be delayed until a patient is at least 19 years old. The surgeons’ group cited insufficient evidence that the benefits of surgery outweighed the risks, and pointed to a controversial report. Created by the Trump administration Returned to his position.
The surgeon group noted that it still opposes the criminalization of such medical services. The Trump administration celebrated the announcement.
“Today marks another victory for biotruth in the Trump administration,” said former Deputy Health and Human Services Secretary Jim O’Neill. Press release. Oz, who compared sex-affirming care for minors to a lobotomy, Applause American Society of Plastic Surgeons “for placing itself on the right side of history.”
In the days that followed, the surgeon’s team appeared to be falling behind. says the American Society of Plastic Surgeons told NPR That its position “does not include a blanket recommendation for surgery on minors.” ASPS did not respond to a request for comment on this story.
The AMA has had trouble communicating its position. In a recent interior Newsletter From the board chair, the association said its policy on gender-affirming care has not changed at all; And it requested a revision from The New York Times in response to the outlet’s coverage of the youth surgery’s initial statement. But the Times says it is No such request received.
This is happening against an intense political backdrop: six states make it one crime For doctors to provide gender-affirming care to trans youth. There are hospitals all over the country off Gender clinic in response to administration pressure. As a result, some young patients are cut off in the middle of treatment, and medical professionals are grappling with how the law affects them.
And despite a lot of news coverage, Gender-specific care Not yet widely understood.
Few transgender youth seek and access surgery. Rely more on hormone therapy and puberty blockers to treat gender dysphoria, which is a medical condition Which can cause significant suffering for trans people.
Puberty blockers delay the hormones that cause children to go through puberty, which can be an intense and emotionally fraught time for trans youth. Many families say this treatment important for their child’s well-being and prevents distress caused by dysphoria. There are potential risks, such as decreased bone density, which are monitored by medical providers. Some providers recommend weight-bearing exercise or diet optimization to increase calcium and vitamin D levels while on puberty blockers.
Hormone therapy, which involves taking testosterone or estrogen to cause physical changes that align one’s body with their gender identity, is another treatment that some trans youth receive to alleviate dysphoria. As with puberty blockers, treatment requires a clinic mental health evaluation as well as parental or guardian consent.
Multiple studies have found that access to this treatment Reduces depression and anxiety For trans youth. But they are now Banned in many parts of the countryRepublican politicians and conservative lobbying groups later State House flooded with bills Aim to limit care to minors.
The Endocrine Society and the American Academy of Pediatrics are under federal investigation for their support of gender-affirming care. Both have medical groups caseAs Govt wants information to determine whether they made “false or unsubstantiated representations” about care.
Attorneys’ general letter to the American Medical Association is increasing pressure on medical groups, Silver said.
“Because care is so politicized, any association that stands up and provides support for physicians who provide care, will make an example of them,” they said.
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