By Joshua Arnold

Fallout continues after an explosive leak earlier this year revealed the World Professional Association for Transgender Health’s (WPATH) supposedly evidence-based guidelines for treating minors with gender dysphoria were actually influenced by political considerations. This summer, the White House’s attempts at damage control precipitated a series of secondary explosions, while in August, the U.S. Department of Health and Human Services (HHS) acquired a congressional investigation for its role in the scandal. Now, the American Academy of Pediatrics (AAP) finds itself within the expanding cloud of radioactive debris.

“When it comes to treating children diagnosed with gender dysphoria, the AAP has abandoned its commitment to sound medical judgment,” alleged Idaho Attorney General Raul Labrador (R) in a Tuesday letter obtained by The Washington Stand. “In 2023, it ‘reaffirmed’ the 2018 AAP policy statement on gender-affirming care” that “endorses treating minors diagnosed with gender dysphoria with puberty blockers, cross-sex hormones, and surgical interventions. And it tells physicians, the public, and parents and their children that puberty blockers used to treat adolescents with gender dysphoria are ‘reversible.’”

The AAP’s 2018 statement was “misleading and deceptive,” argued Labrador’s letter, which was signed by 19 state attorneys general and the leaders of the Arizona legislature. “It is beyond medical debate that puberty blockers are not fully reversible but instead come with serious long-term consequences.” Citing the Cass report produced in the U.K., the letter observed that puberty blockers “(1) may interfere with neurocognitive development; (2) compromise bone density and may negatively affect metabolic health and weight; and (3) block normal pubertal experience and experimentation.”

The AAP’s 2018 statement “is even less defensible now that the World Professional Association for Transgender Health and its standards of care — the AAP’s apparent cornerstone source — have been exposed as unreliable and influenced by improper pressures,” the letter continued. “Indeed, we are additionally concerned about AAP’s involvement in pressuring WPATH to make last-minute changes to SOC8 based on political considerations — and then assuring the public that those same standards are ‘evidence-based.’”

This was the moment when the AAP was sucked into the vortex of the WPATH files, to vary the analogy.

Attorney General Labrador continued to prosecute the case so that the AAP would see their legal jeopardy. “Telling parents and children that puberty blockers are ‘reversible’ at the very least conveys assurance that no permanent harm or change will occur. But that claim cannot be made in the face of the unstudied and ‘novel’ use of puberty blockers to treat gender dysphoria,” he said. “The AAP has no basis to assure parents that giving their children puberty blockers can be fully reversed. It just isn’t true. … And yet, the AAP continues to authoritatively declare that puberty blockers are ‘reversible.’”

Readers may be surprised by this novel approach to the policy debate over gender transition procedures for minors, as the AAP surely was too. After all, what connection is there between state attorneys general and the AAP to make this letter anything more than a hollow messaging stunt?

Helpfully, the letter makes the connection: the claim that puberty blockers are “reversible” is “scientifically unsupported and contradicts what is medically known,” it states. Therefore, it “raises questions under most state consumer protection laws.” For example, Idaho law prohibits “[e]ngaging in any act or practice that is otherwise misleading, false, or deceptive to the consumer.” This law directly applies to “statements made by medical trade associations, like the AAP,” and it indirectly applies to AAP statements that “are connected to commerce and reach consumers,” the letter explains.

Once seen, these connections are impossible to unsee. Of course the AAP has made misleading claims related to gender transition procedures for minors. Of course there should already be a way to hold them accountable. Of course consumer protection laws are a valid tool for holding trade associations accountable for false statements. Once seen, the connection is so clear that it prompts the question, why didn’t anyone think of this before now? (The answer might be that other building blocks of the case, such as the Cass report’s findings, were not available until recently.)

Thankfully, someone did think of this obvious accountability tool, and state attorneys general are now using it to bring the AAP to heel.

One note in the AAP’s favor is that, when it reaffirmed its 2018 statement, it also commissioned a “systematic review of the evidence.” The attorneys general applauded the introspection but insisted that, “whatever the status of that ‘systematic review,’ the AAP continues to mislead and deceive consumers by maintaining its claim that puberty blockers are ‘reversible.’ That claim is misleading and deceptive and requires immediate retraction and correction.”

The letter concluded with demands for the AAP to produce 14 different items “as we continue to review the AAP’s conduct.” The documents requested range from “the draft and review process for the 2018 AAP policy statement” to “substantiation … that the 2018 AAP policy statement and subsequent reaffirmation are ‘evidence driven, nonpartisan and rigorously reviewed’” to an explanation of “how the AAP’s claim that puberty blockers are reversible is consistent with … concerns raised in the Cass Report.”

In other words, these state attorneys general essentially challenged the AAP to a debate over the evidence for their assertion that puberty blockers are safe and reversible. If the AAP loses, or if they refuse the challenge, the state AGs can pursue legal action against them under consumer protection laws.

And the AAP has no chance of winning a debate over the evidence. Even “the 2018 AAP policy statement itself demonstrates that the ‘reversible’ claim is misleading and deceptive,” the letter declared. “It acknowledges that ‘[r]esearch on long-term risks, particularly in terms of bone metabolism and fertility, is currently limited and provides varied results.’”

Unless it wants to endure consumer protection lawsuits, the AAP has one path left open to it. It must back away from its indefensible position on gender transition procedures for minors and do so quickly. This option would be disastrous for the transgender lobby.

The AAP’s politicized stance on gender transition procedures for minors matters more than most medical groups. Along with WPATH, it was the first to endorse the procedures for minors, and other medical associations built their endorsements upon the AAP’s endorsement. WPATH’s credibility is already tottering after six months of scandalous revelations of political machinations. If the AAP retracts their endorsement, suddenly all the other medical groups’ endorsements of gender transition procedures for minors would be based on nothing. The whole superstructure of cards would likely collapse with a flutter.

This crisis for the transgender agenda could not have struck at a more relevant time. This fall, the Supreme Court is scheduled to hear oral arguments in a challenge to a Tennessee law protecting minors from gender transition procedures (United States v. Skrmetti). The U.S. Department of Justice, which challenged the law, has demonstrated its intention to argue that the medical evidence supports gender transition procedures for minors. If a mainstream medical organization like the AAP withdrew their endorsement of gender transition procedures for minors at the last minute, that could significantly weaken their case.

Even if the AAP digs in their heels and fights tooth-and-nail to defend their indefensible position, the very controversy serves to weaken the perceived medical consensus that transgender activists have labored so diligently to manufacture.

Joshua Arnold is a senior writer at The Washington Stand.