A major new report by legal and medical experts from Yale Law School, the Yale School of Medicine’s Child Study Center and Departments of Psychiatry and Pediatrics, and the University of Texas Southwestern analyzes in depth the misleading scientific claims that informed recent actions by Texas and Alabama to criminalize medical treatment for transgender youth.
The report, “Biased Science: The Texas and Alabama Measures Criminalizing Medical Treatment for Transgender Children and Adolescents Rely on Inaccurate and Misleading Scientific Statements,” represents the first comprehensive examination of the Texas Attorney General opinion and Alabama legislation targeting gender-affirming medical care for transgender children and adolescents. The report strongly refutes the misguided scientific claims that inform the measures in both states and contends that the Texas and Alabama authorities omitted important evidence demonstrating the benefits of treatment for gender dysphoria and exaggerated potential harms, painting “a warped picture” of the scientific evidence.
Though a number of scientific and professional organizations have denounced the Texas and Alabama actions, the report by a team of seven experts in science, medicine, and law presents the first point-by-point rebuttal. The report specifically outlines the following:
- Texas and Alabama officials have falsely claimed that doctors are routinely sterilizing children and teenagers with surgical procedures. The authors point out that the authoritative medical protocols for treating transgender young people and prepubertal children do not permit genital surgery before the age of majority.
- The Texas and Alabama actions consistently ignore the mainstream scientific evidence that documents the substantial benefits of gender-affirming care. The best scientific studies show that gender dysphoria is real and that gender-affirming care significantly improves mental health outcomes, including reducing rates of suicide.
- The Texas and Alabama actions greatly exaggerate the risks of gender-affirming drug therapy. Puberty blockers and hormonal treatments, which are used only in adolescents (and not in prepubertal children), are safe and effective and are used only after a careful, staged process of psychological and medical counseling. These therapies have long been approved by the major medical authorities.
- The Texas and Alabama authorities rely on poor-quality evidence. The Texas Attorney General cites debunked and out-of-date studies and relies on 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 write. “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.”
In Texas, the governor cited a legal opinion by the state attorney general to classify gender-affirming medical care as child abuse, and in Alabama, the legislature imposed felony penalties on anyone providing gender-affirming care to individuals under the age of 19. The report comes at a time when anti-LGBTQ legislation is on the rise across the country. According to the American Civil Liberties Union, bills restricting health care for transgender youth have been proposed in at least 19 states in 2022.
“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,” the report’s authors write. “These errors, taken together, thoroughly discredit the AG Opinion’s claim that standard medical care for transgender children and adolescents constitutes child abuse.” The law in Alabama makes similar errors and assertions, according to the report.
Authors of the report include Yale Law Professor Anne Alstott ’87 and faculty at the Yale School of Medicine and Child Study Center: Susan D. Boulware, M.D.; Rebecca Kamody, Ph.D.; Meredithe McNamara, M.D., M.S.; Christy Olezeski, Ph.D.; and Nathalie Szilagyi, M.D. The group of authors also includes Laura Kuper, Ph.D., University of Texas Southwestern and Children’s Medical Center Dallas.
“The Texas AG opinion and the Alabama Law do not represent good-faith efforts with a few mistakes,” said Alstott. “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.”
Henry Robinson ’24, who helped Alstott as a research assistant, said there is a coordinated effort in statehouses around the country to “deny trans children access to healthcare, shut them out of public life, and cut them off from loving and supportive families.” Robinson noted that the efforts rely on sources with little or no scientific credibility.
“This effort relies on misinformed and often outright disingenuous expressions of concern about the supposed harms of gender-affirming healthcare to children,” explained Robinson.
The authors hope that by marshaling the reputable scientific evidence, the report will serve as a vital resource to journalists, the general public, and litigators challenging such laws, and will help ensure other states do not rely on the legal authority of the Texas opinion to enact similar laws around the country.
The Texas AG opinion “was not a fair look at the research,” said Olezeski, another one of the report’s co-authors. “This was biased, politically motivated work.”
By presenting the science in a dispassionate manner, the authors hope to combat misinformation about gender-affirming care that can be quick to take hold in the public’s mind.
“We need to call for fact-based checks on legal opinions and legislation,” said McNamara, a co-author. “Scientists need to have a seat at the table. And perhaps most importantly, there must be a penalty for writing fake science into law. 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.”
Office of Public Affairs
Yale Law School