Last month, at their annual conference, members of the Texas Medical Association met to develop and approve policies, spearheaded by the organization’s 400-member House of Delegates. Yet despite a changing scientific and legal landscape—with the American Society of Plastic Surgeon’s position statement acknowledging the “low quality/low certainty” evidence underpinning youth gender medicine, and the $2 million payout to detransitioner Fox Varian—the conference reflected a continuation of the gender medicine status quo at TMA.
My October 2025 Manhattan Institute report on the TMA chronicled how—through the influence of an LGBTQ affiliation group with notable biases toward preserving “affirming care” as a civil right—the organization adopted policies that endorse gender medicine as “evidence-based.” That position is increasingly out of line with the stance taken by other organizations, but TMA committees and councils refuse to revisit the group’s policies.
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One clear sign of the TMA’s positioning was its appointment of John Carlo as chair of the organization’s Board of Trustees. Carlo is the CEO of Prism Health North Texas, an adult clinic specializing in HIV and LGBTQIA+ care. He also has a history of participation in the TMA’s influential LGBTQ Health Section, which in earlier years discussed ways to use a “trojan horse” to achieve its LGBTQ advocacy goals.
The TMA has also gotten shrewder about handling dissenting delegates. For example, the Board of Trustees issued a report recommending a ban on recording “board, council, committee, taskforce, and section meetings,” unless it is done by a designated staff member charged with recording official minutes. As my report noted, TMA-sanctioned meeting minutes—in at least one instance—radically diverged from what members actually recorded, implying a lack of transparency from leadership in what is ostensibly a professional society designed to promote member interests. After mixed testimony at this year’s conference, this policy was also “referred for study.”
The TMA’s Reference Committee on Financial and Organizational Affairs urged delegates to reject a transparency proposal for reference committees—the bodies that prescreen resolutions. The measure would have required committees to document how evidence and research informed their recommendations. The committee argued that such a requirement would overtax staff resources.
On gender medicine, the TMA’s Reference Committee on Science and Public Health likewise recommended voting down a resolution calling for a comprehensive review of the Trump administration’s report on pediatric gender dysphoria. The proposal would have required the TMA to align its policies with the report’s evidentiary standards, ethical guardrails, and Texas law. In submitted testimony, key TMA councils and committees opposed the measure. The Council on Science and Public Health also sought to dilute it by removing the alignment mandate. (Members who were present told me that despite the Reference Committee recommendation not to adopt the resolution, it was “extracted” for in-person debate and eventually “referred for further study.”)
Such actions are hard to reconcile with the responsibilities of a 501(c)6 nonprofit group. Such organizations must serve their members’ interests, remain faithful to their mission, and avoid advocacy untethered to member mandate or evidence. As my report noted, an internal TMA-wide survey found that only 1 percent of members believed that “affirming care” should be a top organizational priority, while members complained to leadership that “a powerful gender-affirming lobbying bloc is biasing [the] TMA agenda away from our broader, stated mission.”
This disconnect has also created potential regulatory problems for the TMA. Last year, I reported on how the TMA’s continuing medical education course on transgender health care directly violates multiple standards for such courses set by the Accreditation Council for Continuing Medical Education (ACCME). Shortly thereafter, I filed a formal complaint with the ACCME. Since then, TMA members indicate that the course on transgender health care is no longer available on the website.
A TMA member who previously took the transgender health care CME for credit logged into the CME portal in March and saw a placeholder note suggesting that the course had been removed because of new legislation. However, Texas has no such law regulating CME content, and the TMA’s course on transgender health care became available after the state’s 2023 law prohibiting doctors from performing transition procedures on minors.
When asked for comment, the TMA said that the course was cleared by the accreditation council but acknowledged that it was not currently offering any courses on pediatric gender medicine. The TMA did not acknowledge my remarks about the placeholder note but asserted that it “continues to support CME that is consistent with the laws of Texas and ACCME standards and works to update CME to reflect changes in law.”
The TMA should follow other organizations in updating its view of the evidence. Its failure to do so suggests the need for regulators to act. The consumer fraud probes recently launched against the American Academy of Pediatrics and the World Professional Association of Transgender Health by the Federal Trade Commission, for example, seem eminently reasonable in this light.
Medical groups like the TMA have an obligation to inform members of what the best evidence says—and doesn’t say. When they refuse to do so, they’re not just advancing ideological goals; they’re also putting patients at risk.