In 2020, Republican-led states began pushing in earnest to tightly restrict or ban youth gender medicine. In response, the professional organizations — including the
A.M.A., the
A.A.P. and the
American Psychological Association — wrote a flurry of letters to legislators, amicus briefs and sciencey-sounding documents opposing the bans. These documents routinely exaggerated the evidence base for the treatments in question. There was more talk of consensus: “Every major medical association in the United States recognizes the medical necessity of transition-related care for improving the physical and mental health of transgender people,” explained the A.M.A. in a
letter from 2021.
During this same period, a sea change occurred in Europe.
Finland,
Sweden and
Britain conducted systematic evidence reviews of youth gender medicine — a much more transparent and regimented process designed to attenuate the influence of human bias. Every such review revealed deep uncertainty about the evidence base, and as a result the countries that conducted the reviews began more tightly regulating youth gender medicine. (
Denmark has since followed suit, and there are some signs
France and
Norway may as well.) Which science, then, should be trusted? The confident American professional organizations or the skeptical European health care systems? What about when even the professional organizations start to schism?
I’ve been covering this controversy for about a decade from a left-of-center perspective, and I’ve found that anyone who questions these treatments, even mildly, is invariably accused of bigotry. It would be shocking if the professional organizations chiming in on these issues — which, like all such organizations, exist in part to increase the esteem of their members and to enhance their own influence — were immune from such influences. And now that the political winds have shifted radically, with the Trump administration launching an all-out assault on
both the practice of and research into youth gender medicine, it seems some of them are realizing they would benefit from appearing a bit more moderate.
Perhaps I’m being unfair. But it’s impossible to know, because these organizations are quite opaque about the processes that give rise to their public statements. They’ve tried to have it both ways: They’ve presented themselves as representing “the science” while sometimes violating science’s traditional norms of transparency and open debate. (Neither the A.A.P. nor the A.M.A. would grant me an interview. The American Psychological Association responded to some of the questions I sent the organization via email.)
The A.P.A. presents a particularly striking case of why transparency is important. In 2024, it
published what it
touted as a “groundbreaking policy supporting transgender, gender diverse, nonbinary individuals” that was specifically geared at fighting “misinformation” on that subject. But when I reached out to the group this month, it pointed me to a different document,
a letter written by the group’s chief advocacy officer, Katherine McGuire, in September in response to a Federal Trade Commission request for comment on youth gender medicine.
The documents, separated by about a year and a half (and, perhaps as significantly, one presidential election), straightforwardly contradict each other. The A.P.A. in 2024 argued that there is a “comprehensive body of psychological and medical research supporting the positive impact of gender-affirming treatments” for individuals “across the life span.” But in 2025, the group argued that “psychologists do not make broad claims about treatment effectiveness.”
In 2024, the A.P.A. criticized those “mischaracterizing gender dysphoria as a manifestation of traumatic stress or neurodivergence.” In 2025, it cautioned that gender dysphoria diagnoses could be the result of “trauma-related presentations” rather than a trans identity, and noted that “co-occurring mental health or neurodevelopmental conditions (e.g., depression, anxiety, autism spectrum disorder) … may complicate or be mistaken for gender dysphoria.” It seems undeniable that the 2025 A.P.A. published what the 2024 A.P. A considered to be “misinformation.” (“The 2024 policy statement and the 2025 F.T.C. letter are consistent,” said Ms. McGuire in an email, and “both documents reflect A.P.A.’s consistent commitment to evidence-based psychological care.”)
Along those same lines, how did the American Medical Association go from arguing that “forgoing gender-affirming care can have tragic consequences” for “pediatric patients”
in its 2021 letter to its present stance that one such treatment, surgery, should be delayed — potentially for many years — as a general matter of course?
If, as I suspect, political forces are the culprit, that would lead to an inescapable conclusion: You cannot automatically trust what these organizations say at a given moment. Not unless they provide a lot more information about their decision-making processes.
Should we “trust the science”? Sure, in theory — but only when the science in question has earned our trust through transparency and rigor.