The largest medical association in the United States supports gender-affirming care — a stance it has reiterated in different ways over the last 10 years. But as Republicans press leading medical organizations on health care for transgender youth, the American Medical Association (AMA) is the latest group caught between political rhetoric and the complex realities of specialized care that few people receive.

As patients, families and doctors navigate this care in an increasingly confusing and hostile landscape, what medical groups say matters. But lately, what they’ve had to say — and how politicians interpret it — has only caused more uncertainty.

The AMA’s stance was already in question after a January meeting between leaders of major medical groups and Dr. Mehmet Oz, the head of the Centers for Medicare and Medicaid Services. After that meeting, which was first reported by The New York Times, one group in attendance — the American Society of Plastic Surgeons (ASPS) — muddied the waters about whether it had taken a more restrictive stance on gender-affirming care.

Questions soon followed for the AMA, the nation’s most prominent organization representing doctors.

Twenty Republican state attorneys general are pushing for the AMA to broadly oppose gender-affirming care for minors, in response to news coverage about their recommendations around youth surgeries. The attorneys suggest that the AMA may be violating state consumer protection laws by confusing, or even misleading, medical providers and patients about their stance. They mention wanting to “avoid a formal investigation” into the issue.

The attorneys, led by Steve Marshall in Alabama, wrote a letter in February asking whether the group recommends hormone therapy or puberty blockers to treat gender dysphoria in minors.

“If you agree that there is insufficient evidence to support using surgical interventions to treat gender dysphoria in minors — as your recent statement indicates — we do not understand how you can find that there is sufficient evidence to support using hormonal interventions to treat gender dysphoria in minors,” their letter reads.

Read the full article about gender-affirming care by Orion Rummler at The 19th.