Biased Science: The Texas and Alabama Measures Criminalizing Medical Treatment for Transgender Children and Adolescents Rely on Inaccurate and Misleading Scientific Claims

30 Pages Posted: 16 May 2022

See all articles by Susan Boulware

Susan Boulware

Yale University - School of Medicine

Rebecca Kamody

Yale University - School of Medicine

Laura Kuper

University of Texas at Dallas - The University of Texas Southwestern Medical Center

Meredithe McNamara

Yale University - School of Medicine

Christy Olezeski

Yale University - School of Medicine

Nathalie Szilagyi

Yale University - Yale Child Study Center

Anne Alstott

Yale University - Law School

Date Written: April 28, 2022

Abstract

On February 18, 2022, Texas Attorney General Ken Paxton issued an interpretation of Texas state law (the “AG Opinion”), taking the position that certain medical procedures constitute child abuse as defined in the Texas Family Code. Texas Governor Greg Abbott cited the AG Opinion as authority for his February 22, 2022 directive requiring the Texas Department of Family and Protective Services to “conduct a prompt and thorough investigation of any reported instances of these abusive procedures” (the “Governor’s Directive”). On April 7, 2022, Governor Kay Ivey of Alabama signed S.B. 184 (the “Alabama Law”), which imposes felony penalties on anyone providing certain medical care to any child, adolescent, or young adult under age 19.

We are a group of six scientists and one law professor. Among the scientists, three of us are M.D.s., three are PhD’s, and all treat transgender children and adolescents in daily clinical practice. We all hold academic appointments at major medical schools. In this report, we examine in depth the scientific claims made in the AG Opinion and the text of the Alabama Law about medical care for transgender children and adolescents.

After examining the AG Opinion and the findings of “fact” in the Alabama Law in detail, we conclude that their medical claims are not grounded in reputable science and are full of errors of omission and inclusion. These errors, taken together, thoroughly discredit the AG Opinion’s claim that standard medical care for transgender children and adolescents constitutes child abuse. The Alabama Law contains similar assertions of scientific fact, and these too are riddled with errors, calling into question the scientific foundations of the law.

The Texas Attorney General either misunderstands or deliberately misstates medical protocols and scientific evidence. The AG Opinion and the Alabama Law make exaggerated and unsupported claims about the course of treatment for gender dysphoria, specifically claiming that standard medical care for pediatric patients includes surgery on genitals and reproductive organs. In fact, the authoritative protocols for medical care for transgender children and adolescents, which define what we term “gender-affirming care,” specifically state that individuals must be over the age of majority before they can undergo such surgery. The AG Opinion and the Alabama Law also ignore the mainstream scientific evidence showing the significant benefits of gender-affirming care and exaggerate potential risks.

These are not close calls or areas of reasonable disagreement. The AG Opinion and the Alabama Law’s findings ignore established medical authorities and repeat discredited, outdated, and poor-quality information. The AG Opinion also mischaracterizes reputable sources and repeatedly cites a fringe group whose listed advisors have limited (or no) scientific and medical credentials and include well-known anti-trans activists.

Funding and Conflicts of Interest: We received no funding for this project and have no conflicts of interest to declare.

Note:
Funding Information: We received no funding for this project.

Declaration of Interests: We have no conflicts of interest to declare.

Keywords: transgender, child abuse, gender-affirming care, trans youth, trans teens, trans children, Texas, Alabama

JEL Classification: L1, L14, L18, J78

Suggested Citation

Boulware, Susan and Kamody, Rebecca and Kuper, Laura and McNamara, Meredithe and Olezeski, Christy and Szilagyi, Nathalie and Alstott, Anne L., Biased Science: The Texas and Alabama Measures Criminalizing Medical Treatment for Transgender Children and Adolescents Rely on Inaccurate and Misleading Scientific Claims (April 28, 2022). Yale Law School, Public Law Research Paper Forthcoming, Available at SSRN: https://ssrn.com/abstract=4102374 or http://dx.doi.org/10.2139/ssrn.4102374

Susan Boulware

Yale University - School of Medicine ( email )

Rebecca Kamody

Yale University - School of Medicine ( email )

Laura Kuper

University of Texas at Dallas - The University of Texas Southwestern Medical Center ( email )

TX
United States

Meredithe McNamara

Yale University - School of Medicine ( email )

Christy Olezeski

Yale University - School of Medicine ( email )

Nathalie Szilagyi

Yale University - Yale Child Study Center ( email )

New Haven, CT
United States

Anne L. Alstott (Contact Author)

Yale University - Law School ( email )

127 Wall St
New Haven, CT 06520-8215
United States

HOME PAGE: http://www.law.yale.edu/faculty/AAlstott.htm

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