In a recent New York Times guest essay, journalist Jesse Singal explained how U.S. medical associations—through a combination of mission drift, ideological zeal, and institutional incentives—became enthusiastic supporters of medical transition for gender-dysphoric minors.
Some associations have recently revised their positions. Last month, the American Society of Plastic Surgeons issued a position statement rejecting surgical interventions for minor patients, citing challenges to the evidence for these procedures. The American Medical Association soon followed suit. These decisions, as Singal notes, have created renewed attention to other medical association policy statements on “affirming care.”
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Unlike some peer organizations, the American Psychological Association (APA) appears to be attempting a “split the difference” communications strategy. It presented one face in response to Singal, and another to the trans activist community—all while denying the contradictions between the two. It thus embodies many of the institutional failures Singal laments.
The APA attempted this ploy when Singal asked the association for a comment for his Times op-ed. The APA referred him to a letter by Katherine McGuire, the APA’s chief advocacy officer, written to the Federal Trade Commission (FTC). The letter walks back the APA’s unambiguous support for pediatric medical interventions, strongly suggesting that the organization supports only psychological interventions for minors experiencing gender dysphoria.
However, when questioned by trans activist Erin Reed for an article published the day after Singal’s, the APA sent Reed a link to the organization’s controversial 2024 policy statement. The policy statement recommends that trans-identified youth “receive the necessary support and full healthcare attention, inclusive of psychological and medical care, in a compassionate and affirming manner.” It also frequently refers to “affirming care” interventions as “evidence-based” and asserts that they are supported by “a comprehensive body of psychological and medical research.”
The APA’s use of the phrase “evidence-based” to support medical interventions is notably misleading. The term presumably refers to any peer-reviewed study—regardless of the study’s design, methods, or capacity to isolate the impact of an intervention. The policy statement mostly ignores the findings of systematic reviews—the highest quality evidence in evidence-based medicine (EBM). Instead, it cites several methodologically flawed studies that rank lower in EBM’s evidence hierarchy—particularly the 2022 Tordoff study, which has been repeatedly challenged for its lack of experimental rigor. While the statement does cite a systematic review of puberty blockers, it doesn’t acknowledge that the review itself found mixed results on mental-health outcomes. The statement similarly fails to concede that even these mixed-to-positive findings would constitute “low certainty” evidence because most of the studies looked at were small, observational cohort studies with relatively short follow-ups. Physician and gender researcher Johanna Olson-Kennedy, who received an NIH grant to study “affirming care,” notoriously told the New York Times in 2024 that she had not released data from her own puberty blocker study because the findings would likely be “weaponized” by critics of gender medicine.
The 2024 statement further portrays “affirming care” as a civil and human rights crusade. It explicitly frames state restrictions on medical interventions for minors as “gender discrimination” and advocates for insurers to cover “gender-affirming care.” The statement also asserts that “non-affirmation” is a form of “gender-based bias and mistreatment” that increases the risk of suicide—despite a lack of robust supporting evidence for that claim. And it inaccurately asserts that the modern identity category of “gender diversity” has been present “throughout history.”
The APA’s letter to the FTC strikes a remarkably different tone. It foregrounds treatment for “gender dysphoria” while retreating from “gender diversity” language. Most significantly, it makes only two explicit recommendations: that practitioners engage in comprehensive, rigorous psychological assessment, and that they provide psychological support. Whereas the 2024 statement asserts that the science supports both psychological and medical affirmation, the FTC letter recognizes the “lack of long-term data” backing the latter.
McGuire told Singal that the FTC letter and the 2024 statement were “consistent,” and that both documents reflect the organization’s “commitment to evidence-based psychological care.” But it seems more like the group is trying to say different things to different audiences.
Presumably, this fence-straddling behavior reflects the uncomfortable position in which the APA finds itself. It is caught between the desire to placate its own activist members and the need to address the FTC’s and the public’s legitimate consumer-protection concerns. Neither policymakers nor Americans should let the APA get away with this cynical split-the-difference strategy.
Photo by JOSEPH PREZIOSO/AFP via Getty Images