On February 18, 2022, Texas Attorney General Ken Paxton issued an interpretation of Texas state law (the “AG Opinion”), taking the position that certain medical procedures constitute child abuse as defined in the Texas Family Code. Texas Governor Greg Abbott cited the AG Opinion as authority for his February 22, 2022 directive requiring the Texas Department of Family and Protective Services to “conduct a prompt and thorough investigation of any reported instances of these abusive procedures” (the “Governor’s Directive”). On April 7, 2022, Governor Kay Ivey of Alabama signed S.B. 184 (the “Alabama Law”), which imposes felony penalties on anyone providing certain medical care to any child, adolescent, or young adult under age 19. We are a group of six scientists and one law professor. Among the scientists, three of us are M.D.s., three are PhD’s, and all treat transgender children and adolescents in daily clinical practice. We all hold academic appointments at major medical schools. In this report, we examine in depth the scientific claims made in the AG Opinion and the text of the Alabama Law about medical care for transgender children and adolescents. After examining the AG Opinion and the findings of “fact” in the Alabama Law in detail, we conclude that their medical claims are not grounded in reputable science and are full of errors of omission and inclusion. These errors, taken together, thoroughly discredit the AG Opinion’s claim that standard medical care for transgender children and adolescents constitutes child abuse. The Alabama Law contains similar assertions of scientific fact, and these too are riddled with errors, calling into question the scientific foundations of the law. The Texas Attorney General either misunderstands or deliberately misstates medical protocols and scientific evidence. The AG Opinion and the Alabama Law make exaggerated and unsupported claims about the course of treatment for gender dysphoria, specifically claiming that standard medical care for pediatric patients includes surgery on genitals and reproductive organs. In fact, the authoritative protocols for medical care for transgender children and adolescents, which define what we term “gender-affirming care,” specifically state that individuals must be over the age of majority before they can undergo such surgery. The AG Opinion and the Alabama Law also ignore the mainstream scientific evidence showing the significant benefits of gender-affirming care and exaggerate potential risks. These are not close calls or areas of reasonable disagreement. The AG Opinion and the Alabama Law’s findings ignore established medical authorities and repeat discredited, outdated, and poor-quality information. The AG Opinion also mischaracterizes reputable sources and repeatedly cites a fringe group whose listed advisors have limited (or no) scientific and medical credentials and include well-known anti-trans activists.Funding and Conflicts of Interest: We received no funding for this project and have no conflicts of interest to declare
