LITTLE ROCK, Ark.—When a researcher begins with a conclusion, then looks for data to support that conclusion, “it’s a danger to all of science,” Dr. Paul Hruz, a St. Louis physician-scientist, told a federal judge.
Yet he said he has seen this disturbing pattern recur in recent years as he examined studies purporting to prove the benefits of hormones and surgeries as treatments for gender dysphoria in youths.
“It is erroneous to say that we identified an effective solution that maximizes benefits and minimizes risk,” Hruz testified on Dec. 1 in U.S. District Court for the Eastern District of Arkansas.
Assailing the poor quality of research about gender-transition medical treatments for minors and raising concerns about the risk of harm, he said, “There are major, major questions that remain.”
Hruz, a pediatric endocrinologist and researcher, also called the procedures “highly experimental” and “unproven.”
Judge Faces Big Decision
The American Civil Liberties Union (ACLU) filed a lawsuit seeking to throw out the 2021 Arkansas law, alleging that it’s unconstitutional.But the Arkansas Attorney General’s Office is defending the Save Adolescents From Experimentation (SAFE) Act, asserting that the state has a compelling interest to protect vulnerable children from medical interventions that can cause permanent harm, including ongoing health problems and sterility.
No dates have been set for attorneys to file final written briefs—the final pieces of the puzzle for U.S. District Judge James Moody Jr. to consider before he issues a ruling. His decision could influence the way other states and courts respond to controversies surrounding similar legislation.
Treatments ‘Disrupt’ Healthy Process
During the last day of testimony on Dec. 1, Dylan Jacobs, deputy solicitor general for the Arkansas Attorney General’s Office, systematically questioned Hruz to share his extensive knowledge about the treatment of gender dysphoria, or gender-related distress, among adolescents.Based on his 25 years as a pediatric endocrinologist, along with 10 years of intensely researching gender dysphoria, Hruz said he would never prescribe puberty blockers or cross-sex hormones without solid scientific studies showing that they do more good than harm.
Endocrinologists are dedicated to “restoring the body to its natural state of health” by correcting hormonal imbalances or deficiencies, he said.
6,000 Sex-Based Differences
Jacobs pointed out that ACLU witnesses described puberty blockers as a harmless “pause button.”Not so, Hruz said.
Puberty blockers prevent sex-specific changes, including easily observed ones such as breast development in girls and testicle development in boys. But inside the body, many other changes are also occurring during adolescence; the impact of interfering with those changes remains largely unknown, which is troubling, he said.
“It is impossible to turn back time. So once you’ve blocked puberty, you cannot buy back the time when that physical process has been disrupted,” Hruz said.
He also said credible studies show that, if left alone, many transgender-identifying youths will likely revert to their biological sex. But if put on puberty blockers, 98 percent of the youths will go on to take cross-sex hormones.
Flooding a person’s body with hormones of the opposite sex can cause myriad unknown effects, Hruz said, noting that there are more than 6,000 sex-specific genetic differences between males and females.
Rapid-Fire Answers
In instance after instance, Hruz enumerated specific problems with studies that claim hormones or surgeries benefited youths with gender dysphoria.“Despite the claims that are made about the efficacy of the affirmative approach, the evidence is insufficient to make that conclusion,” he said.
With near-encyclopedic detail, Hruz fired off answers so quickly that the court stenographer struggled to keep pace. Moody repeatedly asked him to speak more slowly.
At one point, the judge became so frustrated, he threatened to stop the witness from further testimony unless Jacobs found a way to get Hruz to slow down his statements.
Hruz moderated his pace but continued speaking authoritatively as he testified for more than three hours under Jacobs’s questioning.
Generally, when considering medical treatment options, “the higher the risk, the lower the quality of evidence, the more caution that is used,” Hruz said.
Yet with “gender-affirming care,” that principle seems to not apply, he said.
Hruz couldn’t remember seeing any other medical treatments so strongly recommended despite such poor-quality evidence.
ACLU Asks Few Questions
Chase Strangio, an ACLU lawyer, chose to not challenge Hruz on his assertions about the science surrounding “gender-affirmative care.” Instead, Strangio spent about 10 minutes asking questions that mostly focused on Hruz himself.Hruz acknowledged that he had never diagnosed a patient with gender dysphoria, nor treated one for that condition.
Strangio also pointed out Hruz’s connections to Christian, Catholic, and conservative publications or groups.
In a series of other court cases, Hruz signed on as a supporter to briefs that he apparently didn’t author. When asked about some specific passages in those filings, he responded that he probably would have used different word choices.
In one instance, he offered to “discuss the science that supports that statement.”
Strangio’s response was “No, thank you.”
