Mt. Holyoke prof’s paper dissects reasons for ban on gender-affirming care in suit over Alabama law

Joanna Wuest, assistant professor of politics at Mount Holyoke College.

Joanna Wuest, assistant professor of politics at Mount Holyoke College. MOUNT HOLYOKE COLLEGE


Staff Writer

Published: 03-11-2024 4:16 PM

SOUTH HADLEY — A new study by an assistant professor of politics at Mount Holyoke College argues that recent state bans on gender-affirming care for minors identifying as transgender are based on faulty or distorted evidence.

The study, appearing in the journal “Social Science and Medicine,” calls into question the 375 citations used in litigation over the Save Adolescents From Experimentation (SAFE) Act law that was passed in Arkansas in 2021, the first such law banning gender-affirming care for minors. Since then, several other states have enacted bans on gender-affirming care practices such hormone treatment and surgery, along with supportive counseling, including the states of Texas, Missouri and Tennessee.

Joanna Wuest, the Mount Holyoke assistant professor credited as the first author of the study, said she was interested in discovering why there were so many discussions about the uncertainty of gender-affirming care treatments, such as the use of puberty and hormone blockers, to the point that several states felt the practice warranted a ban. The study was co-authored with Briana Last, a professor of psychology at Stony Brook University in New York.

“There is some uncertainty in gender-affirming care, but we need to recognize that there’s plenty of uncertainty in very routine use of pharmaceutical drugs and surgical procedures that have nothing to do with gender-affirming care,” Wuest said in an interview. “We were interested in how there is a higher bar set for gender-affirming care, at least among ban proponents.”

The study examined all 375 citations in 10 documents used in federal litigation over the SAFE Act bill, featuring witness declarations of support and amicus briefs filed by groups in support of the ban. It then broke down those citations into eight distinct categories, with the most frequent ones casting doubts on effective use of gender-affirming care, claims that gender-affirming care is fueled by political and industry interests, and likening the practice to past unethical treatments such as eugenics.

“Many of these state bills are based on a couple of models that were created and distributed by conservative political organizations,” Wuest said. “This attack on gender-affirming care for minors is not exactly an organic opposition to this form of health care or trans rights, but is rather incredibly coordinated from the most powerful groups in conservative politics.”

Wuest found that many citations could be traced back to organizations such as the Family Resource Council, a nonprofit that lobbies on behalf of evangelical Christian values, and the Alliance Defending Freedom, which receives heavy funding from conservative groups. She also found that many expert witness declarations did not have any clinical research experience in gender-affirming care , but rather worked in other medical fields such as endocrinology and plastic surgery.

Other citations used in legal arguments focused on people who have “detransitioned,” having begun gender-affirming care but later having reversed course. Wuest said that while detransitions do happen, the citations incorrectly frame regret as the sole cause, when other societal factors often play a role in such a decision.

Article continues after...

Yesterday's Most Read Articles

“Detransition is very often the result of things like employment discrimination, inability to get a job, persistent stigma within your family,” Wuest said. “We live in a society that’s not always terribly friendly to people who have transitioned.”

Over the last several years, anti-trans rhetoric has increased across the country, with some clinics that offer gender-affirming care being threatened with violence. In 2022, Boston Children’s Hospital said it had been inundated with death threats due its gender-affirming care clinic, fueled by misinformation disseminated on social media.

“Gender identity clinics for children and adolescents is really targeted by some of the more vocal conservative media types, who have really made this anti-trans position really central to their mission,” Wuest said.

Another common concern in the citations was related to the fact that several puberty-suppressing medications used in gender-affirming care were off-label uses, treatments not FDA-approved for certain conditions or age groups. Wuest said that argument ignores the fact that medications are commonly used off-label in pediatrics and in general medicine, citing the use of aspirin as an example.

“We don’t ban aspirin, even though aspirin can have really horrible effects in some sick children,” Wuest said. “We have a broader problem in American medicine, which is that we don’t always have very good data on dosage safety and efficacy of certain medications in general for non-adults.”

Alexander MacDougall can be reached at