Paul Terdal

Paul is a tireless advocate for patients in Oregon, especially children with autism. 10 years ago, he helped win a major lawsuit in federal court, A.F. v. Providence, which held that since autism was a mental health condition, Oregon and federal law required health insurers to cover all “medically necessary” evidence-based care.

It was a huge win for mental health parity. 

To build off the momentum, Paul reached out to other mental health advocacy groups across the state to notify them of the ruling – including groups focusing on gender dysphoria. 

His goal was to extend the benefits of the ruling to patients with other mental health conditions seeking similar access to medically necessary, evidence-based care.

Oregon later wrote an administrative rule codifying the court decision into policy for autism and gender dysphoria, and it felt like a win. Paul even helped write some of the language for it. 

But years later, he realized a harsh truth: the state of Oregon had dramatically lowered its evidence standards when it came to gender medicine. Worse, Oregon was burying its own research findings that found there was virtually no evidence of benefit – and hiding them from the public for partisan political reasons.

“Since the rule was created, the definition of ‘medically necessary’ for gender medicine has morphed into just ‘whatever care people want,’ missing that important evidence-based part. For autism services, we had to undergo an extremely rigorous evidence review. I had assumed the groups working on gender dysphoria were being vetted with the same level of rigor that we were. But I was mistaken.”

When Paul dug into the evidence supporting Oregon’s policies covering gender services, he was stunned by what he found.

“There was no 900-page AHRQ report, like there was with autism. Instead, there was just a 12-page brief saying there was ‘insufficient evidence’ to even get started with. And I remember thinking, ‘You’re kidding me, right?’ You can’t help transgender individuals by fast-tracking them into highly aggressive care without evidence of benefit.”

Now, Paul worries that Oregon’s watered-down standards are opening the floodgates to highly invasive treatments for patients struggling with gender identity – with no evidence of benefit.

“If you try an autism therapy and it doesn’t help, you might get frustrated, but no body parts have been cut off,” Paul says. “It’s scary to see how many people in my social circle wrongly assume there is rock-solid evidence for the absolute necessity of gender medicine, when the state of Oregon’s own (suppressed) research report found a ‘paucity of evidence.’”

But Paul’s not giving up. He is currently encouraging his home state to develop a more responsible approach to defining the terms that dictate how gender-related policies are applied.

“For people with gender dysphoria in the United States, we have thrown out all of the patient protections that we normally extend to ensure that the care we are providing is safe, effective, and clinically appropriate for the individual patient. The real victims here are transgender individuals – especially children, adolescents, and their parents – who are being oversold on the necessity and benefits of dangerous and unproven medical interventions.” 

Welcome to the fight, Paul. 

Any defender of evidence-based medicine is an ally of Do No Harm.