New Report Finds Gender Medicine Policy Is More Political Than You Might Have Thought

NEW YORK, NY – Medical societies have unilaterally championed “gender-affirming care,” but this united front has recently come under greater scrutiny. In the Skrmetti Supreme Court ruling, Justice Clarence Thomas implicitly questioned the expertise of U.S. medical associations. Also, a 2025 U.S. Department of Health and Human Services report on pediatric gender dysphoria highlighted the role played by U.S. medical associations in propping up an artificial consensus on gender medicine that is undermined by the findings of systematic reviews, the highest standard of evidence in evidence-based medicine. With this in mind, what’s behind the broad acceptance of “gender-affirming care”?

In a new Manhattan Institute report, policy analyst Joseph Figliolia investigates the Texas Medical Association (TMA), a state affiliate of the American Medical Association that has played a key role in driving national medical support for “gender-affirming care.” Through internal documents and interviews with TMA members, Figliolia constructs a timeline revealing the incentives and group psychology that have led nearly every major medical association to endorse “gender-affirming care.”  

His key findings include:

• TMA’s LGBTQ Health Section gained outsized influence: Members of an LGBTQ “affiliation group” became seen as de-facto experts on transgender healthcare. In turn, these members started to occupy positions on prominent councils and committees, which allowed members to influence the policy making process prior to consideration by TMA’s House of Delegates. At different junctures, LGBTQ Section Members were part of key reference committees tasked with evaluating resolutions related to “gender-affirming care.” According to TMA data from 2022, 92% of reference committee recommendations were adopted by TMA’s House of Delegates.
• LGBTQ Health Section agenda was widely unpopular: A TMA internal survey found that only 1% of members stated that “affirming care” was among the top organizational priorities, and fewer than one in four agreed it was “important broadly.” Despite this, transcripts reveal that LGBTQ Section members used vague or misleading language to “trojan horse” unpopular policies.
• TMA’s Board of Trustees ignored the issue: When TMA members expressed concerns that TMA’s social justice activism and the presence of pro-affirming physicians on TMA’s Board of Trustees raised concerns about violations of fiduciary duties, these concerns were not addressed. As a 501(c)(6) organization, members of the TMA’s Board of Trustees are to promote the “best interests” of the TMA.

Figliola warns that this situation represents a clear case of institutional capture, or more specifically committee capture, in which a small group of like-minded activists have complete control in shaping policy, which silences and marginalizes members with opposing views. Figliolia also considers the importance of governance oversight and COI policies in reforming medical associations.

Click here to read the full report.