On Wednesday, the governor of Missouri, Mike Parson, signed legislation to restrict gender-affirming care for minors, becoming the 20th US state in a nationwide wave targeting transgender healthcare.
To promote their legislation, Republican politicians have turned to a handful of controversial doctors, all of whom have ties to rightwing groups and little experience treating transgender patients. Every major medical association in the country has come out against such bans, stating that gender-affirming care should be available to those who need it, including minors.
Drawing on existing reporting and investigations, as well as legislative and legal testimony, the Guardian identified a number of physicians who were repeatedly enlisted to craft and promote policies to limit youth access to gender-affirming care.
Of the four doctors profiled below, all are serving as experts in lawsuits currently moving through the courts, including in Alabama and Arkansas, where advocates are challenging laws banning youth access to gender-affirming care. These doctors have collectively testified in dozens of lawsuits related to trans rights.
All of these doctors have connections to organizations that oppose gender transition on religious or moral grounds. Experts say their views have contributed to the growing opposition across the US to youth access to such care, despite the medical consensus about its safety and efficacy. According to Heron Greenesmith, a senior research analyst at Political Research Associates who monitors anti-LGBTQ+ advocacy, these experts and the groups they are associated with have “absolutely contributed to the mis- and disinformation machine around gender-affirming care”.
Meanwhile, efforts to limit access to transition are being extended to adults. Last year, Florida’s agency for health care administration implemented a healthcare regulation barring Medicaid coverage of gender-affirming care for people of any age; that rule is being challenged in court. All of the doctors profiled here have played a role in crafting the policy or defending it.
Dr Patrick W Lappert
A plastic surgeon who teamed up with the Christian legal movement
Patrick W Lappert has testified in litigation or advocated on behalf of legislation to limit trans rights in states across the country including Alabama, Arkansas, Utah and Florida.
Lappert is a plastic surgeon who provides Botox and other cosmetic procedures at his office in an Alabama strip mall. In a 2022 deposition, he told the court that besides providing minor cosmetic procedures to trans patients, including laser hair surgery, he has never treated someone seeking gender-affirming care. During the deposition, he opined that identifying as transgender constitutes a kind of “delusional thinking” and that pursuing virtually any aspect of medical transition, including taking hormones or hormone blockers, is a “form of mutilation”.
He has publicly castigated physicians who do provide gender-affirming care, stating in a 2019 Catholic podcast that “the idea that you can change someone’s sex is a lie” and that providing gender-affirming surgeries is “utterly unacceptable” on moral grounds. “Will one day the medical profession look at support for transitioning youth in the same manner the eugenics movement is now regarded?” he asked in a 2021 expert report.
Lappert, a devout Catholic, is also one of several physicians who attended a 2017 conference for medical experts hosted by the Alliance Defending Freedom, the rightwing Christian legal advocacy group that has been at the forefront of filing anti-trans and anti-abortion litigation across the country. As he described it in a 2021 deposition, it was at this conference that he and a number of attendees were asked to begin testifying about the supposed harms of gender-affirming care.
At least one judge has limited Lappert’s expert testimony, finding that he was “not qualified to render opinions about the diagnosis of gender dysphoria, its possible causes, the efficacy of the DSM, the efficacy of puberty blocking medication or hormone treatments” or a host of other topics. The judge also cited evidence offered to the court that called his “bias and reliability into serious question”.
Lappert did not respond to request for comment from the Guardian.
Dr Quentin Van Meter
A pediatric endocrinologist who was discredited in court
Dr Quentin Van Meter has served as an expert in litigation to limit transgender rights in Florida and Alabama and in support of legislation in Missouri, Pennsylvania and Texas.
Van Meter is an Atlanta-based pediatric endocrinologist who has stated that since 1995, he has only taken on pediatric patients diagnosed with gender dysphoria with the understanding that he was opposed to providing medical interventions of any kind, including hormones or puberty blockers.
In legal testimony he has described the online transgender community as a “cult” and “indoctrinating society”. In a 2023 expert report, he claimed that “at least half of [his] patients were recruited by transgender or non-binary individuals” and that social media presents troubled youth “with a one-size-fits-all solution which offers acceptance and celebrity instantly”.
He is the former president of the American College of Pediatricians (ACPeds), a group that has been declared a hate organization by the Southern Poverty Law Center. It was founded in 2002, after a small number of doctors broke away from the American Academy of Pediatrics for endorsing adoption by same-sex couples. Since then, the college has continued to promote anti-trans and anti-abortion agendas. In a 2020 Texas divorce and custody case, a judge declared Van Meter “discredited as an expert” and barred him from providing testimony on puberty blockers or the appropriateness of gender-affirming care.
In response to request for comment from the Guardian, Van Meter said that his work is designed to protect “transgender children and adolescents from being harmed by social, medical and surgical interventions that are proven not to resolve their mental health morbidity and that are proven to do far more harm than good”. He also denied that there were legitimate grounds to dismiss his testimony in the 2020 divorce case.
Dr Paul Hruz
A pediatrics professor who has never treated a trans patient
Paul Hruz is an associate professor of pediatrics at Washington University School of Medicine, where he specializes in the study of diabetes. According to a 2022 CV, since 2016 he has testified in at least 10 lawsuits related to gender transition and trans rights, even though, according to a federal judge in North Carolina, he “has never diagnosed a patient with gender dysphoria, treated gender dysphoria, treated a transgender patient, conducted any original research about gender dysphoria diagnosis or its causes, or published any scientific, peer-reviewed literature on gender dysphoria”.
Hruz is a fellow at the National Catholic Bioethics Center, and a member of the Catholic Medical Association, two groups that reject gender transition altogether. In a 2017 deposition, a parent recalled a conversation she’d had with Hruz several years prior, when she was advocating for a children’s gender clinic to open in St Louis. The mother, Kim Hutton, said she told Hruz about how much happier her son had been since transitioning; he responded that medical transition was against God’s plan. When she reminded him of research indicating that children who are denied gender-affirming care are at a higher risk of suicide, he reportedly replied: “Some children are born in this world to suffer and die.” He also attended the 2017 conference organized by the ADF.
The same North Carolina judge wrote that she was “offered evidence that calls Hruz’s motivations – and thereby, his reliability – into serious question”. His testimony played a favorable role in the Keira Bell case, in which a UK court found that children under 16 were probably unable to give consent to receive gender-affirming care. This ruling was reversed on appeal.
Hruz did not respond to request for comment from the Guardian.
Dr Michael Laidlaw
An adult endocrinologist who compared gender-affirming care to Nazi experimentation
Dr Michael Laidlaw has testified in favor of bans on gender-affirming care for youth in Alabama as well as in Florida, where according to Forbes, he helped guide the state board of medicine’s decision to implement a ban on doctors providing such care by citing “widely disputed research suggesting 50% to 90% of children who believe their gender identity does not match their biological sex eventually change their minds”.
He is an adult endocrinologist and former member of the American College of Pediatricians who operates a practice in Rocklin, California. In a 2022 deposition, he testified that he has never conducted any primary research related to gender identity, published any peer-reviewed studies about the efficacy of treatments or managed the care of a patient diagnosed with gender dysphoria.
In March, Mother Jones reported on a batch of leaked emails showing that Laidlaw, along with members of the College and an affiliate of the Alliance Defending Freedom, worked with the South Dakota legislator Fred Deutsch to pass an anti-trans law. When he testified in the state legislature in support of the bill, Laidlaw compared the provision of gender-affirming care to youth to the Tuskegee experiment on Black men and human experimentation on children in Nazi Germany. Although that bill ultimately failed, the effort helped drive the introduction of similar legislation in other states. In February 2023, South Dakota successfully passed a similar bill, which was subsequently signed into law.
In Arizona, Judge Scott Rash cited Laidlaw’s testimony when he refused to block the state’s policy to exclude gender-affirming surgeries from Medicaid coverage.
Laidlaw did not respond to request for comment from the Guardian.
