Witness disputes reliability of North Dakota doctors who treat transgender minors

A Toronto psychologist on Monday spoke in favor of the state’s ban on gender-affirming care for minors, arguing that the testimony of North Dakota doctors who treat transgender adolescents is not reliable.

North Dakota in 2023 passed a law criminalizing gender-affirming care, including hormone therapy and puberty blockers, for anyone under 18. It includes an exemption for minors who were receiving the treatment before the ban went into effect.

James Cantor was called by the state of North Dakota to testify in a trial challenging the law. The lawsuit is brought by Luis Casas, a North Dakota pediatric endocrinologist who says the law is an unconstitutional infringement on equal protection and personal autonomy rights. Casas brought the case on behalf of himself and his patients.

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Over the past few years, Cantor has established himself as a voice against gender-affirming medical care, testifying as a witness for states trying to establish similar bans or related laws.

He doesn’t have expertise diagnosing or treating minors with gender dysphoria. Instead, Cantor said he based his testimony on his review of research. He said this makes him more trustworthy than medical doctors who treat transgender adolescents, like Casas. He described the perspectives of such clinicians as limited and ethically compromised, since they have a financial interest.

Cantor said adolescents struggling with gender dysphoria would be better off seeking therapy.

He characterized the existing research in support of the treatments as flimsy and unreliable.

“We really have no idea what the long-term consequences are,” he said.

Experts called by plaintiffs earlier in the trial agreed that there is a lack of high-quality research on gender-affirming medications.

Many common medications are prescribed without robust clinical research to back up their effects, they said. The plaintiffs’ experts said that this kind of research is sometimes impossible to conduct because of funding and ethical issues, especially with pediatric medicine. They said the bulk of existing research on gender-affirming treatments suggests that it works and is safe for adolescents. 

Transgender teen urges judge to legalize gender-affirming care for minors in North Dakota

Four doctors with personal experience treating transgender kids, including Casas, testified that for some patients, gender-affirming medication is life saving. Two North Dakota teens who are patients of Casas also testified last week that the treatment is essential to their wellbeing.

Cantor said he believes that many cases of gender dysphoria are not legitimate but instead stem from “poor socialization.” He said he bases this theory on the fact that these days, a greater share of young people being diagnosed with gender dysphoria also have conditions that can affect social skills, like autism or ADHD.

“This is a socialization problem,” he said. “And among the several different disorders that they’re experiencing, they’re not developing a healthy identity about gender.”

He accused medical organizations that publish guidelines endorsing the use of gender-affirming care for minors, like the World Professional Association for Transgender Health and the Endocrine Society, as scientifically bunk. He said that the organizations’ recommendations are biased and not evidence-based.

He said that states like North Dakota that have passed laws banning gender-affirming care for minors “have done what should have been done” by the medical community.

More than a dozen American medical associations have put out statements in support of the treatments, including the American Academy of Pediatrics, American Psychiatric Association and the Endocrine Society, attorneys for the plaintiffs have said.

Prestigious medical institutions like the Mayo Clinic also provide gender-affirming care, attorneys pointed out.

The attorneys for the plaintiffs said that Cantor is not without his own conflicts of interest. He acknowledged that he’s made a lot of money testifying against gender-affirming care for North Dakota and other states.

Advocates against gender-affirming care for minors testify in North Dakota trial

Cantor said he’s read scientific literature suggesting that doctors are not rigorous enough when diagnosing adolescents with gender dysphoria and can be easily swayed by patients who insist they need gender-affirming care.

Jess Braverman, an attorney for Gender Justice, asked Cantor if he is accusing North Dakota doctors of practicing medicine this way.

Braverman went on to ask Cantor if he has ever personally witnessed a North Dakota doctor diagnose a child with gender dysphoria.

“There are only two possibilities, yes or no,” Braverman said. “So which one is it, Dr. Cantor?”

“Neither,” he said. “The question itself is presuming an answer which is unanswerable.”

The trial is expected to end this week. 

North Dakota’s law also bans gender-affirming surgeries for those under 18, but those procedures were not performed on minors before the ban went into effect.