Tennessee Attorney Generals Letter
Tennessee Attorney Generals Letter
Tennessee Attorney Generals Letter
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Growing concerns about the current treatment of pediatric gender dysphoria make a free and open
dialogue urgently necessary. For example, the Florida Medicaid Unit, after reviewing the available
medical literature on the use of puberty suppression, cross-sex hormones, and surgical procedures,
determined that there was “insufficient evidence” that such treatments are a “safe and effective
treatment for gender dysphoria.”1 While the American medical organizations endorse a monolithic
consensus they tout as impermeable to doubt, other countries have moved to restrict the medical
treatment of pediatric gender dysphoria. Determining that the risks outweigh the benefits, Sweden’s
National Board of Health and Welfare recommends2 tight restrictions on hormonal interventions for
minors. The board previously highlighted a 1500% increase3 in gender dysphoria diagnoses among
teenage girls over a ten year span. Finland’s leading authority, the Council for Choices in Health Care,
also recommends4 strict limitations on the use of hormonal intervention for juveniles. The council
further recommends against any surgical treatment for minors with gender dysphoria.
Meanwhile, in the United Kingdom, a blue ribbon investigation5 led to the closure of the country’s
only dedicated gender identity clinic and raised serious concerns about the use of puberty blockers.
And the National Academy of Medicine in France advises6 caution in pediatric gender transition and
expresses concern over the existence of epidemic-like case clusters of adolescent gender dysphoria.
One might expect a bit more intellectual humility from U.S. medical organizations when they address
the life-altering, irreversible procedures they are championing as the cure du jour for pediatric gender
dysphoria. Last century, leaders of the American Medical Association embraced eugenics as a cure for
various social ills. Mid-century, the frontal lobotomy came into vogue as a treatment for psychiatric
ailments.
Despite these past cautionary tales and recent radical changes in pediatric practices, the medical
establishment asks you to forcibly eliminate criticism of the treatment regime for gender dysphoric
1
Generally Accepted Professional Medical Standards Determination on the Treatment of Gender Dysphoria, Florida
Medicaid, p3, June 2, 2022, http://www.ahca.myflorida.com/Medicaid/GAPMS/index.shtml.
2
Updated recommendations for hormone therapy in gender dysphoria in young people, Sweden National Board of
Health and Welfare, Press Release, Feb. 22, 2022, https://www.socialstyrelsen.se/om-
socialstyrelsen/pressrum/press/uppdaterade-rekommendationer-for-hormonbehandling-vid-konsdysfori-hos-unga/.
3
Multiple psychiatric diagnoses common in people with gender dysphoria, Sweden National Board of health and
Welfare, Press Release, Feb. 2, 2022, https://www.socialstyrelsen.se/om-socialstyrelsen/pressrum/press/vanligt-
med-flera-psykiatriska-diagnoser-hos-personer-med-konsdysfori/.
4
Medical treatment methods for dysphoria associated with variations in gender identity in minors –
recommendation, Council for Choices in Health Care in Finland, June 16, 2020,
https://palveluvalikoima.fi/documents/1237350/22895008/Summary_minors_en+(1).pdf/fa2054c5-8c35-8492-59d6-
b3de1c00de49/Summary_minors_en+(1).pdf?t=1631773838474.
5
Implementing advice from the Cass Review, National Health Service of England, (Oct. 10, 2022)
https://www.england.nhs.uk/commissioning/spec-services/npc-crg/gender-dysphoria-clinical-
programme/implementing-advice-from-the-cass-review/.
6
Medicine and gender transidentity in children and adolescents, French National Academy of Medicine, Press
Release, Feb. 25, 2022, https://www.academie-medecine.fr/la-medecine-face-a-la-transidentite-de-genre-chez-les-
enfants-et-les-adolescents/?lang=en.
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minors. We would welcome clarification from the organizations as to the scope of their request, but
as of now it appears they would rather silence critics than debate them.
We respectfully demand that you stand down and allow the national conversation to continue. Now
is a time for more speech, not less. Each side must have the opportunity to marshal evidence, make
its case, and attempt to persuade the American people of the rightness of its position. This is the
process most likely to attain the truth and promote effective policymaking. Silencing critics of current
gender dysphoria treatment practices for minors will not make children any safer or healthier. Instead,
it will lead to bad decision-making and erode public confidence in both the federal government and
the medical community.
We are particularly troubled by the medical organizations’ parallel calls to you and leading social media
platforms to take action against speech they find unwelcome or inconvenient regarding the treatment
of pediatric gender dysphoria. A concerted effort by government and industry to suppress speech
violates America’s most fundamental principles. As you are aware, any conspiracy between federal
officials and private actors to deprive Americans of a constitutional right would give rise to civil and
criminal liability for all involved. 18 U.S.C. § 241; 42 U.S.C. § 1983; Dennis v. Sparks, 449 U.S. 24 (1980).
Americans frequently disagree about important issues. That is normal and healthy. But the answer to
disagreement is never the criminalization of speech. “If there is any fixed star in our constitutional
constellation, it is that no official, high or petty, can prescribe what shall be orthodox in matters of
politics, nationalism, religion, or other matters of opinion, or force citizens to confess by word or act
their faith therein.” West Virginia Bd. of Ed. v. Barnette, 319 U.S. 624, 642 (1943).
Nothing matters more than protecting our children. We need to make sure we are doing that right.
The only way to obtain that certainty is through rigorous interrogation of current practices. Criticism
must be welcomed, not silenced. Thank you for your consideration.
Sincerely,
Jonathan Skrmetti
Tennessee Attorney General
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Leslie C. Rutledge
Arkansas Attorney General Austin Knudsen
Montana Attorney General
Todd Rokita
Indiana Attorney General Douglas J. Peterson
Nebraska Attorney General
Derek Schmidt
Kansas Attorney General
John M. O’Connor
Oklahoma Attorney General
Daniel Cameron
Kentucky Attorney General
Alan Wilson
South Carolina Attorney General
Jeff Landry
Louisiana Attorney General
Ken Paxton
Texas Attorney General
Lynn Fitch
Mississippi Attorney General
Patrick Morrisey
West Virginia Attorney General
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c.c.
Mark Wietecha
Chief Executive Officer
Children’s Hospital Association
600 13th Street, NW. Ste. 500
Washington, D.C. 20005