New England Journal of Medicine, November 24, 2022
A virulent brand of science denialism is emerging in the U.S. legal system, as states enact bans on gender-affirming health care. Misused clinical research and disinformation have provided legal cover for bans on essential treatments for transgender and gender-expansive (TGE) people. A template for challenging science denialism could come from collaborations between medical and legal experts that have supported initiatives to protect access to gender-affirming care.
Transgender and nonbinary (TGNB) youth in the US face growing sociopolitical obstacles in pursuit of health care. In 2021 and 2022, Arkansas and Alabama enacted legislative bans on gender-affirming care (GAC), with penalties for physicians ranging from loss of licensure to imprisonment. In 2022, the Texas attorney general set a troubling precedent by issuing a legal opinion equating GAC with child abuse, claiming that this treatment constitutes forced sterilization and experimentation. Such actions rely on scientific misinformation, retracted research, and politically biased sources. These bans on GAC place guardians and health care professionals in an ethically precarious position, in which the law and the standard of care conflict.
With Christina Lepore, Rebecca Kamody, Laura Kuper, Nathalie Szilagyi, Susan Boulware, and Christy Olezeski
Journal of Adolescent Health, July 2, 2022
Up to 10% of youth express some degree of gender expansivity and about 1.8% identify as transgender. All providers working with children and adolescents care for transgender or gender expansive (TGE) youth, but knowledge gaps and low comfort levels with GAC are common. Legally codified misinformation presents an additional challenge to those on the front lines of clinical care. In this commentary, we identify and correct misconceptions that providers may encounter in this new sociopolitical climate.
Legislation attacking medical care for transgender youth marks a new extreme for scientific misinformation in the America. Years of study and scientific scrutiny have established safe, evidence-based guidelines for delivery of lifesaving, gender-affirming care. Medical ethics as outlined in the Hippocratic oath and professional guidelines not only permit but require doctors to provide it.
