This is what working for the people, working for the public means. This is what representing the will of the people / public looks like. This is what is attracting the people / public voters to the democrats, yet Chuck Schumer as yet to endorse Mamdani. Why? Because the two are the opposite sides of the political coin. One wants to serve and represent the people / public and the other is a corporate democrat beholden to big money donors and major lobbyist groups. Same with Hakeem Jerofies who only endorsed Mamdani when on election night it became clear he would be the winner. Hugs
NEW YORK (AP) — The Trump administration said Monday it will resume flying a rainbow Pride flag on a federal flagpole at the Stonewall National Monument in New York City, reversing course two months after removing the banner from the first national monument commemorating LGBTQ+ history.
The government revealed the decision in court papers as it agreed to settle a lawsuit filed by advocacy and historic preservation groups who had sought to block the Feb. 9 removal. A judge approved the deal.
The Interior Department and National Park Service “have confirmed their intention to maintain a Pride flag at Stonewall,” lawyers for the government and the groups wrote in a joint court filing.
The flag — one of several Pride banners at the 7.7-acre (3.1-hectare) park — won’t be removed, except for “maintenance or other practical purposes,” the filing said. (snip-details of position and measurements of the Pride flag)
I am leaving for the second part of my book tour in 10 hours and I have not done laundry, packed, or (if I’m being honest) unpacked from the first leg of book tour. In spite of the fact that the first stops were so lovely and fun and filled with fellow weirdos who completely understood my anxiety, I am once again convinced that everyone will hate me and no one will show up and probably I will be eaten by sea lions. So right now I am writing this to you and reminding myself that everything will be okay.
I did lots of little drawings this week but Hunter S. Thomcat is laying on my sketch pad and I don’t want to move him so instead I’m sharing a drawing from the book because I drew it when I was having a high anxiety week and it feels fitting to come back to it now. Just a reminder that even when things feels scary, you can always make a little oasis in your mind. My spell check tried to change that to “you can always make a little oatmeal in your mind” and I’m feeling very relieved that I caught that because that’s even weirder than my normal letters to you.
This column first appeared in The Amendment, a newsletter by Errin Haines, The 19th’s editor-at-large. Subscribe today to get early access to her analysis.
When Alexis McGill Johnson took the helm as leader of Planned Parenthood in 2020, the nation’s largest provider of reproductive care and a major force in American politics was already at a critical juncture.
The organization’s last president had lasted just eight months; she followed Cecile Richards, the charismatic and connected leader who was in the role for a dozen years. The future of abortion rights looked potentially shaky, and Donald Trump was in his first term.
In the six years since, the U.S. Supreme Court ended federal protections for abortion, a major challenge both for providing care and for the organization’s political arm — then Trump won a second term and moved to take away federal funding, slashing a third of Planned Parenthood’s budget. Under the first Trump administration, Planned Parenthood had more than 600 health centers. Since the start of 2025, 53 have closed. More are threatened since Trump on July 4 signed into law a measure to block them from accepting Medicaid.
The end of federal abortion protections led to a surge in energy around the issue from Democrats and the left. It has faded since then as the president’s military actions and mass deportation strategy dominate attention — but McGill Johnson still has to figure out how to galvanize supporters; keep Planned Parenthood clinics serving patients; and elect Democrats in key races in states including Georgia, North Carolina and Ohio.
As one of the abortion rights movement’s key standard bearers, McGill Johnson is navigating expectations from activists, donors and voters who want a fighter and expect her to deliver. Their sense of urgency can obscure what it means to both lead the fight and provide essential care to millions of Americans in an intentionally overwhelming and chaotic news cycle.
Alexis McGill Johnson’s presence at the top of Planned Parenthood reflects a broader pattern in American institutions, in which Black women are often called on to lead in moments of crisis while having limited room for error and a lack of support. (Jessica Rinaldi/The Boston Globe/Getty Images)
“When I look at where Planned Parenthood is in this moment, we are navigating all of the chaos, but also looking for where the opportunities are inside that chaos,” McGill Johnson said. “Chaos is a strategy: throw everything at people so they don’t know where to look or how to fight.”
McGill Johnson describes her style as collaborative; those who know her best say she’s a master strategist, confronting a challenging political climate with courage, clarity and creativity.
The political climate in which McGill Johnson has led can really not be compared to any other past leader, said Fatima Goss Graves, president of the National Women’s Law Center.
“This isn’t something that’s happened over three decades; this has been the last six years,” said Goss Graves, who first met McGill Johnson in 2017 after Goss Graves became the first Black woman to head her organization. “Alexis was the right person at the right time. It is a big deal that surviving the level of attacks they have faced, that they are still here, they are serving patients, they are still committed, and they have had to make adjustments. The work is what she’s doing.”
Planned Parenthood is shorthand for dual entities: Planned Parenthood Federation of America, the nonprofit supporting affiliate clinics across two dozen states; and Planned Parenthood Action Fund, the group’s political arm, focused on organizing, advocacy and voter education.
McGill Johnson’s path to leading both came after a career working on voting rights and civil rights, and she approaches the work through a racial and gender lens. She is only the second Black woman leader in the organization’s existence of more than a century.
Her presence at the top of Planned Parenthood reflects a broader pattern in American institutions, in which Black women are often called on to lead in moments of crisis, with limited room for error and a lack of support.
McGill Johnson talked about the added weight of doing this work as a Black woman in a movement that has been largely White at the national level. She said that having lived and worked at the intersection of race and gender has been an asset in her current role.
McGill Johnson is familiar with leading in moments like the one Planned Parenthood is facing, “moments where our leadership is judged more harshly, where we may be granted more scrutiny, less grace.”
“Those are the places where I’ve had to find my center, to remind myself that I’m in this role to be unapologetic about fighting for the liberation of women of color, Black women, at the center of that liberation, because I think that actually transforms the liberation of everyone else,” she said.
Former Democratic U.S. Sen. Laphonza Butler, the first Black woman to head EMILY’s List, the political action committee focused on electing Democratic women, put it this way when asked about the challenges of leadership for Black women: “It is an expectation whose bumper sticker reads: ‘Fix it for us, please.’ When you look across the movement spaces where both crisis and care are on a collision course, it is Black women like Alexis who are stepping up.”
The Supreme Court’s 2022 decision in Dobbs v. Jackson Women’s Health Organization, which ended the nearly 50-year precedent of legal abortion access nationwide, angered many Democratic women and motivated them in record numbers in the 2022 midterm elections.
Then-Vice President Kamala Harris championed reproductive rights as a pillar of her 2024 presidential campaign — but her loss was criticized by some, in part, as prioritizing abortion access over the economy. Now, the Democratic Party’s uncertainty around whether and how to talk about abortion to voters adds to McGill Johnson’s challenges in this moment.
The stakes on the ground are still life and death for many Americans, but political strategists say the issue of abortion has proved less politically potent as the national spotlight has moved on.
“For someone fighting on this issue, the progressive movement that was so galvanized is less so because they’re focused on many of the other things that Trump is doing that are dangerous to the country,” said Democratic strategist Karen Finney.
Abortion can still be a motivating issue for Democrats — especially as it’s related to the two biggest issues at the moment, health care and affordability, said Democratic pollster Celinda Lake.
“It’s still motivating to voters for turnout,” Lake said. “Right now, everything is being pushed out by the war and the economy. I think it will reemerge as a much more powerful issue in 2028. Health is the number one issue, the number one pocketbook issue. When you talk about abortion and broaden it, it’s very powerful there.”
McGill Johnson worked to do just that, emphasizing Planned Parenthood’s presence particularly in communities with a lack of options for reproductive care. Politically, she has framed the issue as one of affordability and of democracy, and is focused on a message to voters about how the administration’s actions in recent years are impacting them.
“It may not feel as though abortion is as front and center as it was in the year or two after the Dobbs decision … but when you bring it to people and remind them that these things are happening, it taps directly into that rage,” McGill Johnson said.
She added that part of the job now also looks like acknowledging the concerns of those in the movement as a leader of a complex organization with little room for error. Supporters of abortion rights — and even supporters of McGill Johnson herself — have criticized her for not responding strongly enough to attacks on access, saying they don’t see her fighting in the way they want.
What does it mean when some on the left are more in the mood for a wartime general than a collaborator?
“In the day-to-day, it is a lot of navigating people’s frustrations, anxieties and hopes, and how to keep people focused on that hope and a strategy for how to get there,” McGill Johnson said. “We’re living in moments where philanthropy has pulled back from a number of institutions where there is a federal defund, which has impacted a lot of my colleagues. One day, you’re navigating ICE and the next day, the country’s at war, right? All within the same time period. I think my kind of special superpower is the ability to kind of keep myself at the 30,000-foot view to understand how all of these things are interacting with each other.”
McGill Johnson said the urgent question for her is: Who are we going to be now that we’re no longer defending Roe? It’s one that no other president of Planned Parenthood had to grapple with after the landmark 1973 case that made abortion the law of the land.
Since 2019 when she became interim leader, Planned Parenthood’s supporter base — which includes volunteers, donors, activists and email subscribers — has grown from 13 million to 20 million.
In addition to her focus on the campaign trail, McGill Johnson will also have to continue the work of reimagining Planned Parenthood’s network of clinics as part of the national health care infrastructure. According to the organization, 1 in 3 women in the United States has visited a Planned Parenthood clinic.
“I believe that Planned Parenthood could become the Cleveland Clinic of sexual and reproductive health care, because we have such great clinical excellence,” McGill Johnson said. “We are already a leader in standardizing best-in-class care, on sexual, reproductive health care, including abortion, so I think a lot about what it would mean for us to to focus on seeing as many patients as Planned Parenthood can, but to also export that influence into ensuring everybody else’s is standard of care is raised.”
To get there, McGill Johnson will have to endure and survive the current climate and the demands of the post-Roe era. Reproductive Freedom for All President Mini Timmaraju said meeting the multiple challenges at the local, state and federal level with diminished resources and competing areas of attention is daunting.
“We have to do more than we’ve ever done before, and the funding is not what it should be,” said Timmaraju, the first woman of color to lead her organization. “We are all scrambling to make sure that in the moment where abortion funds need funding, clinics need funding, we also have enough resources for advocacy at every single level, and that’s really challenging in an environment where donors are understandably a little frustrated with progressive entities right after 2024 so we’re having to prove ourselves again, and continually having to prove and reprove, over and over again, the salience of abortion electorally.”
The 2025 law forbade any flags on public property other than the flags for US America, Idaho, cities and tribes, military services, and a few other official flags of “a governmental entity.” The bill’s Republican sponsor insisted that this wasn’t culture war, heavens no, it was about promoting unity, and America, and “stuff that we can all agree on.”
The Boise City Council promptly turned right around and passed a resolution adopting the Pride flag as one of three official City of Boise flags, and ran the rainbow colors up the flagpole again. Hooray!
Unwilling to accept such rampant disrespect to their edict, Republicans in the Lege this year passed a whole new flag law, this one adding a new rule saying that only official city or county flags “designated prior to 2023” will be allowed. The new law also added a $2000 per day / per flag fine, to show Boise what serious business this flag war is. The bill’s sponsor, state Rep. Ted Hill (R), explained the fine was absolutely necessary to force compliance from “insubordinate government officials. […] It sets a tone of anarchy.” He too said that we must have “unity” under the stars and stripes, orelse.
Pride flags along Harrison Blvd. in Boise, 2023. Since Trump’s first term, assholes have stolen and even burned multiple flags each year. They’re then replaced by the volunteers who put ‘em up in the first place. Screenshot, KTVB-TV on YouTube.
In an extra little kick at Boise, where light poles on the median of one major residential street have long displayed Pride flags throughout June, the bill specifically applies to land along “parks, roads, and boulevards.” No nice things for you, Boise.
Just to be a real prick about it, Gov. Brad Little signed the bill on March 31, the Trans Day of Visibility. Little also signed another far worse bill criminalizing trans people who use bathrooms or locker rooms that match their gender identity, not only in schools and public buildings, but also in “public accommodations,” like private businesses. First offense is a misdemeanor, with up to a year in prison, and a second offense would be a felony, with up to five years in prison. The Idaho affiliate of Planned Parenthood Alliance Advocates called it “the most extreme anti-transgender bathroom ban in the nation.”
In response to the two new laws, Boise Mayor Lauren McLean ordered the Pride flag lowered outside City Hall, but also presided over a special session of the City Council to honor the Trans Day of Visibility. Choking back tears, McLean said to the Council and an audience of about 60 Boiseans, “Many people in this state and around this country are seeking to divide us. They’re seeking to divide us by targeting the most vulnerable among us. I want the people in this room to know that I see you. We see you. You are wanted, important, and unique members of our community.”
That night, City Hall was lit in the colors of the transgender flag.
Then, a week after the Pride flag came down, the three flagpoles in front of City Hall sported new vinyl wraps in the colors of the Pride/Progress flag, and a big new banner was visible in the building’s windows, with the rainbow and the slogan, “Creating a city for everyone.” Yr Dok Zoom went downtown to take some photos, and damn right he plugged in his EV at one of the two free EV chargers at City Hall (still hadda feed the meter, though, so that explains the $1.50 on my company card, Rebecca).
You can see the poles up top, and here’s that nice new sign:
And now at nighttime, City Hall is lit up in rainbow colors as well. Gosh I like my city a lot!
City Council President Meredith Stead told local TV station CBS2 that the city is observing the new state law to the letter, and joyfully at that. “The law was based on the flag and we are using rainbows, and it’s not at all a flag,” Stead explained, and I hope she was grinning. “So I would say we are in full compliance of the law, that’s certainly the most important thing to us. So we’re going to be sure that we always are, and this was just a different way to celebrate our diversity and values.”
The cost of the flagpole wraps and new banners was $5,931.87, from the city’s operating budget. We think that may also have included the printing costs for these spiffy new stickers you can pick up at City Hall; I got a nice big one that looks great in the rear window of my EV:
We like this “everyone” thing the mayor is going on about! Photo: Dok Zoom.
Needless to say, while all the folks you’d like to hang out with in Boise are delighted by the city’s latest reply to the Lege, the Usual Suspects are big mad about this latest besmirch statement by the city, and we can only imagine what sort of stupid crap law the Idaho Lege will pass next year in another futile attempt to control the wayward capital city. We’ll close with this line from the very timely second season of Andor, which Dallas ally, former Obama official, and teamonger Brandon Friedman says nicely sums up Boise’s Rainbow Battle: “Tyranny requires constant effort. It breaks, it leaks. Authority is brittle.”
At a New York party, attendees spent Trans Day of Visibility dancing, DJing, and learning how to become less visible online.
Imani Thompson, digital security trainer and organizer of the event / Photo by Janus Rose
It’s Trans Day of Visibility, and I’m at an event space in the heart of New York City’s Commie Corridor to learn how to become less visible online.
The crowd gathered at the aptly-named Trans Pecos in Ridgewood, Queens is here for “404: Deadname Not Found,” a digital self-defense workshop which promises to teach trans people how to find and remove their sensitive personal information from the internet (and which also has no relation to this website). The vibe is giving OpSec rave happy hour—attendees sip colorful drinks, groove to DJ sets, and huddle around laptops using online tools to track down their own digital footprints.
The goal of the exercise is to find holes in your digital defenses, a practice cybersecurity folks call “red-teaming.” A slide deck guides participants through this “self-doxing” ritual, instructing them to use websites like IntelBase, PimEyes, and haveibeenpwned to find addresses, selfies, passwords, old names and aliases, and other personal info that might have been left sitting around on the open internet.
It makes for great cocktail party banter. One participant raises their arms in triumph upon receiving a clean bill of health while checking if their information was leaked in a data breach. Others swivel laptop screens and compare notes on the various places their digital detritus had cropped up. In my case, I was lucky: I mostly found data brokers with incorrect information, a long-forgotten MySpace page, and a woman whose spam calls I’ve been receiving for the past 10 years. Finally, participants are directed to various pages where they can request data to be removed, or sign up for discounted services like Kanary and DeleteMe that do the removals on your behalf.
Behind the fun and light atmosphere, everyone here knows the unspoken reality that drives tonight’s activities: an unrelenting wave of discriminatory bills and executive orders that are rapidly demolishing trans rights across the US. “Trans Visibility” is a nice idea, but it turns out it really sucks to be visible in a fascist surveillance state where the highest levels of government are obsessively trying to destroy your ability to live.
“In this world of hyper-surveillance, I want to make sure all my stuff is safe and that no one is trying to harvest my data for anything,” Anna, a workshop participant, told 404 Media. Anna asked to use a pseudonym to protect her identity, which is not surprising given that the goal of the workshop is to make it harder to be doxed. “Especially now that there’s lots of incentives for the federal government to get into that business, I just wanna make sure all of that is under wraps.”
Like the event’s name suggests, many attendees are looking for traces of their “deadnames,” which is how some trans folks refer to the names they were given pre-transition. Trans people face a disproportionatelyhigh risk of being doxed online, and deadnames and other sensitive info are frequently dug up on right-wing hate forums like KiwiFarms and social media sites like Elon Musk’s X, where harassment campaigns and hate speech are allowed and even encouraged.
“We have to protect ourselves,” said Ryan, who also used a pseudonym. “It’s great to know how to find stuff like this, because you never know what’s still out there.”
Imani Thompson, a digital security trainer who organized the event as part of her series Cache Me Outside, says she started hosting the free workshops at queer bars in Brooklyn a year ago, after noticing trans and intersex friends who were noticeably shaken by the opening salvos of the second Trump administration.
“I hadn’t seen cybersecurity events that looked like they would attract or resonate with the crowds I felt needed this information the most,” she told 404 Media. “I wanted to make this fun and un-intimidating and doing digital security training at the bar is kind of silly and fun and gives us a built-in VPN and protection from sensitive convos being recorded.”
There are specific reasons many trans people are anxious about their personal data and online presence these days. For one, trans identities often don’t fit neatly into government boxes, and the name and gender they are assigned at birth may or may not match their government-issued IDs. Recently, a new law in Kansas resulted in hundreds of trans people being told that theirdrivers licenses and IDs had been invalidated overnight, forcing them to obtain new documents that revert to the sex marker assigned at birth. JournalistMarissa Kabas later reported that the 300 trans IDs in question had been flagged and not immediately invalidated, but the goal of the law and its ensuing chaos was clear: requiring trans people to have IDs that don’t match their appearance or lived reality, forcing them to out themselves and introducing friction and discrimination into their everyday lives.
The same Kansas law also implemented the first state-level “bathroom bounty,” making it a crime for trans people to use appropriate bathrooms and changing rooms and promising rewards to random passersby who feel “aggrieved” by someone they think might be trans. Lawmakers in Idaho have passed an even harsher bill, which would charge repeat trans bathroom-users with a felony and up to 5 years of jail time. These bills threaten not only trans people, but anyone whose appearance might fall outside of someone’s normative expectations of “male” and “female.” And they are especially dangerous at a time when facial recognition can near-instantly identify someone with a quick search.
Thompson also worries about the information that queer folks can reveal while asking for help online. Trans people experienceunemployment,housing insecurity, andviolence at exponentially higher rates than cis people, and it’s not uncommon to see Gofundme pages and Venmo accounts flooding social media feeds. These posts will sometimes include personal details like a person’s name, face, transition status, location, immigration status, and even how much they have in their bank account—great for getting donations, but not so great for the doxable breadcrumbs they leave behind.
“I think the risk is tenfold for the dolls and Black trans siblings because of disproportionate scrutiny in light of these bathroom bills and also how we do mutual aid,” said Thompson. “Whenever I see a mutual aid request being reposted or processed it makes me nervous, because we’re basically doxing our most vulnerable friends.” To reduce risk, she recommends people take down mutual aid posts as soon as needs are met and set their Venmo activity to private. “I feel like the intention in listing off how all these systems of oppression impact our friends are meant to create a sense of urgency and care, but then months later it’s still floating around and is a goldmine for someone who wants to claim they were made to feel unsafe in a bathroom so they can claim $3k or further an agenda.”
The privacy attitudes on display at the event contrast with the dominant media narratives about trans communities a decade ago. Fresh off the Supreme Court victory in Obergefell vs. Hodges that legalized same-sex marriage, many at that time were convinced that trans visibility would pave the way to equality, as glossy magazine covers featuring stars like Laverne Cox declared a “Trans Tipping Point.” But while conditions for some trans people marginally improved, we all know what happened next: a wave of reactionary anti-trans state laws, culminating in the re-election of Donald Trump and a series of executive orders aimed at destroying trans peoples’ access to healthcare, sports, bathrooms—essentially the ability to live a normal life.
At the same time, protection can’t be a retreat back into the closet. “It’s still important for trans voices to be heard in online spaces,” said Anna. “It’s not like I wanna go into the shadows or anything. I just don’t want people to know my personal data, my personal records, any of that.”
“Being Black, I also understand the distinction between visibility and hypervisibility and the precarity and lack of agency that hypervisibility creates,” said Thompson. “It’s tricky to find language around digital security that doesn’t imply queerness is something to hide or a shameful thing, because of course it’s not. I think having agency and purpose in how we can show up online and interact with tech as well as literacy around how technology and surveillance operates makes us better equipped.”
Janus Rose is New York City-based journalist, educator and artist whose work explores the impacts of A.I. and technology on activists and marginalized communities. Previously a senior editor at VICE, she has been published in digital and print outlets including e-Flux Journal, DAZED Magazine, The New Yorker, and Al Jazeera.
Erin In The Morning is a reader-supported publication. To receive new posts and support my work, consider becoming a subscriber.
In the latest episode of their podcast A Touch More, all-star athletes Megan Rapinoe and Sue Bird denounced the International Olympic Committee’s new rule requiring sex testing for athletes competing in the women’s category.
The anti-trans policy will subject athletes competing in the women’s division—and only women’s, not men’s—to invasive sex testing to determine whether they have an SRY gene. Why this is where the International Olympic Committee chose to draw the gender line is arguably arbitrary.
No major medical organization endorses this litmus test as a reliable marker of athletic skill or “biological sex.” Even the scientist who discovered the SRY gene has slammed this practice in sports, saying “science does not support” this “overly simplistic” approach. Rather, it’s an arbitrary line in the sand used to cram unscientific ideas about gender and sex into manmade, binary boundaries.
Nonetheless, if a woman tests positive for the gene, she could be forced to compete in the “male” category. This has had dire consequences the last few times it was deployed against women’s athletes. From 1992 to 1999, cisgender women were forced into testing and found out, on the world stage, that they had intersex conditions they never knew about. The spectacle led to ostracization, disqualification, and at least one suicide before such testing was abolished.
“What we’re doing is subjecting everybody, all women and all people who are identifying as women, to this really invasive testing that only to me just says like, oh, so we’re just trying to whittle it down to a certain type of woman,” Rapinoe said.
Rapinoe is one of the most high-profile athletes in the country, a soccer player with three Olympic competitions under her belt and a decorated career in the U.S. Women’s National Team (USWNT). Bird, meanwhile, is among the most successful athletes in history—the retired WNBA legend spent her 20-season professional career as a point guard for the Seattle Storm, and is a record-breaking Olympian in her own right. The athletic power couple has been engaged since 2020. Together, they’ve long been outspoken advocates for the LGBTQ community.
Rapinoe connected the anti-trans vitriol in sports to the right wing’s broader attacks on queer and trans people, calling the push for sex testing “hateful.”
“They sort of like, lost the battle on gay marriage,” Rapinoe said. “So, it’s just like, we’re going to have this whole campaign for all these years to just hate trans people, which is such a small percentage of the population.”
Countless women, cisgender and transgender alike, have faced harassment and persecution because of the anti-trans athlete witch hunt.
“It’s just a total acquiescence to the Trump Administration,” Rapinoe said. “It’s just horrible, and I’m just sickened by it.”
The IOC rule is part of a broader pattern. In the United States, sports bans have served as a Trojan Horse for more sweeping anti-trans policies. The DOJ’s recent lawsuit over “women’s sports,” for example, also demands that transgender students be banned from bathrooms and locker rooms.
“Can we please stop obsessing over trans people and, I don’t know, maybe focus our time, energy, and resources into real problems women’s sports face?” Bird chimed in. She rejected the idea that sex testing, as the IOC claims, “protects women,” instead calling it a “fear-mongering” political ploy meant to generate support from conservative voters.
“That’s all this is,” Bird said. “If you crack this door open, it gets blown open. You’re now policing women’s bodies across the board.”
Erin In The Morning is a reader-supported publication. To receive new posts and support my work, consider becoming a subscriber.
The largest medical association in the United States supports gender-affirming care — a stance it has reiterated in different ways over the last 10 years. But as Republicans press leading medical organizations on health care for transgender youth, the American Medical Association (AMA) is the latest group caught between political rhetoric and the complex realities of specialized care that few people receive.
As patients, families and doctors navigate this care in an increasingly confusing and hostile landscape, what medical groups say matters. But lately, what they’ve had to say — and how politicians interpret it — has only caused more uncertainty.
The AMA’s stance was already in question after a January meeting between leaders of major medical groups and Dr. Mehmet Oz, the head of the Centers for Medicare and Medicaid Services. After that meeting, which was first reported by The New York Times, one group in attendance — the American Society of Plastic Surgeons (ASPS) — muddied the waters about whether it had taken a more restrictive stance on gender-affirming care.
Questions soon followed for the AMA, the nation’s most prominent organization representing doctors.
Twenty Republican state attorneys general are pushing for the AMA to broadly oppose gender-affirming care for minors, in response to news coverage about their recommendations around youth surgeries. The attorneys suggest that the AMA may be violating state consumer protection laws by confusing, or even misleading, medical providers and patients about their stance. They mention wanting to “avoid a formal investigation” into the issue.
The attorneys, led by Steve Marshall in Alabama, wrote a letter in February asking whether the group recommends hormone therapy or puberty blockers to treat gender dysphoria in minors.
“If you agree that there is insufficient evidence to support using surgical interventions to treat gender dysphoria in minors — as your recent statement indicates — we do not understand how you can find that there is sufficient evidence to support using hormonal interventions to treat gender dysphoria in minors,” their letter reads.
This is an escalation of a familiar tactic, said Khadijah Silver, director of gender justice and health equity at Lawyers for Good Government. And if it works, it will be a major weapon in the political fight to delegitimize gender-affirming care, they said.
“If you can convince the public that they have shifted stance, that’s extremely powerful,” they said, referring to the AMA.
In some ways, that impact is already being felt.
In a recent congressional hearing on rising health care costs, the board of trustees chair for the American Medical Association was asked about how patients across the country are struggling to find doctors. Two hours into the hearing, he was also asked about gender-affirming care for trans youth — a topic that affects few Americans, but takes up a lot of political air.
Rep. Erin Houchin, a Republican from Indiana, asked why the medical group changed its position on surgeries for trans youth.
But the AMA maintains that it has not changed its position.
“In surgery and minors, our belief is that it should generally be deferred until adulthood. But, we respect the physician-patient-family relationship in determining that,” Dr. David H. Aizuss answered in response to the question from the congresswoman.
That exchange took only a few minutes out of a hearing that spanned the gamut of crises facing the U.S. health care system, like skyrocketing insurance premiums and a worsening physician shortage. But it represents a growing tension between Republicans and medical groups, as elected officials who oppose gender-affirming care push for major health care organizations to do the same.
The American Medical Association declined to comment on the attorneys general’s letter, which had asked for a response by March 25. In a broader statement, the medical group said it supports gender-affirming care.
“We support evidence-based treatment for medical care, including gender affirming care,” an AMA spokesperson said in an email. “Currently, the evidence for surgical intervention in minors is insufficient for us to make a definitive statement. In the absence of clear evidence, surgical interventions in minors should be generally deferred to adulthood. Treatment decisions should be made between the physician and the patient (and family) based on the best medical evidence and clinical judgment.”
That position aligns with the World Professional Association for Transgender Health (WPATH), an authority on medical care for trans people. WPATH recommends that patients generally wait until adulthood before seeking surgery. Trans youth rarely undergo surgery of any kind; of the small number performed on adolescents, the majority are mastectomies.
If an adolescent does need surgery, WPATH recommends they meet extensive criteria — including a full understanding of reproductive side effects, a year’s worth of hormone therapy, sustained gender incongruence, plus emotional and cognitive maturity.
The questions surrounding surgery come on the heels of the American Society of Plastic Surgeons’ response to the January meeting with Oz. In what the Times described as a “tense” meeting, Oz pressed leaders of organizations including the AMA and the ASPS on why they recommend gender-affirming care for trans youth. At that meeting, the surgeons group said it would be changing its position, per the Times.
Weeks after the meeting, ASPS released a nine-page statement saying that gender-affirming surgery should be delayed for minors until a patient is at least 19. The surgeons’ group cited insufficient evidence that benefits for surgery outweigh risks, and pointed to a controversial report created by the Trump administration to back its position.
The surgeons group noted that it still opposes criminalization of such medical care. The Trump administration celebrated the announcement.
“Today marks another victory for biological truth in the Trump administration,” said former Deputy Health and Human Services Secretary Jim O’Neill, in a press release. Oz, who has compared gender-affirming care for minors to lobotomies, applauded the American Society of Plastic Surgeons “for placing itself on the right side of history.”
In the following days, the surgeon’s group appeared to backtrack. The American Society of Plastic Surgeons reportedly told NPR that its position “does not include a blanket recommendation for surgery for minors.” The ASPS did not respond to a request for comment on this story.
The AMA has had its own trouble communicating its position. In a recent internal newsletter from the board chair, the association said that its policy on gender-affirming care has not changed at all; and that it requested a correction from The New York Times in response to the outlet’s coverage of its initial statement on youth surgeries. However, the Times says it has received no such requests.
This back-and-forth is taking place against an intense political backdrop: Six states have made it a felony for doctorsto provide gender-affirming care to trans youth. Hospitals across the country have shuttered gender clinics in response to pressure from the administration. As a result, some young patients are cut off in the middle of treatment and medical professionals are grappling with how the law impacts them.
And despite ample news coverage, gender-affirming care is still not widely understood.
Very few transgender youth seek and access surgeries. More rely on hormone therapy and puberty blockers to treat gender dysphoria, which is a medical condition that can cause significant distress for trans people.
Puberty blockers delay the hormones that cause kids to go through puberty, which can be an intense and emotionally fraught time for trans youth. Many families say this treatment is crucial for their child’s wellbeing and prevents distress caused by dysphoria. There are potential risks, like decreased bone density, which is monitored by medical providers. Some providers recommend weight-bearing exercise or diet optimization to boost calcium and vitamin D levels while on puberty blockers.
Hormone therapy, which involves taking testosterone or estrogen to cause physical changes that align one’s body with their gender identity, is another treatment that some trans youth receive to alleviate dysphoria. As with puberty blockers, clinics require a mental health assessment as well as parental or guardian consent for the treatment.
The Endocrine Society and the American Academy of Pediatrics are under federal investigation over their support for gender-affirming care. Both medical groups have sued, as the government seeks information to determine if they have made “false or unsubstantiated representations” regarding the care.
The attorneys’ general letter to the American Medical Association is leveling up that pressure on medical groups, Silver said.
“Because the care is so politicized, any association that stands up and asserts its support for physicians who provide the care, will be made an example of,” they said.
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