Indiana State Medical Association Rejects Gender Transition Procedures for Minors

The Indiana State Medical Association (ISMA) passed a resolution to “oppose medical and surgical gender transition treatment for minors” at its annual convention over the weekend. The state medical association is the first mainstream association to challenge the trans ideology promulgated by national medical associations such as the American Medical Association (AMA), the American Association of Pediatrics (AAP), and the Endocrine Society.

This spring, the Indiana General Assembly enacted SB 480, which protects minors from gender transition procedures and creates a private right of action for those harmed by these procedures. The resolution admitted that ISMA opposed SB 480 and gave reasons for changing their position.

“For a statewide medical association to buck the system is a huge accomplishment,” Meg Kilgannon, Family Research Council’s senior fellow for Education Studies, told The Washington Stand. “It shows that what people are doing politically impacts institutions and culture.”

The resolution pointed out the many harms of gender transition procedures for minors, stating that they “entail the medical suppression of their normal hormonal mechanisms necessary for mental and physical growth and development.”

“Medical and surgical gender transition treatments in children are known to frequently lead to reduced stature, reduced bone mineral density, irreversible changes to the voice, abnormal hair loss patterns, sterility, and anorgasmia,” the resolution continued. They also “have poorly-studied but potential long-term ill effects such as higher rates of cardiovascular disease and cancer and burden children with expensive lifelong requirements for hormonal suppression and replacement.”

The resolution further stated that “gender dysphoric children have high rates of complicating intellectual and mental health comorbidities, such as autism, adverse childhood experiences, and mood and behavioral disorders that typically precede the development of gender dysphoria, and which are often unaddressed by transition caregivers.” These other psychological conditions “have their own attendant rates of suicidal ideation,” but “there is no evidence that gender transition therapies improve their social functioning or symptomatology in the longer term.”

“By the completion of puberty,” the resolution continued, “gender dysphoric children not subjected to medical and surgical treatments desist from their dysphoria and embrace their biological sex at high rates, from 60% to 95% of the children depending on the subgroup in question.” By contrast, “95% or more of those who elect to take puberty blockers proceed as soon as possible to cross-sex hormones and surgery,” becoming lifelong patients.

The resolution rejected the claim that gender transition procedures are “evidence-based,” noting that “the scientific evidence is weak, usually involving small-scale, single-center, uncontrolled, voluntary surveys conducted within a few weeks of surgery and which usually have high rates of non-participation.” In these studies, “contradictory evidence is ignored or downplayed.” It further pointed out that “many very socially liberal countries in Western Europe … have revised their policies to allow the medical or surgical transition of minors only as part of properly overseen research protocols with narrowly limited entry qualifiers and with court-supervised systems to protect the participating children.”

The resolution also rejected the claim that gender transition procedures “are necessary to prevent dysphoric children from committing suicide,” noting that “there is no scientific evidence that dysphoric children who do not receive these treatments attempt or complete suicide at a higher rate than those who are treated.”

The resolution then rejected the claim that puberty blockers are “safe, temporary, and fully-reversible,” noting that “interrupting puberty … for any significant duration does cause significant irreversible changes … to the stature and bone density attainment.” Additionally, “no reliable studies … exclude other potential long-term effects.”

“On balance, the current practice of medical and surgical gender transition treatment is harmful to children,” the resolution concluded. “The first duty of ISMA members is to do no harm to patients.”

In addition to reversing ISMA’s stance on medical and surgical gender transition treatments for minors, the resolution also committed ISMA to “carry forward a resolution to the AMA to oppose medical and surgical gender transition treatment for minors with federal lawmakers and regulatory agencies.”

ISMA also debated a resolution to “oppose any legislation that will restrict funding and programming around diversity, equity, and inclusion [DEI] and implicit bias in medical schools and their affiliated institutions of higher education.” According to Do No Harm, “instead of passing the resolution, ISMA kicked it to a board for further study — effectively killing it for now.”

“In the work we do in state legislatures and in schools to combat gender ideology, one of the refrains we hear often is: ‘But all the major medical associations agree with gender affirmation. We are just following established medical guidelines,’” said Kilgannon. Now, the Indiana state association has broken that orthodoxy, she said. “Our work to protect children and adults from the dangerous idea that one can be born in the wrong body are making a difference. Let’s double and redouble our effort — now is not the time to slow down.”

The advocacy group Do No Harm emphasized the same point. “These positive steps should inspire the Indiana General Assembly to take up the torch of reform. State lawmakers should continue to protect children from transgender activists, while taking bold action to get DEI out of medical education — especially at the IU School of Medicine, which is one of the most politicized in America.”

ISMA is not the first state association to publicly break with its national counterpart over the latter’s left-wing policy agenda. By June 2022, 30 state school board associations had denounced and 26 had dissociated themselves from the National School Boards Association (NSBA) after that organization colluded with the Biden administration on an October 2021 letter inviting the administration to investigate concerned parents as domestic terrorists.

In July 2023, the Montana State Library Commission voted to withdraw from the American Library Association (ALA) after that organization elected a self-described “Marxist lesbian” as its new president. A Texas library commission followed suit in August, and lawmakers in at least seven other states have proposed to do the same.

If state medical associations follow the pattern of state school board associations and state library commissions, other state associations could join Indiana’s in contradicting the AMA’s position on gender transition procedures for minors, or even dissociating from the national organization.