AMA at a crossroads: Support or restrict trans treatment for minors?

The American Medical Association (AMA) today finds itself in the midst of a credibility crisis: no one seems to know for sure what its position is on transgender treatments for minors.

What began as a sentence in an article in The New York Times has turned into, according to reports from The Free Press, an internal battle, a political confrontation and a communications dispute that exposes the division in the medical profession over "gender-related care" in childhood and adolescence.

The origin of the controversy

The trigger was a statement issued in February by the American Society of Plastic Surgeons (ASPS), the first major medical society in the country to recommend that so-called gender reassignment surgeries not be performed on minors. The ASPS argued that there is little long-term evidence on these procedures and their mental health outcomes for patients, and warned of "emerging" risks of complications and possible long-lasting adverse effects.

"ASPS concludes there is insufficient evidence demonstrating a favorable risk-benefit ratio for the pathway of gender-related endocrine and surgical interventions in children and adolescents. ASPS recommends that surgeons delay gender-related breast/chest, genital, and facial surgery until a patient is at least 19 years old," the report reads.

An article in The New York Times reported shortly thereafter that the AMA, without abandoning its general support for "gender-related care" for minors, accepted the ASPS position. In the words of the newspaper, the AMA agreed that, "in the absence of clear evidence," surgical interventions on minors "generally should be deferred until patients reach adulthood."

The ASPS and AMA statements came just days after a jury in White Plains, N.Y., awarded $2 million to Fox Varian, a young woman who sued her doctors over a mastectomy she underwent when she was 16.

The case was landmark, representing the first time a "detransitioner" brought a malpractice case to trial.

Response from politicians and the legal system

In the weeks that followed, the controversy transcended the medical field. A score of Republican attorneys general sent a letter to the AMA accusing the organization of issuing a confusing and potentially misleading statement.

According to these officials, while AMA acknowledged the weakness of the evidence on transition surgeries, it had said nothing equivalent about puberty blockers and cross-sex hormones, treatments it recommended as standard for minors in previous years.

"We thus find it concerning that the AMA continues to support the use of puberty blockers and cross-sex hormones to treat gender dysphoria in minors. The quality of evidence is the same as it is for surgeries: low and very-low quality," the letter said.

Prosecutors warned that the association may have violated consumer protection laws, and threatened a possible investigation if the AMA did not clarify its position on these treatments.

"Thus, while we hope to avoid a formal investigation under our consumer protection laws, we do have concerns that the AMA may be violating those laws. Under Alabama law, for instance, it is unlawful for an organization to cause “confusion or misunderstanding as to the … sponsorship, approval, or certification of goods of services,'" the letter said.

According to TFP, a representative from the state attorney general's office, which addressed the letter, declined to comment on whether the AMA had met the deadline of March 25 to respond.

AMA appears to contradict itself

In the two months since the New York Times article was published, AMA has moved between silence, contestation and reiteration, without coming up with a coherent narrative. Internally, according to internal documents and videos obtained by The Free Press, there is open discord among different factions of the organization.

The AMA's internal LGBTQ+ group expressed concern on the organization's message network, fearing that the phrase about postponing surgeries until adulthood meant a revision of a policy that had always called medical and surgical treatments for gender dysphoria "medically necessary" and without explicit age limits.

Some physicians, such as Dr. Frank Dowling, a psychiatrist at Stony Brook School of Medicine, accused AMA leadership of bowing to political pressure from the Trump administration, going so far as to speak of "harming teens for political gain."

Dr. Frances Grimstad, a pediatric gynecologist at Boston Children's Hospital, called the board's silence a "smack in the face" to the community working on "gender-related care."

Who said what and what did they say?

In a March statement, AMA board Chairman Dr. David Aizuss, stated that "while some media coverage characterized this as agreement with the ASPS statement, that phrasing did not come from the AMA." Aizuss claimed that the organization had sent a letter to the newspaper requesting "a correction on their part to reflect the actual language the AMA used."

The New York Times responded that it "has received no requests to correct, clarify or update" its articles from AMA and that the quote came from an official statement from Josh Zembik, the organization's director of communications.

In an internal meeting recorded on Feb. 10, which The Free Press had access to, AMA Executive Director Dr. John Whyte stated that the board did approve the decision to publicly align itself with ASPS and to recommend that transitional surgeries on minors be postponed until adulthood. "That was the position the board voted on," Whyte stated, adding that that recommendation dovetailed with existing policy.

This contradiction has fueled the communicative chaos. In a subsequent message, Aizuss admitted: "There continues to be a discrepancy between what the New York Times states they were told and what our communications people say they said," and acknowledged that, if the spokesman used the phrase "the AMA agrees with the ASPS," it was an unauthorized error.

"[The spokesman] unfortunately does not recall if he used those words," he added.

The weight of ambiguity

The AMA has been caught between two forces: on one side is a medical community that sees "gender-related" care as a supposedly crucial tool for reducing depression and suicide in teens with gender dysphoria, and on the other is growing political and legal pressure that questions the lack of robust evidence and the possibility of irreversible harm.

Today, the AMA reflects the deep divide in the medical community on childhood gender transitions: rather than leading the debate, the organization has ended up embodying the ambiguity that many patients, families and politicians are seeking to avoid. And as the organization studies new statements, the confusion lives on, both within its ranks and in the rest of the health care system.