The Paid ‘Experts’ Defending Anti-Trans Laws

Hruz is part of a small but prolific roster of expert witnesses who crisscross the country to testify in defense of anti-trans laws and policies facing a legal challenge. Pulling ideas from the fringes of medicine, their purpose is to convince judges that gender-affirming care is scientifically controversial, unnecessary and dangerous.

Most, like Hruz, practice medicine in a field related to gender-affirming care — such as psychiatry or endocrinology — but have treated only a handful of adolescent patients for gender dysphoria, if that, and haven’t published relevant research. Several belong to openly anti-trans groups and have urged state legislatures to pass the very laws they get paid to defend.

Some of the most prominent witnesses were recruited by the Alliance Defending Freedom, a conservative legal powerhouse whose mission is to realize a country governed by far-right Christian values. And many share ADF’s extreme antipathy toward LGBTQ+ people.

“They’re hired guns,” said Omar Gonzalez-Pagan, a lawyer for the LGBTQ+ rights group Lambda Legal who has faced Hruz and his cohorts in several cases. “These are not real experts. They’re manufactured as experts by the opponents of transgender rights.”

Still, for a rate of hundreds of dollars an hour, they can lend a sheen of scientific rigor to school bathroom restrictions and bans on gender-affirming care.

And they are increasingly having an impact. On Aug. 25, a Missouri judge temporarily upheld the state’s four-year ban on most gender-affirming treatments for minors, writing, “The science and medical evidence is conflicting and unclear.”

HuffPost scoured thousands of pages of court filings and dozens of state vendor databases and filed more than 40 public records requests to get a full picture of their growing cottage industry. The search revealed that these expert witnesses routinely pull down five figures in return for just a few weeks of work. Since 2016, state and local governments have spent more than $1.1 million on expert testimony, much of it going to just six go-to witnesses.

Some states also hired high-priced outside legal teams, at a cost of another $6.6 million. The University of North Carolina hired the conservative legal giant Jones Day for up to $1,075 an hour after becoming embroiled in the state’s 2016 bathroom ban.

All these figures likely undercount the true cost by at least half: Out of more than three dozen state and local agencies that defended anti-trans laws in court, fewer than 20 disclosed their spending.

For years, these experts have struggled to establish their credibility in court. Judges have found their testimony to be “biased,” “illogical,” “conspiratorial” or based on fabrication, or tossed their testimony in its entirety for having no basis in research. More than a dozen major U.S. medical associations have endorsed gender-affirming care as medically necessary, including for adolescents.

Florida Gov. Ron DeSantis’ administration enlisted nearly every expert witness of note to craft and defend a 2022 state ban on Medicaid coverage for transition care. Yet all the witnesses combined, in the words of U.S. District Judge Robert Hinkle, could muster “no evidence that these treatments have caused substantial adverse clinical results in properly screened and treated patients.” Hinkle struck the ban down in June.

But for the first time, other courts have begun to buy their arguments. Fortified by a belief that attacking trans people is “a political winner,” in 2023, state lawmakers, mostly Republicans, have introduced more than 550 new bills assailing trans health care and legal recognition. Not only are the experts having their busiest year as a result, but they have notched several critical successes.

In July, a 6th U.S. Circuit Court of Appeals panel allowed Tennessee’s ban on gender-affirming care to remain in place while a legal challenge proceeds. In August, an 11th U.S. Circuit Court of Appeals panel reinstated Alabama’s ban on puberty blockers and hormone therapy for trans youth.

The courts, applying the same reasoning the Supreme Court used to overturn Roe v. Wade, ruled transgender care is not constitutionally protected and that states only need some rationale to regulate it. The expert witnesses were key to cultivating the impression that the medical community is divided. “The medical and regulatory authorities are not of one mind about using hormone therapy to treat gender dysphoria,” wrote the 6th Circuit panel.

The rulings increase the odds of a split among the circuit courts and the likelihood that the Supreme Court will eventually take up the issue of gender-affirming care.

And in the meantime, these experts have helped block medically necessary care for thousands of trans people around the country.

“They’re wasting their time and their energy and money trying to convince me and people like me we aren’t who we say we are, and we aren’t who we feel we are,” said Dylan Brandt, a high school senior and the lead plaintiff challenging Arkansas’ first-in-the-nation ban on gender-affirming care for trans minors.

“I’ve known for a long time exactly who I am, and I am so much happier now that I can express and show who I am. For people to be trying so hard and using so much time and effort to stop me — that’s hard.”

Besides Hruz, the core group of experts includes James Cantor, a Canadian psychologist; Stephen Levine, a clinical psychiatrist whom prisons often enlist when they are facing pressure to provide gender-affirming care; Patrick Lappert, a former plastic surgeon, who has said he considers gender-affirming surgery “diabolical in every sense of the word”; Michael Laidlaw, an endocrinologist who has urged lawmakers to criminalize gender-affirming care; and Quentin Van Meter, a pediatric endocrinologist and the former head of the anti-LGBTQ+ American College of Pediatricians.

This ragtag group of outliers did not find their way into the courtroom at random. Dismayed at the “poverty of people who are willing to testify” in defense of anti-trans laws, according to Lappert, the Alliance Defending Freedom, one of the most formidable forces on the religious right, held a conference in Arizona in 2017 to identify potential recruits. Lappert, who later described the conference in a deposition, Hruz, Van Meter and a California family physician named Andre Van Mol all attended and became go-to witnesses soon afterward. A few years later, the ADF enlisted Cantor to his first case — a lawsuit brought by another expert witness who claimed his university fired him for his courtroom work.

ADF’s recruitment effort paid off right away. Around the same time as the conference, Ashton Whitaker, a 16-year-old transgender boy, became one of the first students to sue over his school’s bathroom ban. An administrator at his high school, part of Wisconsin’s Kenosha Unified School District, had gone so far as to suggest he wear a bright green wristband so teachers could monitor his restroom use, the lawsuit said.

The legal team Kenosha hired spent months poring over past cases and medical journals for potential expert witnesses, according to records obtained by HuffPost — a search that produced little more than several thousands in legal bills and a list of people who seemed “likely favorable” toward the ban. Then a lawyer reached out to the Alliance Defending Freedom, and Kenosha finally retained an expert: Hruz.

ADF plays a central role in the mounting backlash to LGBTQ+ rights — the witness roster is just one piece. The group, envisioned by its founder as a “Christian legal army,” has a $104 million annual budget and drives impact litigation around the country. On gender issues, it has helped organize a diffuse group of reactionary and religious-right lawmakers, lawyers and activists into a sprawling working group that trades model legislation, coordinates PR campaigns and fine-tunes bills to withstand legal challenges, a recent Mother Jones investigation found.

Several of the expert witnesses are active members of the working group, such as Laidlaw. Emails leaked to Mother Jones show he told lawmakers that gender-affirming surgical procedures are “crimes waiting to be recognized and codified into law.”

Kenosha lost its trial and a subsequent appeal. After that, ADF began closely coordinating with Kenosha’s legal team to try to appeal the case before the U.S. Supreme Court. They spent weeks strategizing on the legal approach and amicus briefs before the district ultimately chose to settle.

Opponents of trans rights lost most of their early legal battles in the late 2010s and early 2020s — Kenosha was just one. But the new cadre of experts has no shortage of work. Although their No. 1 assignment today is to defend bans on gender-affirming care for minors — these target puberty blockers and hormone therapy — the core group of experts has defended every variety of anti-trans policy under the sun, from school sports and bathroom bans to orders to investigate parents for child abuse if they support their child’s transition, to bans on gender-affirming care for adults.

The most prolific is Cantor, the Canadian psychologist, who has been a witness in 24 cases total, 11 this year alone. Close behind are Levine, who has been a witness in at least a dozen challenges to anti-trans laws and is the only defense witness with substantial experience treating transgender people, and Hruz.

Most of them bill between $200 and $650 an hour — which is standard for an expert trial witness — for writing reports, giving depositions and trial testimony, and traveling. When Cantor testifies in person versus over video, he said in an interview, he usually earns an extra $10,000 for traveling and waiting his turn in the courtroom.

In Brandt v. Rutledge, the case in which Dylan Brandt is the plaintiff, Arkansas paid Hruz, Lappert and Levine more than $40,000 apiece, records show. (“Yes, I find it pays well, but not nearly as well as your information suggests,” Levine said in an email.)

Mark Regnerus, a sociologist who testified, pocketed $57,062. Regnerus is a veteran of the expert witness circuit, having previously testified that children of same-sex couples grow up at a disadvantage in defense of bans on same-sex marriage. Hruz, a few months after he submitted his expert report to Arkansas, sold a “nearly identical” version to North Carolina, court records show.

“It’s not a difficult job for $200, $300, $400 an hour,” said Carl Charles, a senior attorney at Lambda Legal. But few are willing to do it, he speculated, because “These bills do real harm to young people and to their families, and I think doctors take that pretty seriously.”

Cantor, the Canadian psychologist, does not share the religious mission of groups like ADF. He credits “his inner Vulcan” for his ability to testify in cases that involve banning a 10-year-old trans girl from playing on the girls’ softball team or stopping adults from correcting their gender on their government documents, to name two recent examples.

“When I first started getting contacted by these groups, it was a long, hard conversation I had to have with myself,” he said. “It’s not up to me, I ultimately decided, what society does. That’s up to society.”

Although he has defended more policies involving trans kids than any other expert, Cantor has never counseled a transgender child or teenager. He has never carried out original research involving trans people, either. His expertise is in paraphilia: abnormal sexual desires, such as pedophilia. And he has acknowledged in court that gender dysphoria — the distress a person feels when they don’t identify as their sex assigned at birth — is not a form of paraphilia.

In a 2022 deposition over West Virginia’s ban on trans girls playing in school sports, Cantor failed to recall the names of any puberty-blocking drugs: “Oh, I couldn’t tell them to you by name so much as by function,” he said. “I’ve always been bad with names,” Cantor told me. “These drugs have had different names in different countries at different times.”

Cantor believes his lack of direct experience allows him to evaluate the field dispassionately.

“The best analogy I have is that, if you want to know if fortunetelling is valid, you’re not going to find that out by just asking the fortunetellers,” he said.

A deposition he gave last summer defending Indiana’s ban on trans girls playing girls’ sports suggests he does not believe trans adolescents are really trans, but are primarily either gay, young and “mistak[ing] the emotions that they’re having” for gender dysphoria, or have autogynephilia, an outlier theory holding that some trans women are merely aroused by the thought of themselves as a woman.

“It’s just a different phenomenon that only looks similar superficially” in children, he said in our interview.

He also argues that studies “consistently, even unanimously” find that the majority of youth who identify as trans stop doing so after a few years. But many of the sources he has cited aren’t studies of trans kids: In multiple examples, the researchers didn’t differentiate between kids who consistently and persistently identified as trans and kids who just behaved in ways associated with the opposite gender. Several studies are decades old and have research topics like “the sissy boy syndrome.”

More recent research finds very low rates of detransitioning among children who socially transitioned, and for reasons that include social pressure and a lack of parental support.

Cantor earned $23,400, he said, defending Texas Gov. Greg Abbott’s notorious directive to investigate the parents of children who receive gender-affirming care for child abuse. In the case over Alabama’s ban on gender-affirming care for minors, he earned $52,400. Because of his lack of experience treating trans youth, the judge in that case, Liles C. Burke, a Trump appointee, ruled that Cantor’s testimony held “very little weight” and blocked the ban from taking effect. A dozen states have nevertheless asked him to be an expert witness since that May 2022 ruling. The 11th Circuit Court of Appeals reversed Burke’s ruling a few days after we spoke.

“The question in the back of people’s heads is, is he only saying this for the money?” Cantor said in our interview. “If my assessment of the literature was the other way around, I’d be working from the other side. It wouldn’t make a difference. So it’s good that I’m getting paid, right?”

Levine declined to be interviewed because he is an expert witness in at least one ongoing case. (HuffPost contacted all the experts named in this story and was unable to reach Lappert despite multiple attempts.) In response to specific questions, Levine wrote, “Your questions illuminate how information can be dysinformation [sic] or simply wrong. Like delusions that often contain a kernel of truth, it is the distortions of reality that enable the label delusion.”

In 1997, he chaired a committee of the organization known today as WPATH, which develops the best practices for treating gender dysphoria. He cut his ties, however, after WPATH became too responsive, in his view, to trans advocacy.

Before he started defending anti-trans laws as an expert witness, Levine provided expert testimony for prisons seeking to block trans inmates from socially transitioning or receiving gender-affirming care, which prisons often oppose for cost reasons.

In that role, Levine has also questioned whether trans people are genuinely trans or if their gender dysphoria is actually an expression of deviant desires or something unresolved from childhood, like “excessively symbiotic” mothering. Of one trans inmate, he wrote that her “transgenderism is tied very much up to her narcissistic character, her demanding character.”

Van Meter, the former president of the American College of Pediatricians, or ACPeds, has appeared in at least six cases. Like ACPeds’ original founders, he became disillusioned with the American Academy of Pediatrics and sought an alternative because the AAP would not endorse the superiority of the “intact, married family” over same-sex parents and single mothers, he said in an interview.

Van Meter has seen a very small number of adolescent patients with gender dysphoria but says he believes the root cause in “100%” of cases is their family environment. “Divorce is probably the most common thread in all of these cases,” he said. He refers these patients to counseling for depression and anxiety, believing it will resolve their gender dysphoria — an approach with roots in gay conversion therapy that research has linked to an increased risk of suicide attempts.

“You basically ruin their lives” by allowing adolescents to transition, Van Meter said, and so at every opportunity, he pressures them to abandon the idea. To one of his current patients, “I have said it a bazillion times … You will always be a biological female.”

“You have a group of people who say they exist, and what they are saying is, ‘No you don’t. You’re not real, you’re sick,’” said Michelle Forcier, a professor of pediatrics at Brown University and a clinician specializing in gender-affirming care. “Let’s be clear: These are adults who are bullying children.”

Dylan Brandt decided not to be in the courtroom on the days that Arkansas presented its case, but his mother, Joanna Brandt, was. The hardest moment for her was when Regnerus, the sociologist opposed to same-sex parenting, minimized the risk of suicide among trans youth, saying researchers had “document[ed] fairly small numbers of actually completed suicides.”

“If we distinguish suicidality from actual suicides — completed suicides — we see a much more narrow story validated,” he said.

Joanna thought about Dylan and felt the sting of tears.

“I was afraid I would start loud, ugly crying, so I got up and left,” she recalled. “How could you come here and talk about these people that you’ve never spoken to, that you don’t know anything about, in such a way? Actual lives are being saved by affirming care, and nobody on the state side cared about that.”

Hutton never forgot her lunch with Hruz. And in the years that followed, as Hruz developed his side hustle as an expert, she began to testify at some of the same trials that he did.

In a 2017 case where Hruz was defending the St. Johns County School District’s bathroom ban, she recalled before a court in central Florida how Hruz had said her child might be “born to suffer and die.” This summer, she flew down to Tallahassee to face off against Hruz again, this time over the state’s Medicaid ban. (She was only reimbursed for travel.)

Her goal is for the courts to understand his true motives. “I know he’s wrapping his whole presentation up in court now as based on science, but that is not what is driving Paul Hruz,” Hutton said. “It is religion.”

Hruz is not the only expert who appears to have religious motivations.

Lappert, the former plastic surgeon, is a chaplain in Alabama for a Catholic organization called Courage, which, according to its website, counsels “men and women with same-sex attractions in living chaste lives.” In a 2018 presentation titled “Transgender Surgery & Christian Anthropology,” he said “the challenge” at hand was “evangelizing people who are being relentlessly [misled] concerning human sexuality.” They needed “catechesis” and “the sacraments.”

Van Meter, on learning that Gov. Brad Little of Idaho had signed two bills the group supported, boasted, “God is with us!”

“It’s not that I’m driven by a religious ideology,” Van Meter said in an interview. “I do use that as a battery pack, during the weary times, to say, don’t give up, there is a reason you are here.”

Courts place few restrictions on who can serve as an expert witness, as long as their testimony is relevant and soundly reasoned. The bar is low enough that groups suing to overturn anti-trans laws rarely challenge these experts’ ability to testify. But when they do, courts have discounted their testimony in about half of cases.

“Hruz fended and parried questions and generally testified as a deeply biased advocate, not as an expert sharing relevant evidence-based information and opinions,” Judge Hinkle wrote when he blocked Florida’s Medicaid ban. Another judge called his testimony “conspiratorial.”

Levine has had parts of his testimony struck several times, including for relying on a fabricated anecdote.

There are moments in the courtroom when the lack of qualification on the defense side is obvious. During a deposition defending Florida’s Medicaid ban, G. Kevin Donovan, who recently retired as the director of Georgetown University’s center for clinical bioethics, claimed that most transgender girls eventually “revert in their self-perception.” But when pressed for his sources, he flailed.

Q: “What is your evidence of that statement?”
A: “Oh, that — that’s been widely published and repeatedly published.”
Q: “Can you name the study that that information comes from?”
A: “I’m sure I could. It’s more than one source, but, yeah.”
Q: “Can you name those studies?”
A: “Not right now, no.”

Records show the Florida Agency for Health Care Administration paid Donovan $34,650. He did not respond to questions about his testimony.

The other side has its experts, too. Typically, they are clinicians who have provided gender-affirming care to hundreds of trans people or published substantial research on gender-affirming care, or both.

The expert witnesses for the defense, lacking the same breadth of experience, typically try to poke holes in the research supporting gender-affirming care, largely by nitpicking and misrepresenting the evidence or ignoring newer studies in favor of dated ones. “Their way of operating is to look at each study, say it has limitations, and because it has limitations, to disregard it entirely,” said Gonzalez-Pagan, the Lambda Legal attorney. “And the pile of evidence never grows because they keep finding reasons to disregard studies.”

Many have seized on the fact that there were no long-term, randomized controlled trials to test the efficacy of puberty blockers and hormone therapy for treating gender dysphoria.

Framing randomized trials as the only valid form of evidence lets them ignore the large body of observational and clinical data that does support gender-affirming care. Nearly 20 studies with components of randomized trials — that follow trans adolescents receiving gender-affirming care over a long period of time, or compare outcomes for trans people who accessed gender-affirming care with those who didn’t — have associated gender-affirming care with better mental health outcomes, such as reductions in depression, anxiety or thoughts of suicide.

Those positive associations make it unethical to run a randomized trial over the long term, especially one involving adolescents. “You wouldn’t randomly assign people to smoke a pack a day,” said Briana Last, a research psychologist at Stony Brook University, adding that scores of common medical practices were established without randomized trials.

And, in the past few weeks, researchers have published a randomized trial of 64 transmasculine adults showing that suicidality declined by more than half for the participants who received treatment right away.

The research that expert witnesses for the defense don’t ignore, they often distort. Many, especially Levine, have argued that transition care is potentially harmful by pointing to a 2011 Swedish study that found that trans people who had gender-affirming surgery still had a 19.1% higher suicide rate than the general population.

But the lead author, Cecilia Dhejne, says that is a blatant misrepresentation of the study, which actually showed that providing medical care is not enough without also fighting societal discrimination.

When he deposed Levine in 2022, Charles, the Lambda Legal attorney, read Dhejne’s critique of how Levine misused her research out loud. Undeterred, Levine cited Dhejne again this year in support of Florida’s Medicaid ban.

Several of these experts have argued that other countries, such as the U.K., Finland, Norway and Sweden, have severely restricted puberty blockers and hormone therapy for adolescents. “They’ve decided that in all, it’s experimental and does more harm than good, and they’re stopping,” Kristopher Kaliebe, who has testified in three cases, said in an interview.

But in reality, none of those countries have imposed outright bans. In the U.K., the National Health Service is limiting the future use of puberty blockers to adolescents enrolled in a research study, and puberty blockers and hormone therapies remain available through private care. In Finland, transgender adolescents who meet certain criteria can receive puberty blockers and hormones at the country’s two major research hospitals. Reports of Norway banning gender-affirming care are simply false and propagated by websites known for spreading misinformation. Sweden’s medical board urged clinicians to use “caution” with puberty blockers and hormones for adolescents but did not call for a ban, and specialized providers continue to offer the treatment.

Gender-affirming care providers acknowledge their field faces unanswered questions and that people’s understanding of their gender identity can deepen over time.

Before puberty, Forcier noted, gender-affirming care consists mostly of supporting children if they want to dress or cut their hair differently or go by a new name. “The vast, vast majority will say, this is what I need and where I want to be,” she said, but “it’s OK to change your mind if you’re more gender fluid, it’s OK to change your plan.”

Opponents of gender-affirming care, she argued, aren’t bent on studying and improving care but on eradicating it. Recently, a former employee, Jamie Reed, accused Washington University’s gender clinic of rushing adolescents on to puberty blockers and hormones. While her core claims appear to be proving false or alarmist — one parent said Reed “twisted” her child’s medical history; out of nearly 1,200 patients who sought care at the clinic, Reed claims 16 detransitioned — the main challenge the clinic appears to face is overwhelming demand. Missouri’s response has not been to increase funding for adolescent trans care, but to pass a ban.

“I’m not seeing these people say, ‘This is such an important problem, let’s shift money from white male cardiovascular research to gender care,’” Forcier said. “They are making these arguments in favor of a ban.”

Out of all the government offices asked to justify their hiring of these experts, only the Florida Agency for Health Care Administration, which wrote the state’s Medicaid ban, responded.

“Our process has been transparent and based on factual evidence that we put out for the world to see,” said Bailey Smith, the agency’s spokesperson, hyperlinking to a webpage containing the expert reports from Hruz, Laidlaw, Levine, Van Meter, Lappert and others. “Maybe you just fear the evidence will challenge your biased view of the world.”

The spike in anti-trans legislation means states need even more experts to defend it. And in order to deepen the bench, states have started enlisting academics who aren’t in health care or don’t even primarily research humans.

One is a Manchester University professor named Emma Hilton, who mainly studies a particular species of frog and how it offers an understanding of inherited human genetic disorders.

Hilton is a founder of a British group, Sex Matters, that advocates for legally segregating spaces by sex. She earned $300 an hour last year defending bans on trans girls playing on girls’ sports teams in Utah and Indiana. By way of explaining why she was qualified to weigh in on school sports, she told one court, “I participate keenly in sports at an amateur level, playing netball recreationally.”

“Our understanding of human biology is in part a result of the study of animal models,” Hilton said in an email. She declined to address the relevance of netball, which is like basketball without dribbling.

Another is Michael Biggs, an Oxford sociology professor who admitted in court to writing transphobic tweets under the pseudonymous handle @MrHenryWimbush and described himself as a “teenage shitlord [turned] Oxford professor.” “Transphobia is a word created by fascists, and used by cowards, to manipulate morons,” reads one representative post.

Florida paid Biggs $400 an hour to defend its Medicaid ban. But he plays another, more important role in the expert pantheon: churning out publications that question the efficacy of gender-affirming care. One of his oft-cited critiques of puberty-blocking hormones relied on a questionable reading of hormone trials in sheep, in which the sheep appeared to have anxiety. The other experts have cited Biggs scores of times.

Dylan, the teenager challenging Arkansas’ ban on gender-affirming care, avoids thinking about a future in which these people’s arguments carry the day. Instead, he thinks about going to college in a state that isn’t hostile and studying education. “I’ve dealt with a lot of bullying, but I’ve had some pretty amazing teachers [who’ve] given me a safe place,” he said. “I want to be that for somebody else.”

His lawsuit has already made a temporary shelter for other trans teenagers. In June, a judge struck down Arkansas’ ban. The state had assembled a who’s-who of experts — Lappert, Hruz, Levine and Regnerus — but “failed to prove that gender-affirming care for minors with gender dysphoria is ineffective or riskier than other medical care provided to minors,” in the words of U.S. District Judge James M. Moody.

“He knows better than any of these people, better than I do, who he is, and none of them have any right to tell him any differently,” Joanna said of her son.

“When I started testosterone, I felt like I could breathe normally for the first time,” said Dylan. “In the past three years, I have been able to look at myself in the mirror and smile. It’s changed my life — it’s saved my life — in so many ways.”