The AAP Files: Complete American Academy of Pediatrics Emails Showing LGBTQ Affinity Group Balking Over Florida Conference, Plus Background on Elusive Top Gender Doc Jason Rafferty

This is an appendix to my NY Sun investigation of internal tensions at the AAP over holding its conference in Florida, with scores of emails I obtained via public-records requests.

Beleaguered Brown University child psychiatrist and pediatrician Dr. Jason Rafferty, who while still a resident, wrote the American Academy of Pediatrics’ 2018 policy statement on the gender-affirming care method for minors—which is now the centerpiece of both a lawsuit and a probe by state attorneys general. Dr. Rafferty also heads the AAP’s LGBTQ affinity group.

Today, I published an investigation in The New York Sun that I’ve spent all year on, delving into the fraught internal politics at the American Academy of Pediatrics over pediatric gender medicine. My reporting found that members of the AAP’s LGBTQ affinity group—called the Section on LGBT Health and Wellness, or SOLGBTHW—sought to pressure the organization’s leadership, including through threats of a boycott, to pull its annual conference out of Florida. While the AAP considered heeding to such demands, ultimately it quietly decided to stick with the state—for financial and logistical reasons. Hurricane Helene notwithstanding, the Orlando conference starts today, September 27, and runs through October 1.

This Substack is an appendix to my article in the Sun. Below, I provide in their entirety scores of the internal emails on which I based my reporting. In addition to diagraming the drama over the conference, these internal documents help shed light on the background, disposition and thinking of one of the most influential doctors in U.S. gender medicine: Brown University child psychiatrist and pediatrician Dr. Jason Rafferty.

Dr. Rafferty is the author of the broadly influential 2018 AAP policy statement on the gender-affirming care method for minors. The document is now the centerpiece of a lawsuit against Dr. Rafferty and the AAP. And just this week it became the subject of a probe by 20 state attorneys general.

I was able to retrieve, in particular, an email in which Dr. Rafferty expressed an equivocal perspective on cross-sex hormones’ efficacy as a treatment for suicidality among gender dysphoric youth.

I obtained all of these emails from public-records requests that I sent to the public-university employers of AAP members who accessed or participated in these email exchanges through their university email accounts. It first occurred to me to start sending such requests after AAP CEO Mark Del Monte in December ordered those in leadership positions within the organization to cease using professional email accounts and to use private email accounts instead, which are not subject to public-records requests. This suggested to me that there was a there there.

There was. Nine months later, highlights of the hundreds of emails I have thus far retrieved (more are combing) are below.

I lightly redacted these emails to hide details about the pediatricians’ family members and to cover the doctors’ email addresses, phone numbers and work addresses. In some cases, where a doctor refers to details about their family, I blocked out the name of the author of the email instead of details about the family (which still will not identify any individual people).

The email threads appear below in the order that they are referenced in my article. Then I added many other emails that I was not able to report upon.

Reporting Texas legislators to child protective services?

In the Dec. 2023 email thread below, a Hawaii AAP member responded to a new paper in Pediatrics that argued that withholding gender-affirming care is a form of child maltreatment. The Hawaii doctor suggested reporting legislators in Texas to child protective services for putting in place policies she saw as harmful to trans kids.

Also, a Kaiser Permanente Northern California pediatrician reported how very supportive the Biden administration officials were about pledging to fight for pediatric access to gender-transition treatment at the recent USPATH conference. And she said she was “thinking of mobilizing” Kaiser’s “data to show the mental health impact this anti-trans movement has had on” trans youth.

(If you’re reading this Substack over email, you’ll need to click onto the version online or on the app to click on each individual photo in these galleries.)

A discussion among AAP members about how they might find a way to punish lawmakers who put in place policies they see as harmful to transgender youth, inspired by a paper in Pediatrics calling the withholding of gender-affirming care childhood maltreatment

Heated talk of pulling the AAP out of Florida over the state’s LGBTQ-related policies under DeSantis

After one AAP member, the parent of an adult transgender son, told the LGBTQ listserv about a family whose kids they cared for fleeing Florida for New Jersey, this sparked a heated discussion about pushing the AAP to pull its conference out of DeSantis country over its LGBTQ-related policies. “We all know gender-affirming care is life saving,” said the Florida pediatrician in the Jan. 17 email that sparked the thread. Doctors expressed anger over the fact that that the nonprofit FAIR was allowed to hold a booth at the 2023 conference; one doctor claimed to have received harassment from FAIR.

A impassioned thread over policies that deny pediatric access to gender-transition treatment leads to talk of pulling the AAP conference out of Florida.

The thread continues below (Substack only allows nine images per gallery). A couple of pediatricians indicated they are activists, with one talking about the myriad ways that the AAP supported his advocacy work as he fought bans on pediatric gender-transition treatment in Ohio and Kentucky.

Three final emails from the thread are below, one of which came after the big email from Dr. Rafferty that immediately follows this gallery.

Jason Rafferty informs the LGBTQ Affinity group about how the AAP decided not to pull the conference out of Florida

In a Jan. 19 response to the long email thread above, Dr. Rafferty, who at least at that time was the head of the AAP’s LGBTQ affinity group, explains to the group in exacting detail how the AAP leadership considered and ultimately rejected the proposition of pulling the conference out of Florida. They cited financial and logistical reasons.

The 2023 AAP Leadership Conference Resolutions

Dr. Rafferty informed the affinity group about a pair of resolutions regarding LGBTQ-related care that passed at the 2023 AAP leadership conference. In one, the AAP pledged to develop programming for the conference that “that empowers pediatricians and ensures their well-being,” while rationalizing why it couldn’t pull the conference out of Florida. The second committed the AAP to advocating for federal protections for gender-transition treatment for minors.

Two LGBTQ-related resolutions from the AAP's 2023 leadership conference

Do cross-sex hormones reduce suicidality in gender dysphoric youth?

In an April 2019 exchange, one doctor asked for help with the teenage child of a friend who had gender dysphoria and was suicidal. The doctor asked Dr. Rafferty if cross-sex hormones were effective at treating suicidality. Dr. Rafferty’s response was both detailed and equivocal.

A discussion about treating suicidality in a dangerously depressed teenager with gender dysphoria

What happens if a medical resident refuses to participate in gender-transition treatment on religious grounds?

This real-world dilemma, discussed in a Sept. 2019 exchange, prompted Dr. Rafferty to recall how when beginning his medical training, he “struggled personally” with abortion. He said this was in part a product of his having gone to Catholic school.

Dr. Rafferty speaks personally about his evolution about abortion.

Calling SEGM a hate group

In an Aug. 2021 email that ultimately got forwarded to AAP members across western North America, one pediatrician branded the Society for Evidence Based Gender Medicine a hate group based on an article by British activist Mallory Moore.

AAP’s considerable efforts to keep secret its LGBTQ affinity group’s meeting at the Orlando conference

The first screenshot below is an email the members of the LGBTQ affinity group received detailing all the ways that the AAP was seeking to keep secret the private meeting they would have at the Orlando conference. The second screenshot is that meeting’s agenda, which includes more details on how the proceedings would be kept private and secret. The agenda was password protected, so I did not think I would be able to obtain it. But a public-records request succeeded in unearthing it. The gathering will take place Monday afternoon.

I’ve provided yet more AAP and Dr. Rafferty emails below

I have included additional AAP emails below that were not referenced in my New York Sun article, but which provide more interesting background on Dr. Rafferty and on the AAP’s approach to gender-transition treatment. This includes a time that Dr. Jack Turban hit him up for expertise when Dr. Turban was still a resident at Harvard.