‘Ideology, Not Science’ Animates Medical-Interest Groups on Trans Interventions on Minors

Proponents of—euphemism alert!—“gender-affirming care” for minors are challenging provisions of a Kentucky law that bar prescribing or administering puberty blockers and cross-sex hormones to minors for such a purpose. Christopher Mills, a former law clerk to Justice Thomas (and an occasional NRO contributor) has submitted a devastating amicus brief that exposes the ideological agenda and shoddy scientific claims of medical-interest groups that masquerade as scientific authorities.

From the brief’s introduction (some citations omitted; italics in original):

WPATH’s claim of robust evidence [that supports the efficacy of gender-transition medical interventions for minors] has always been false. How do we know? Because after the Family Research Council filed a brief in [a previous] case exhaustively showing that nearly everyone—other than ideologically-captured American medical interest groups—recognizes the paucity of reliable long-term evidence about sterilizing interventions in minors, WPATH quietly deleted every claim about a “robust body of empirical evidence” from its brief on that appeal— and all its future briefs. Then WPATH refused repeated invitations to explain its about-face, instead retreating to meaningless and still-incorrect claims that “evidence indicates the effectiveness of treating gender dysphoria according to the guidelines.” WPATH’s “indicatory” evidence is a handful of slipshod studies that failed to control for relevant variables or to reach statistically or clinically significant results.

The medical groups’ reliance on such studies to claim a “robust” scientific “consensus” exposes WPATH, the AAP [American Academy of Pediatrics], and others for what they are: policy advocates rather than honest brokers of medical evidence, at least when it comes to this issue. The one common ground in all the literature—even the medical groups’ own policy statements—is that, as an England National Health Service review recently concluded, there is “limited evidence for the effectiveness and safety of gender-affirming hormones in children and adolescents with gender dysphoria” and the “long-term safety profile of these treatments” is “largely unknown.” WPATH’s own new Standards of Care, which nonetheless approve chest and genital surgeries to transition children regardless of age, say that because “the number of studies” about adolescent treatment “is still low,” “a systematic review regarding outcomes of treatment in adolescents is not possible” and “the long-term effects of gender-affirming treatments initiated in adolescence are not fully known.”

But once again, WPATH withholds that information from the Court, suggesting no evidentiary doubt whatsoever about giving cross-sex hormones to an 11-year-old….

The reason to wait for medical interventions—and the reason that this law passes any level of scrutiny—is that the consequences of “gender-affirming care” for a minor are drastic. Gender dysphoria in the vast majority of children does not persist into adulthood. But children who take puberty blockers then cross-sex hormones—the near-universal transitioning pathway—are expected to become sterile and potentially suffer many other negative repercussions.

All this is why Kentucky had to act: to protect girls and boys from a medical establishment more interested in profit and ideology than the needs of children. The Plaintiffs rely on certain interest groups to define the standard they want to govern the people. But constitutional law should not be outsourced to medical interest groups. On this issue, these groups’ positions derive from ideology, not science. The Court should deny a preliminary injunction.

The body of the brief is replete with damning details, too numerous to try to summarize. Here’s an example that illustrate how WPATH’s ill-founded “standards of care” license money-grubbing doctors to inflict sterilizing interventions on children in the absence of any long-term studies demonstrating their safety and effectiveness:

As a doctor in Vanderbilt’s transition clinic bragged, the hospital started the clinic after being convinced that it would be a “big money maker”: hormone interventions “bring[] in several thousand dollars,” while “top” surgeries “bring in” $40,000, and “female to male bottom surgeries are huge money makers” ($100,000) because they are so “labor-intensive” and “require a lot of follow-up.” Why bother with the difficult work of addressing underlying mental health issues through psychosocial support—an approach that many countries mandate but WPATH here ignores—when profitable genital surgeries on vulnerable children without threat of lawsuits await?