Respect Equality

Report says gender-affirming care bans in Alabama, Texas based on ‘flawed science’

“The scientific errors and omissions are so extensive that the conclusion is clear: these laws are motivated by bias and crafted to achieve a preordained goal: to deny gender-affirming care to transgender youth,” one of the report’s authors said.
Texas Attorney General Ken Paxton speaks during the 2021 Conservative Political Action Conference in Dallas. (Brandon Bell/Getty Images)

Story at a glance

  • A report from researchers at Yale University and the University of Texas Southwestern Medical Center (UTSMC) claims efforts to ban gender-affirming care for transgender and nonbinary youth in Texas and Alabama are based on “flawed” scientific evidence and unreliable sources.

  • Officials in Texas and Alabama intentionally omitted critical evidence demonstrating the benefits of gender-affirming care, a panel of seven experts wrote in the report.

  • An Alabama law criminalizing gender-affirming care for minors went into effect over the weekend, while efforts in Texas have mostly stalled.

A new report “strongly refutes” the scientific backing of measures against gender-affirming care introduced in Alabama and Texas, claiming authorities in both cases omitted critical evidence that demonstrates the benefits of interventions like puberty blockers and hormone therapies in treating gender dysphoria in transgender and nonbinary youth.

Officials in Alabama and Texas have “exaggerated potential harms” of gender-affirming care and intentionally painted “a warped picture of the scientific evidence” that is available, a team of seven medical and legal experts at Yale University and the University of Texas Southwestern Medical Center (UTSMC) wrote in a recent report.

An Alabama law criminalizing gender-affirming care for minors was signed by Gov. Kay Ivey (R) late last month and went into effect on Sunday. Under the law, it is now a felony — punishable by up to a decade in prison — to provide or recommend puberty blockers, hormone therapies or other gender-affirming interventions to patients younger than 19 years old.

“We should especially protect our children from these radical, life-altering drugs and surgeries when they are at such a vulnerable stage in life,” Ivey wrote last month in a signing statement. “I believe very strongly that if the Good Lord made you a boy, you are a boy, and if he made you a girl, you are a girl.”


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The law has been challenged in several lawsuits, and a two-day hearing in a case seeking a preliminary injunction ended Friday with no indication of whether a judge will halt the law’s enforcement while litigation continues.

In Texas, Republicans have launched several efforts to restrict or ban gender-affirming care.

In February, an opinion authored by Attorney General Ken Paxton equated gender-affirming care to “child abuse,” prompting Texas Gov. Greg Abbott (R) to order state agencies to open abuse investigations into the parents of transgender youth, warning of “criminal penalties.”

A Texas judge in March blocked those investigations by issuing a statewide injunction, which Paxton has sought to appeal.

Researchers at Yale and UTSMC in their report argue that the evidence used to justify both measures is deeply flawed — and intentionally misleading.

“The Texas AG opinion and the Alabama Law do not represent good-faith efforts with a few mistakes,” Anne Alstott, a Yale law professor and one of the report’s authors, said in a news release. “The scientific errors and omissions are so extensive that the conclusion is clear: these laws are motivated by bias and crafted to achieve a preordained goal: to deny gender-affirming care to transgender youth.”

According to Alstott and her colleagues, claims made by Texas and Alabama officials that doctors are “sterilizing children” and young adults by performing gender-affirming surgeries is categorically false, citing guidance from the World Professional Association for Transgender Health (WPATH) and the Endocrine Society, which do not permit genital surgery before the age of majority, which in most places is 18 years old.

The only medically accepted form of gender-affirming care for prepubertal children is social transition, which may include a name or pronoun change or gender-affirming haircut.

While some forms of gender-affirming care, like hormone therapy, may reduce fertility to some degree, evidence suggests that these effects are reversible and can be managed by standard medical protocols.

According to the report’s authors, the Alabama and Texas measures also “consistently ignore” current mainstream scientific evidence that documents the benefits of gender-affirming care.

Paxton in his February opinion wrote that “the medical evidence does not demonstrate that children and adolescents benefit” from gender-affirming care (which he referred to as “irreversible sterilization procedures”). Most reliable research says otherwise.

“The established scientific evidence shows that treatment improves mental health outcomes, including reducing rates of suicidal ideation and suicide attempts,” the report’s authors wrote. 

A recent study published in the Journal of the American Medical Association found that receiving gender-affirming interventions like puberty blockers or hormones was associated with 60 percent lower odds of depressive symptoms and 73 percent lower odds of self-harm or suicidal thoughts during the first year alone.

Yale and UTSMC researchers in their report add that Texas and Alabama officials have greatly exaggerated the risks of puberty blockers and gender-affirming hormones, which have long been approved by major medical organizations like the American Medical Association and the American Academy of Pediatrics to treat gender dysphoria.

Efforts to ban gender-affirming care in both states also rely heavily on “poor-quality evidence,” according to the authors, which claim that Paxton’s opinion uses “debunked and out-of-date studies” and uses evidence from an “unvetted website created by political activists with little or no relevant scientific expertise.”

“These are not close calls or areas of reasonable disagreement,” the authors wrote. “The AG Opinion and the Alabama Law’s findings ignore established medical authorities and repeat discredited, outdated, and poor-quality information.”

“We need to call for fact-based checks on legal opinions and legislation,” Meredithe McNamara, a doctor with the Yale School of Medicine and Child Study Center and one of the report’s authors, said in a statement.

“Scientists need to have a seat at the table. And perhaps most importantly, there must be a penalty for writing fake science into law,” she said. “Trans and nonbinary youth are facing the fight of their lives to simply exist and we can’t let them stand alone. This is a matter of life and death.”