On Thursday, the U.S. Department of Health and Human Services (HHS) formally announced two anticipated proposed rules with implications for hospitals that render “sex-rejecting procedures” on dysphoric minors. One rule would make participation in Medicare and Medicaid programs contingent on health care entities not rendering “sex rejecting procedures” for dysphoric minors, while the other proposed rule would prohibit Medicaid and CHIP from funding “sex-rejecting procedures” for minors. Notably, both rules will undergo a 60-day public comment period and will likely face legal challenges before implementation. The HHS press release for the rules cites it's recent peer-reviewed report on gender dysphoria, noting that the report makes it clear that “these procedures do not meet professionally recognized standards of health care.”
This week, the House passed two bills with implications for pediatric medical transition in the United States. One of the bills, sponsored by Rep. Marjorie Taylor Green, would expand the definition of "genital and bodily mutilation and chemical castration," making it a felony to render pediatric medical transition procedures, with violators facing up to ten years in prison. The bill passed the House 216-211, with four Republicans voting against, and three Democrats voting in favor. The other bill, sponsored by Rep. Dan Crenshaw, would prohibit Medicaid funding for “affirming care.” On Thursday, Crenshaw’s bill passed the House 215-201, with four Democrats voting in favor. The bills are ultimately expected to die in the Senate, however.
A Sixth Circuit panel ruled in a 2-1 decision that Michigan’s ban against “conversion therapy”—which includes attempts to change “gender identity” although the term historically applied to sexual orientation change efforts—violates the plaintiffs 1st amendment rights by regulating the content and viewpoint of their speech. The panel reversed an earlier decision by a federal judge which denied the plaintiffs a preliminary injunction blocking enforcement of the policy. Although state conversion therapy bans normally include carve outs for “exploratory psychotherapy,” which is often considered to have a more favorable risk-benefit profile than medical transition, these laws have a chilling effect on clinicians who worry about indirectly running afoul of the law. The Supreme Court is set to weigh in on a different case involving Colorado’s conversion therapy ban at a later date.
After New Zealand moved to ban new prescriptions of puberty blockers for the purpose of pediatric medical transition after an evidence review found “a scarcity of quality evidence” regarding the impact of puberty blockers on mental health and well-being outcomes, the High Court in Wellington temporarily halted enforcement after a request for judicial review by the Professional Association for Transgender Healthcare Aotearoa (PATHA). Although New Zealand’s Health Minister, Simeon Brown, argues that the policy is necessary because the lack of evidence informing the use of blockers poses unintended consequences for gender dysphoric youth, PATHA argues that the policy is “illegal and unethical.” “In this judgement I make a declaration that the Crown should take no steps to enforce the regulations pending the judicial review being determined” wrote Justice Michele Wilkinson-Smith. “Standing back and looking at the overall justice of the situation, I am persuaded that a delay in enforcement of the regulations is the best option now available” she added.
In the Dallas Morning News, Leor Sapir argues that the release of new videos featuring clinicians from the World Professional Association for Transgender Health (WPATH) conceding that they perform life-altering procedures on adolescents and young adults with no supportive evidence, transfigures the debate over pediatric medical transition. While the public generally presupposes that medical associations support medical transition because it is safe and effective, Sapir exposes how these doctors practice “on the edge of medicine” without ethic oversight or mental health assessments, despite WPATH’s own guidance to conduct robust biopsychosocial assessments to rule out alternative diagnoses. Sapir focuses on the rise of what is known as “non-binary” procedures which aim to make patients sexually ambiguous, but these procedures lack a clear clinical indication or supporting evidence-base. Sapir goes on to explain how gender medicine is propped up in the U.S. by deference to WPATH’s controversial standard of care, which includes a chapter arguing that “eunuch” is a valid “gender identity” necessitating surgical intervention.
The Society for Evidence-Based Gender Medicine (SEGM) released a new digest summarizing the findings of five notable recent publications in gender medicine. The digest covers papers on hormonal transition and suicidality, how gender medicine is exceptionalized compared to other medical subfields, how publication bias and censorship skew the debate over evidence, detransition and sexual functioning, and a critique of the Canadian Pediatric Society’s stance on “affirming care.” “This issue brings together five papers that illuminate the core challenges now facing the field: insufficient methodological rigor, a lack of openness to debate, and policies not grounded in transparent evidence appraisal” SEGM writes.
Florida has filed a lawsuit against three medical associations for allegedly advocating for pediatric medical transition despite a lack of supporting evidence. The suit accuses WPATH, the Endocrine Society, and the American Academy of Pediatrics of violating Florida’s Deceptive and Unfair Trade Practices Act and engaging in racketeering by misleading “patients, parents, insurers, regulators, and courts about the reversibility and efficacy of pediatric sex interventions.” “For years, these groups insisted the recommendations were settled science, but behind closed doors, they knew the evidence was weak,” remarked Attorney General James Uthmeier in a video statement. Florida wants the court to determine that associations engaged in unfair trade practices, to impose a civil penalty against each defendant, and to prohibit the organizations from advertising medical transition as “safe and reversible” going forward.
In City Journal, I wrote about how NYC mayor-elect Zohran Mamdani’s use of moral rhetoric to argue for pediatric medical transition obscures nuance and debate. More specifically, I explain how much of Mamdani’s “LGBTQIA” policy platform—from putting LGBTQ “liaisons” in schools to creating a centralized hub to access exclusively “affirming” mental health services—is out of sync with key developmental considerations and is likely to push sex-distressed youth down a medicalization pathway.
Last week, Texas Attorney General Ken Paxton announced that the findings of an investigation warranted adding additional claims against two Texas doctors accused of rendering pediatric medical transition procedures in violation of Texas law. Because new evidence suggests that the two physicians—May Lau and Brett Cooper—falsified medical records, used inappropriate diagnostic codes, and submitted false billing claims, Texas added claims of healthcare fraud to the complaint under the Texas Health Care Program Fraud Prevention Act. “By submitting deceptive billing records, Lau and Cooper were able to conceal the ‘gender transition’ interventions and secure Medicaid reimbursement for services that Texas law and Texas Medicaid explicitly do not allow” reads a press release. In another notable suit, Paxton has accused the healthcare technology company, Epic Systems, of using a default configuration in their digital healthcare portal that limits the ability of parents to access the health records of their teenage children.
Joseph Figliolia
Policy Analyst
News
