Brenna Bird joins other Republican AGs to threaten the American Academy of Pediatrics over its support for transgender young people

Iowa Attorney General Brenna Bird this week joined a group of other Republican state attorneys general in sending a letter to the American Academy of Pediatrics (AAP) accusing the organization of potentially violating consumer protection laws. A group of Republicans says the AAP’s guidelines for standards of care for transgender and gender nonconforming (TGD) young people seeking gender-affirming treatment amount to consumer fraud.

The letter was sent Tuesday by the leader of the Republican group, Idaho Attorney General Raúll Labrador. Like Bird, Labrador was elected attorney general in 2022 and is serving his first term. He gained national attention last year when he announced he would go after health care providers that refer patients needing abortions to doctors in other states. (Idaho bans abortions that begin with the fertilization of an egg.) A federal judge issued an injunction barring Labrador from bringing any such charges.

In a written statement about the AAP letter, Labrador said: “It is shameful that the most basic principle of medicine – do no harm – has been abandoned by professional associations under political pressure.”

Labrador then accused the AAP and other medical organizations that support gender-affirming medical treatments for TGD youth of “sacrificing children’s health and well-being with medically unsupported treatments that leave behind lasting harm.”

According to Labrador, even selective use of drugs that block puberty hormones causes “lasting damage.” The letter cites studies conducted in other countries that are, in part or in whole, inconsistent with AAP guidelines for the care of TGD youth.

“Children with gender dysphoria need and deserve love, support and medical care rooted in biological reality,” Labrador said. “Parents should be assured that a doctor’s medical recommendations are not just the latest talking point in a dangerous and discredited activist agenda.”

The letter sent by Labrador and other Republicans warns AAP that Idaho’s consumer protection law “prohibits ‘(e)ngaging in any act or practice that would otherwise be misleading, false or deceptive to the consumer.”

“Most other states also prohibit making claims to consumers that are false, misleading or deceptive,” the letter adds on behalf of the other signatories. “Each of us takes our responsibility to protect consumers in our states very seriously.”

In addition to Bird, 18 other Republican state attorneys general joined in signing the letter. So did the president of the Arizona Senate and the speaker of the Arizona House, both right-wing Republicans. (Arizona Attorney General Kris Mayes is a Democrat.)

The letter responds to the AAP board’s vote to “affirm the 2018 AAP Policy Statement on Gender-Affirmative Care.” That vote took place in early August 2023. Neither Labrador’s statement nor the letter explains why a group of Republican officials waited over a year to send the letter, nor does it explain why they chose to warn a nationally respected professional organization that had just threatened 42 penalties days before the national elections.

Donald Trump has made attacks on gender-affirming care for young people a regular feature of his campaign speeches. He repeatedly told outlandish lies about children going to school, undergoing surprise gender reassignment surgery during the school day, and returning home after school that same day as a different gender.

The 2018 AAP guidelines state that gender-affirming care is “best facilitated by the integration of medical, mental health, and social services, including specific resources and supports for parents and families. Providers work together to destigmatize gender differences, promote children’s self-esteem, facilitate access to care, educate families, and advocate for safer community spaces where children can freely develop and explore their gender.”

The letter states that the AAP guidelines claim that the effects of puberty-blocking hormone therapies are always reversible – which the signatories say may constitute consumer fraud – but the 2018 guidelines include a section on “reversibility” that clearly distinguishes between effects that may be “(p)erially reversible (skin texture, muscle mass and fat deposition)” and those that are “irreversible once developed (testosterone: protrusion of the Adam’s apple, voice changes and male pattern baldness; estrogen: breast development). ”

At the same time that the AAP board voted to reaffirm the 2018 guidelines in August 2023, it also voted to authorize “the development of an expanded set of guidelines for pediatricians based on a systematic review of the evidence.” In a letter sent this week, Labrador, Bird and other GOP elected officials want the AAP to turn over documents used in this assessment, as well as “all correspondence” related to the process.

AAP is yet to respond to this letter.

Iowa is one of 25 states that has passed a ban on gender-affirming health care for transgender people under 18. (The law does not restrict any gender-affirming care for cisgender people under the age of 18). SF 538, passed in March 2023, was opposed by every health care professional who testified before the Iowa Legislature. Every Republican in the Iowa Senate voted for the health care ban, while every Democrat in the Senate opposed it. In Iowa, five Republicans joined all Democrats in the chamber in voting against her.

Gov. Kim Reynolds signed the bill into law after equating gender-affirming medical care for transgender minors with behaviors that threaten health and safety, such as smoking and drinking alcohol, and saying a ban “is in the best interest of children.”

New, peer-reviewed study published in a scientific journal Nature on Thursday examined the impact of banning gender-affirming medical procedures for transgender minors in the 19 states that have enacted such bans by 2022. Researchers found that suicide attempts among transgender and gender non-determined teens increased by as much as 72 percent in the years following the bans. (Iowa data was not included in the study because SF 538 went into effect in 2023.)

Bird is yet to make any statement regarding the threat letter to AAP or mention it on her social media accounts. Typically, Bird seeks to draw attention to issues that excite conservatives, such as her joining more than a dozen lawsuits against the Biden administration since she became attorney general 22 months ago, or her repeated attempts to invalidate state laws and regulations in California.

This isn’t the first time Bird has joined other Republican attorneys general in sending letters warning of possible criminal prosecution to put pressure on private organizations that operate in ways that conservatives oppose. In December, she and 13 other Republican attorneys general sent a letter to New York TimesThe Associated Press, CNN and Reuters have warned them that covering Israel’s war in Gaza could result in them being charged with “material support for terrorism.”

Two weeks before that letter was sent, Bird signed another letter from a group of Republican attorneys general to two large investor research and advisory firms, demanding that they “stop recommending wake investment strategies” or face legal action for violating their fiduciary duties to their customers.

Last July, Bird and a group of Republican state attorneys general sent letters to the CEOs of companies on the Forbes 100 list, warning them that states could face legal consequences if they do not eliminate their diversity, equity and inclusion programs. (None of these companies are based in Iowa.)

Bird signed the first threatening letter of its kind just a month after taking office. In February 2023, she joined Republican colleagues in letters to the CEOs of Walgreens and CVS, threatening the pharmacy chains with unspecified legal action if they comply with FDA regulations and facilitate the availability of a prescription drug commonly used in medical abortions.

Bird has not yet taken any legal action based on any of these letters.

Earlier this week Des Moines Register released the results of a new Iowa survey examining statewide elected officials’ job approval ratings. According to the poll, only 36 percent of Iowans approve of the job Bird is doing.