Dr. Paul Hruz has suggested that being transgender is caused by a “social contagion.”
He has spoken against gender-affirming care at a conference led by a recognized hate group that’s pushed for forcibly sterilizing transgender individuals.
And as a physician, he has declined to see anyone who is transgender. “I intentionally do not treat transgender patients,” he acknowledged in one court deposition.
This is the doctor who is now serving in the position created specifically for a “board-certified physician with expertise in gender identity health care” on the Utah commission that examines the bodies of transgender girls, to determine whether they can compete in high school sports.
Hruz was selected by Utah House Speaker Brad Wilson to join the seven-member board.
The Salt Lake Tribune attempted to ask Wilson about his choice — the law gives the speaker sole discretion to fill the only opening reserved for a physician. But his office did not respond to emailed questions and multiple requests to connect a reporter with the Republican leader, who also announced this week that he would be resigning from his position, likely to focus on running for U.S. Senate.
Instead, his office sent a statement from Wilson that didn’t address his decision: “The commission’s role is to take a holistic approach to evaluating individuals. While speaking with other commission members, each expressed appreciation for one another’s expertise and professionalism. I appreciate their work and thoughtful approach to a complex issue.”
Several other state leaders and offices — including the office of Gov. Spencer Cox, the Utah High School Activities Association and the Utah Attorney General’s Office — did not respond or declined to answer questions from The Tribune about the trans sports commission.
The spokesperson for the Attorney General’s Office said: “I am told that the commission handles its own questions about its operation.” Kevin Olsen, an attorney in the office, confirmed he is acting as secretary for the commission, which is formally called the School Activity Eligibility Commission.
But Olsen declined to answer most questions about the work of the group, including how many times it has met and if it’s ruled on any cases. He isn’t responsible, he noted, for appointing members or checking their qualifications.
Although the law requires the physician board member to have expertise in gender identity health care, one federal judge, for instance, has declared Hruz an unreliable expert on the topic.
Hruz “has never diagnosed a patient with gender dysphoria, treated gender dysphoria, treated a transgender patient, conducted any original research about gender dysphoria diagnosis or its causes, or published any scientific, peer-reviewed literature on gender dysphoria,” the North Carolina judge pointed out.
Olsen said the members are not paid for being on the commission, but they will be paid for any travel expenses. None have been incurred yet, he said, as all meetings have so far been conducted online via Zoom.
Hruz is one of three commission members from outside Utah. He also did not respond to an email from The Tribune seeking comment, nor did the spokespeople for Washington University in St. Louis, where Hruz has been employed since 2000 (after completing a residency and fellowship there).
The law gives various political leaders the power to select board members. There is no mechanism for others to challenge whether appointees fit the criteria.
Among the people chosen to serve — who were never publicly announced — Hruz stands out for being openly anti-LGBTQ. Organizations across the country have rebuked him for holding views that fall outside accepted science and medicine and are more often aligned with his faith.
At a religious conference in 2017, for instance, at the Holy Apostles College & Seminary, Hruz displayed photos of transgender kids on a screen, which can be seen in a recording of his lecture on YouTube. He told the audience the images were “disturbing” and it “probably goes back to some of the early heresies in the church.”
Operating in secrecy
Like similar measures in other states, the main point of the bill was to ban transgender girls from competing in high school sports on girls’ teams.
But a district judge here issued an injunction last fall to stop a ban from being enforced while the Utah law is being challenged by two trans athletes. As the law’s backup plan, the creation of the commission was then triggered, in August 2022.
At the time, a spokesperson for the Utah Legislature had said members would be announced “in the coming days.” But the names were never publicly announced.
The governor’s office would only confirm members were finalized by Feb. 8 this year — five months after the commission was set in motion. A spokesperson in the office then said they’d been instructed not to say anything more on the commission.
“Counsel for the commission has advised not disclosing further detail,” the spokesperson said.
Olsen declined to comment on why it took so long to name the members. The Utah High School Activities Association, which oversees public K-12 athletes, also deferred comment on all aspects of this story, including Hruz’s appointment, saying: “UHSAA is not the staffing entity for the commission.”
Cox is responsible for choosing a representative of UHSAA, and he picked Jan Whittaker, an assistant director for the association. He also selects an athletic trainer who serves student athletes on the collegiate level, and tapped Talon Bird, who works at Southern Utah University.
Utah Senate President Stuart Adams also fills two seats under the law: a mental health professional and a statistician “with expertise in the analysis of medical data.” Both of his picks are from other states: Stacy Feiner, a performance psychologist based in Ohio, whose name is misspelled on the state’s list, and Paul Thompson, a professor at the University of South Dakota.
The House speaker fills two more seats, picking Hruz and Michael Henrie, a Utah sports medicine doctor, for the seat for a sports psychologist. Henrie is listed as the commission’s chair; attempts by The Tribune to reach him were unsuccessful.
There is also one ad hoc member, who is chosen by the local athletic association based on the region of play for the individual student being considered. This changes for each athlete.
The terms for board members are one year, but they can be renewed for two more after that.
The work of the trans sports commission is largely private, and Olsen declined to say how many times the commission has met. It is subject to state public meetings law, though, which means it must post agendas online. The Tribune searched those and confirmed it has met four times.
Olsen said any decisions about whether an athlete can play are not to be disclosed, a provision specifically written out in the law. He declined to provide a number of cases ruled on or general descriptions of the outcomes.
Based on the scant meeting minutes, it appears the commission has talked about specific cases four times — though it’s not clear if some are repeat cases. Athlete names are redacted and decisions, made in closed sessions, are not disclosed.
Hruz hasn’t said much during those sessions; none of the other members have drawn attention for having controversial views.
The commission’s task
The members of the commission are tasked with hearing from transgender girls here who want to play under their preferred gender and determining if they should be allowed to — or whether members think they’d have an unfair advantage and should be barred.
Commission members have been instructed to measure a player’s wingspan, weight and height, and to factor in whether the player went through puberty as a boy or if they’ve taken blockers to stop that process, part of the threshold for letting them play.
But gender-affirming care for minors has been blocked in Utah, which would include new prescriptions for puberty blockers. So athletes who hadn’t already been using those medications won’t able to do so, LGBTQ advocates have pointed out.
Concerns have also been raised about the commission invading the privacy of minors and crossing boundaries by looking at their bodies.
Now, with the appointment of Hruz, some said their worries are amplified. Sue Robbins, who is transgender and a member of the Transgender Advisory Council of Equality Utah, said she feels the commission is a sham, purposefully composed to block transgender girls in the same way a full ban would.
“You cannot say this appointment [of Hruz] is by accident,” she said. “If you put someone in who’s openly hostile to the transgender community and says their health care is invalid, then that person is automatically going to become a negative force.”
Robbins added: “This is not a neutral commission.”
Wilson has previously said he was disappointed when the ban on transgender girls playing sports was enjoined by the court. He said he was hopeful that the commission members would ensure “Utah’s female athletes can compete on a level playing field.”
Hruz has not worked in sports or gender medicine. He is a pediatric endocrinologist in Missouri, where he has specialized in diabetes.
Because endocrinologists are focused on hormones, many do treat those experiencing gender dysphoria — a condition of distress where a person feels like they weren’t born in the right body with the sex they were assigned at birth. Hruz has said he refuses to do so, including in a recent expert report for a court in Florida.
He’s part of a small cadre of doctors who have ties to rightwing groups and have been repeatedly called on to provide expert medical testimony by conservative states trying to defend anti-LGBTQ or transgender-restrictive laws. Since 2016, he’s been called as a witness in at least 11 court cases on the topic across the country, including in Florida, Arkansas and North Carolina.
And he’s paid to participate; in Florida, he testified that he was compensated at $400 an hour for consulting on the case, in which the state’s health administration was sued for denying transgender health care coverage for those on Medicaid.
In cases, Hruz largely speaks against any kind of treatment or care for gender dysphoria, suggesting it hasn’t been studied enough and is too experimental. He and other opponents of using puberty blockers posit that they could lead to infertility and issues with bone growth.
Instead, Hruz promotes a method he calls “watchful waiting,” suggesting that most kids, if left alone, will return to identifying with the sex they were assigned at birth.
Researchers are working to learn more about the impacts of puberty blockers on fertility and bone growth and how to manage them. But in the meantime, taking the sole approach of “watchful waiting” is opposed by every major medical association in the country, which have all supported providing care to transgender youth, including puberty blockers, and consider such care crucial to reducing suicidal ideation.
In each of the court cases he’s participated, judges have acknowledged that conflict and, at least partly, disqualified Hruz’s testimony. They most often cite Hruz’s lack of direct experience in the field.
A judge in North Carolina called his testimony “conspiratorial.” Another in Florida said Hruz presented “as a deeply biased advocate, not as an expert sharing relevant evidence-based information and opinions.”
One of his most controversial connections is to Alliance Defending Freedom, or ADF, which has advocated for state-sanctioned sterilization of transgender people. The organization is recognized by the Southern Poverty Law Center as a hate group. Hruz has confirmed in two separate court depositions that he attended a 2017 ADF conference in Arizona, which several doctors who attended have testified was called to cultivate a list of court witnesses to speak against transgender care.
Hruz attended a second controversial conference in Spain in 2018, which he again acknowledged in court depositions. That conference was organized by HazteOir and its international platform, CitizenGo. Both are far-right anti-LGBTQ organizations, and the conference was described as “the world’s first great public objection to totalitarian LGBTI laws.”
Hruz said in a North Carolina case: “I am willing to present to any audience that is willing to hear that information.”
Nearly all of his writing on gender dysphoria is published in religious outlets, where he has advocated in favor of Catholic theologies on the division of men and women. According to his resume, Hruz is a fellow at the National Catholic Bioethics Center and a member of the Catholic Medical Association. Both groups have rejected gender transition.
In an essay for “Catholic Physicians Throughout the World,” Hruz posited that “social contagion” is an “arguably stronger hypothesis” to explain what he sees as a rising number of individuals identifying as transgender.
One of his most recent pieces was published in Church Life Journal in March. In that, he called identifying as transgender a “distorted portrayal of sexual identity.” And he said he feels it could be linked to an overuse of birth control by women.
In that same article, Hruz also advocates against using a transgender child’s preferred pronouns, suggesting that kind of social affirmation will make them less likely to “desist” and return to their sex assigned at birth. Again, the consensus in the medical community does not support that.
Fact-checking Hruz’s claims
Hruz’s views on gender dysphoria have been rejected by authorities that include the U.S. Department of Health and Human Services, the American Medical Association, the American Academy of Pediatrics, the American Psychological Association, the American Psychiatric Association, the Endocrine Society and the Pediatric Endocrine Society.
And researchers have said Hruz leaves out key information when he describes their work. For instance, Hruz repeatedly states that 80% to 85% of kids who are transgender will realign with their sex assigned at birth if left alone.
In his 2023 expert report in a Florida lawsuit, he stated: “My decision is strengthened by the knowledge that the vast majority of children who report gender dysphoria will, if left untreated, grow out of the problem — a natural coping-developmental process — and willingly accept their biological sex.”
That idea comes from three studies, one led by Kelley Drummond in 2008, and another by Thomas Steensma in 2011 and again in 2013. All have been critiqued for their methodology.
Rather than using gender dysphoria as the criteria for the kids they studied, they used the broader category of “sex-discordant gender identity disorder.” That been thrown out as a classification in the most recent Diagnostic and Statistical Manual of Mental Disorders, often referred to as the “DSM,” which professionals rely on for psychological diagnoses.
That previous grouping included anyone with any variation in how they perceived their gender, such as girls referred to as “tomboys.” In most of those cases, according to several reviews on the criticized studies, it makes sense that a child who wasn’t identifying as transgender did ultimately align with their sex assigned at birth. So the percentage would be artificially high.
The researchers of the studies also concede that they counted children who didn’t respond to their follow-up — which amounted to 22% of their original pool — as “desisters,” or kids who never went back to their sex assigned at birth. Again, that would make the number appear bigger than it is.
Steensma, one of the researchers, told VICE News in 2022 that he feels his work is often taken out of context by doctors like Hruz. Steensma is the principal investigator at Amsterdam University’s Center of Expertise on Gender Dysphoria, and he strongly supports gender-affirming care for youth.
The landmark longitudinal study that has been widely regarded as the most rigorous on the issue found 2.5% of transgender youth “retransitioned” back to sex assigned at birth. That was conducted by Dr. Kristina Olson, at Princeton University, in 2022.
And the doctor who came up with the “watchful waiting” concept, Dr. Kenneth Zucker, has said that is only helpful for prepubescent kids; he has said if a child persists in their gender dysphoria into adolescence, then they should be treated with puberty blockers.
Parents and an advocate speak out
In 2013, Missouri mom Kim Hutton sat down with Hruz, wanting to explain how her son is transgender and was struggling until he started transitioning to his preferred gender. She said she told Hruz about research, too, that showed transgender kids who are denied gender-affirming care have a higher risk for suicide.
She recounted in a court deposition that Hruz responded: “Some children are born into this world to suffer and die.”
Hutton said Hruz then vowed there would never be a pediatric gender center at the St. Louis Children’s Hospital, where he still works. (One opened there in 2017, but care stopped earlier this month under a new state law.) In court, he didn’t deny making the comment about suffering. He also stepped down as the division chief for pediatric endocrinology in protest when the gender clinic started.
Sydney C. has two nonbinary kids, both adolescents, in Utah schools. She already had reservations with the idea of the trans sports commission, she said, with fears about adults judging minors’ bodies behind closed doors.
With the selection of Hruz, she said, she now feels certain it was never intended to give transgender girls a chance to play sports.
“They literally looked for someone who is dead set against [these girls],” said the mom, who The Tribune has agreed to identify with only her last initial to protect the privacy of her kids. “There’s absolutely no question in my mind that the bigotry is the point, the cruelty is the point.”
“There are dozens of physicians here in gender-affirming care,” Sydney C. said. “There are pediatricians here who do real work on the subject. It should be someone who’s actually seen a patient who’s experienced gender dysphoria.”
Both say asking transgender girls to go in front of Hruz for a hearing on their sports eligibility is too much to ask of already vulnerable youth.
“We are sending our kids through a doctor who has been testifying against their health care in a number of states,” Robbins said. “This is not a good way to treat our youth. This is harmful.”
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