(The Center Square) – Claims of the effectiveness of gender-affirming care have been corroborated by even the most thorough and scrutinizing institutions, including universities, government agencies, and U.S. courts, despite evidence to the contrary.

In April, the Fourth Circuit Court of Appeals ruled that West Virginia’s and North Carolina’s decision to exclude gender-affirming care from coverage violated state and federal law.

That ruling rested on the dubious claim that gender-affirming care is “medically necessary,” as described by the World Professional Association for Transgender Health (WPATH) in its official standards.

WPATH is the world’s leading transgender health organization and is cited dozens of times in the ruling.

Yet, increasingly, the research backing those standards is coming into question. As a result, countries in Europe have begun clamping down on puberty blockers and gender-affirming surgery for youth, a trend the United States has yet to catch up on.

Though the Society for Evidence Based Gender Medicine identified that the studies which form the basis for the WPATH standards of care are methodologically-flawed, the Department of Health and Human Services continues to claim that “research demonstrates that gender-affirming care improves the mental health and overall well-being of gender diverse children and adolescents.”

Even America’s finest universities have yet to concede the uncertainty and possibly harmful effects of gender-affirming care for minors.

“Gender-affirming care saves lives,” says Columbia University. “Growing legislative attempts to limit, ban, or criminalize access to this critical model of medical care endangers the health and well-being of transgender and nonbinary youth.”

That is “completely false,” Leor Sapir told The Center Square. Sapir is a fellow at the Manhattan Institute who specializes in gender medicine.

“Every systematic review of the research that’s been done on this question in recent years has found that the research is extremely weak. No control groups, no follow-up beyond a few months, a high degree of selection bias. Basic methodological problems,” Sapir said.

According to an article from Sapir in 2022, the AAP’s position on GAC “is based on a single non-peer-reviewed policy statement published in 2018 in its own journal, Pediatrics. A peer-reviewed fact-check of that article revealed that it completely misrepresents the research and omits all the studies that undermine the affirmative model.”

The AAP continues to cite that article as the basis for its official policy statement.

Recently, the Washington Free Beacon revealed that WPATH officials pushed for the use of the phrase “medically necessary” in its official standards as “a tool for our attorneys to use in defending access to care.”

In some cases, gender-affirming care might be deemed cosmetic or elective and thus ineligible for coverage.

“The original Medical Necessity Statement was specific to the US because this was where we were experiencing the problem,” one WPATH official said in an email, according to the Free Beacon.

In other words, because it was difficult to acquire cost-free care in the United States, WPATH needed health care officials to think that gender-affirming care was existential to the individual’s health.

Sapir says that WPATH officials believed that the mental-health issues of transgender individuals were the result of the perception of them as pathological, or “in some way disordered.”

“The thinking was ‘we need to de-pathologize trans identity,’” Sapir said. “The problem is, if you de-pathologize transgender identity, how can you get transgender procedures covered by insurance?”

“In one way or another, all of the problems in this area of medicine stem from this contradiction,” Sapir says. “Because of this fundamental contradiction, they’re forced to constantly lie.”

From 2017 to 2021, youth diagnoses of gender dysphoria increased by 178%, according to Komodo Health Inc.

The remarkable increase is attributed to a confluence of social, psychological, and biological factors, according to a report from Dr. Hillary Cass.

“For most young people, a medical pathway will not be the best way to manage their gender-related distress,” Cass said.

Aside from being scientifically unfounded, gender-affirming care is also expensive. Surgeries can top $60,000, many of which are covered by insurance. And puberty blockers are no exception, costing tens of thousands of dollars annually, according to Reuters.

In 2016, the federal government simplified access to treatment when President Barack Obama’s administration barred health insurers and medical providers from restricting care based on an individual’s gender identity.

This policy change led to broader public and private insurance coverage for gender-affirming care, including for children.

“The [Biden] administration is redefining the word sex to mean gender identity and sexual orientation,” Edmund F. Haislmaier, a healthcare expert at the Heritage Foundation, told The Center Square. “There’s a strong case to be made under the Loper decision that that’s not how Congress did it and the Court should interpret it based on what Congress thought when it wrote [the Civil Rights Act].”

Further, Haislmaier says that the Biden administration claims it has the authority under the Civil Rights statute to regulate private health plans extensively.

He argues that this interpretation imposes a new regulatory regime not intended by the statute, akin to the Supreme Court’s West Virginia v. EPA decision, which rejected the EPA’s broad use of the Clean Air Act to regulate carbon emissions.

These rulings, known as the major questions doctrine, clarify that significant regulatory changes cannot be introduced without clear congressional authorization.