AMA Urged to Do More to Safeguard Adolescent Gender-Affirming Care

CHICAGO -- How should the American Medical Association (AMA) respond to the rapidly increasing number of state prohibitions on gender-affirming care for adolescents? Delegates considered the topic during committee discussions at the AMA House of Delegates meeting Saturday.

The AMA already has a policy in place for gender-affirming care, and a new draft resolution moves the policy forward from "passively supporting" gender affirming care to "proactively protecting it," according to Charles "Charlie" Adams, a draft resolution co-author.

Adams, a medical student and alternate delegate from Missouri, explained that as a kid, he longed for a medical career, but felt uncomfortable seeking one in the body he was born into. He said he had every opportunity available to him as a child, except access to puberty blockers.

"Who I am today was once a figment of my wildest dreams. I am a man -- a transgender man," he said.

Resolution co-author Amanda "Mandy" Bell, MD, who spoke on behalf of the Endocrine Society, noted that multiple states currently ban transgender care for children. In 2023 alone, 556 anti-LGBTQ bills were introduced and 83 passed into law, she said.

The Endocrine Society recommends gender-affirming hormone therapy as an option for adolescents "who continue to demonstrate gender incongruence with pubertal hormone suppression and who demonstrate the ability to provide informed consent, usually beginning at 16 years old," according to the draft resolution.

Gender incongruence is defined as a situation where a person's gender identity does not match the gender the individual was assigned at birth. Gender dysphoria is a condition where a person's gender incongruence leads to "significant burden," noted the resolution.

The society, along with the American Association of Clinical Endocrinology and the American Society for Reproductive Medicine, called on the AMA to oppose criminal and legal penalties targeting young patients seeking gender-affirming care, as well as the parents or guardians who support them, and advocated for protections from "violence ... [and] adverse medical licensing actions and liability" for healthcare facilities and physicians providing such care.

The draft resolution directs the AMA to meet with state and specialty societies, and to "communicate" with the Federal State Medical Boards, about the need to preserve such care. Finally, it calls for expanding the current definition of medical necessity in the current AMA policy, to include gender dysphoria and gender incongruence.

Adams and co-author Delia Sosa, a trans alternate delegate to the Medical Student Section, told MedPage Today, that some states have begun targeting transgender adults.

The criminalization of gender-affirming care puts families and doctors in danger, said Sosa, who uses "they/them/their" pronouns.

"And it's trying to erase our existence," they said. "So this [resolution] really is important, because it says that one of the largest medical associations in the entire world says 'We stand behind trans people. We want to make sure that not only do they have access to healthcare, but that the people that are supporting them are also safe.'"

While the line of physicians in support of the draft resolution extended outside the room, there were some who questioned whether providing gender-affirming care to adolescents could have unintended consequences.

Dennis Galinsky, MD, an alternate delegate from Illinois, speaking on his own behalf, called for referring the resolution to the Board. He said that the late Stanley Biber, MD, a pioneer in gender reassignment surgery and a relative of Galinsky's, never performed surgeries on anyone under age 19. "He was very careful," Galinsky said.

Lee Voulters, MD, an alternate delegate from Mississippi, said he sympathized with the "terrible" hardships experienced by those with gender dysphoria.

"Anything we can do to alleviate that with scientifically proven treatments is, of course the right thing to do," Voulters said.

However, Voulters said there is "a body of evidence" suggesting "that childhood dysphoria symptoms often reverse spontaneously without any treatment ... I think we have to follow the science here."

But Hans Arora, MD, PhD, a delegate for the American Urological Association, argued that "the personal objections being presented here are not based on science. They're not based in evidence."

Arora, a pediatric urologist who provides gender-affirming care, urged the AMA to protect physicians from "criminalization of the care that our patients deserve."

"This is a life and death matter," Adams later told MedPage Today. Approximately 50% of transgender male teens, 30% of transgender female teens, and 42% of nonbinary youth have reported attempting suicide during their lifetime, according to the resolution.

As for the idea that gender dysphoria would just go away on its own, Adams suggested physicians talk to the trans community about that.

"If it could go away by trying, it would have gone away, because for a long time I tried very hard, very, very hard, but you can't change, you just can't."

The AMA will decide whether to affirm this and other draft resolutions over the next few days.

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