A coalition of 20 state attorneys general in the United States has sent a letter to the American Medical Association (AMA), demanding that the organization explain its continued support for puberty blockers and gender-affirming hormones for minors. The letter was signed by Alabama Attorney General Steve Marshall on behalf of the coalition and addressed directly to AMA CEO Dr. John J. Whyte.
Argument for "Weak Evidence"
The attorneys general noted that the AMA recently agreed with the American Society of Plastic Surgeons (ASPS) on delaying gender-affirming surgeries until adulthood due to a lack of "clear evidence." However, they argue that the quality of evidence for puberty blockers and gender-affirming hormones is also "low or very low," similar to surgical interventions.
The letter cites systematic reviews from the U.S. Department of Health and Human Services and a report by Dr. Hilary Cass, which highlight the lack of high-quality data on the long-term safety and efficacy of these interventions for children. The coalition questions the consistency in evaluating scientific evidence: if surgery lacks sufficient basis, why are hormone therapies considered to have adequate evidence?
Warning of Investigation and Demand for Response
The letter also raises the possibility of review under consumer protection laws in some states, citing Alabama's law prohibiting the promotion of goods or services with unsubstantiated or misleading benefits. The attorneys general have demanded an official response from the AMA by March 25.
Stances from Other Professional Organizations
Earlier this month, the American Society of Plastic Surgeons (ASPS) recommended delaying gender-affirming chest, genital, and facial surgeries until at least age 19, following an evidence review process. Meanwhile, other professional organizations such as the World Professional Association for Transgender Health (WPATH), the Endocrine Society, and the American Academy of Pediatrics continue to support the use of puberty blockers and hormone therapy in certain cases, according to current standards of care. As of publication, the AMA has not issued an official response to the letter.
List of Participating States
The letter was signed by the attorneys general of the states of: Alabama, Arkansas, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Nebraska, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, and West Virginia.
