Letitia James’s Empty Threat Against Responsible Doctors
Why New Yorkers should ignore their Attorney General when she cries "discrimination"
Imagine you’re a surgeon. Many of your patients are women who need a mastectomy to excise breast cancer. You’ve also removed tissue from teen boys with gynecomastia. One day a 14-year old girl and her parents darken your door. They want you to remove the girl’s breasts because, they say, she is a “transgender boy.”
As a surgeon, you know that the procedure would destroy function by killing erotic sensation that most women’s breasts possess and the ability to breastfeed in the future. (Apologies for the remedial mammary lesson – many of my subscribers are gay men.) This makes the operation different from removing boys’ excess chest tissue. The operation would also carry all the typical risks of mastectomy, like nerve damage and a long recovery period. Finally, you know this treatment for supposed “gender dysphoria” is not evidence-based. So you tell the family you won’t remove her breasts.
Then your state’s Attorney General charges you with violating the girl’s civil rights.
New York’s AG Letitia James wants surgeons to fear this scenario. But her threats are empty. In this post I’ll explain why. It’s not intended as legal advice but rather as a public service announcement. Any doctor who’s worried should consult a lawyer with this link in hand.
DISCLOSURE: I used to work for James. She fired me on Jan. 22 because my public critique of trans legal arguments “undermines [James’s] mission, work and efforts (including litigation positions), and credibility.”
The Warning
Days after retaking office in January 2025, President Donald Trump issued an executive order directing federal officials to defund hospitals that practice pediatric gender medicine (PGM). James and 22 other AGs sued to block implementation of the order. They secured a temporary injunction, but nevertheless many hospitals bailed on PGM.
NYU Langone was caught cancelling puberty blocker appointments, which triggered a march through Midtown Manhattan on Feb. 3, 2025, at which the actress Cynthia Nixon announced her daughter and niece were trans, as well as her daughter’s best friend and her best friend’s daughter.
That same day, James issued a Dear Colleague letter. The New York Times reported she sent it to “health care providers and other organizations.” It read:
Regardless of the availability of federal funding, we write to further remind you of your obligations to comply with New York State laws, including those that prohibit discrimination against individuals based on their membership in a protected class, such as sex, gender identity or expression, sexual orientation, race, creed, color, national origin, citizenship or immigration status, military status, disability, or marital status. See, e.g., N.Y. Exec. Law § 296(2); N.Y. Civ. Rights Law § 40-c. Electing to refuse services to a class of individuals based on their protected status, such as withholding the availability of services from transgender individuals based on their gender identity or their diagnosis of gender dysphoria, while offering such services to cisgender individuals, is discrimination under New York law.
A few weeks later James referred to Trump’s order itself as “discriminatory.” She has since continued to suggest that civil rights law requires surgeons to inject kids with the hormone of their choice. For example, in an August 2025 lawsuit against the Trump administration, New York and other states argue:
if providers cease providing [PGM] …, they risk running afoul of many Plaintiff States’ anti-discrimination … laws. Those laws prohibit discrimination on the basis of sex, gender identity, gender expression, transgender status, diagnosis of gender dysphoria, or intersex status …
Even though plenty of New York healthcare providers don’t transition children, James has never charged any of them with human rights violations. It seems she doesn’t want to test her theory.
What New York Law Actually Says
New York bans discrimination on the basis of “gender identity” by statute and in its constitution. While the latter point is particularly embarrassing, it doesn’t make a difference to the issues in this post.
The Text
New York Executive Law section 296:
It shall be an unlawful discriminatory practice for any … place of accommodation … because of the … gender identity or expression … of any person, directly or indirectly, to refuse, withhold from or deny to such person any of the accommodations, advantages, facilities or privileges thereof…
Needless to say, the law does not explain what gender is, but here’s what it says about gender identity or expression:
The term “gender identity or expression” means a person’s actual or perceived gender-related identity, appearance, behavior, expression, or other gender-related characteristic regardless of the sex assigned to that person at birth, including, but not limited to, the status of being Transgender.
Sidenote: in trans ideology, gender identity and gender expression are different. The former is subjective (how you see yourself), the latter objective (how others see you). But NY law crunches them together, making it hard to figure out which bathroom to use. Go with the urinals because I have short hair or hold it in because I don’t have a gender identity?
Section 296 is a “public accommodations” law – the sort of statute that ensures black people can access hotels and Brits can’t be kicked out of Irish pubs on St. Patrick’s Day in Queens. Extending the protections based on “gender identity or expression,” if it means anything, must mean business owners can’t refuse to serve someone based on the color of their shirt or whether they say they are “Transgender.”
Applying the statute to doctors means they can’t refuse to X-ray a man’s elbow because he says “Call me Isabelle.” There’s no medical reason not to X-ray him, just as there’s no medical reason to deny a black person an X-ray when a white person with the same presentation would get one.
But James suggests doctors must treat the “Transgender” patient the same as a “cisgender” patient when there is a medical reason not to, e.g., the former doesn’t have cancer while the latter does; the girl’s breasts have functionality and the boy’s do not. This is just inane, like calling a restaurant racist because it refuses to serve a black person who ordered raw chicken. No legislator ever intended civil rights laws to override a doctor’s medical judgment.
That said, “anti-transgender discrimination” is the same argument the ACLU advanced in its challenges to state bans on PGM – and it won several victories before the Supreme Court wiped them out in Skrmetti. Those lawsuits were brought under the federal Constitution, so Skrmetti doesn’t preclude a different ruling under NY law. (Indeed, some challenges to PGM bans continue in state courts.) But I think judges would see this version of the argument much more clearly. Instead of fighting to allow doctors to practice, as the ACLU does, James is trying to force doctors to prescribe drugs or perform surgery. It’s blatantly authoritarian.
The only thing that could potentially strengthen James’s argument is precedent. But while NY state courts have indulged in a bit of gender woo, they have not lent support to the idea that doctors must block puberty on demand.
How New York Judges Interpret Gender Identity Discrimination
Whatever “gender identity discrimination” means to New York courts, it doesn’t mean “withholding estrogen from autistic boys is bigotry.”
I wrote about New York’s GI laws in 2024. I found that only one appellate court had weighed in, and it did so in a way they treated GI as a belief, not a fact. In other words, it protected a man’s right to think he’s a woman, the same way a Druid can’t lose her job for believing in magic. The court did not say he was entitled to be treated as though he were a woman. That would be like a Druid demanding her coworkers pretend to be spellbound.
I concluded that the true meaning of “gender identity discrimination” in NY was up in the air but could turn on a few disputes making their way through the legal system at the time.
In one of those matters, a man filed a claim with the state’s Human Rights Division that Hooters refused to hire him because he was “transgender.” That seems to have vanished – perhaps he dropped it or Hooters quietly paid him off. Another pair of lawsuits, brought respectively by James and a “women’s” roller derby team called The Roller Rebels, challenged a Nassau County (Long Island) law that blocked co-ed sports teams from pretending to be all-female when using public facilities.
That litigation has become tangled. The trial court upheld the law in a final judgment on October 6, 2025. Two days later, a unanimous 5-judge panel of the Second Department (an appellate court based in Brooklyn) granted the Roller Rebels a preliminary injunction (PI) in the same matter. This is confusing, and the Second Department didn’t help matters by failing to acknowledge the recent judgment. It had heard oral argument less than two weeks before, suggesting the judges may have rushed this decision out the door.
Meanwhile, James is still litigating her similar lawsuit in the trial court. She also filed an amicus brief in the Roller Rebels case.
In its pro-trans ruling, the Second Department chastises the trial court for “improvidently exercis[ing] its discretion in denying the motion for a” PI. It maintains that “Courts must construe these [civil rights] laws ‘broadly in favor of discrimination plaintiffs, to the extent that such a construction is reasonably possible[.]’” For this idea it cites Syeed v. Bloomberg, in which a woman sued her employer for sex discrimination after it allegedly promoted a less qualified man over her because, it told her, the job wasn’t designated as a “diversity slot.” This neatly encapsulates how “gender identity” advocacy stands on top of pro-woman precedent to hurt women.
That paragraph of the decision reads like a preamble to explaining why the Roller Rebels have a “likelihood of success on the merits” (the first prong of the test for a PI). But there is no reasoning on the Roller Rebels’ likelihood of success, i.e., why their case is good. It’s a conspicuous void. Perhaps the Second Department wasn’t sure how to talk about this point because, again, the claim had already failed on the merits in the trial court.
The Second Department holds the state law “irreparably harms” the Roller Rebels because it requires them to be honest:
While the County suggests that the plaintiff can use its facilities by designating itself as a mixed-sex league, which is permitted under the local law, this would change the identity of the league and would force its players to identify themselves as playing in a mixed-sex league.
These cases seem destined to land before New York’s highest court, the Court of Appeals. Until then, that Second Department decision stands as a GI ruling that can’t be extended beyond the context of men seeking to play women’s sports because it doesn’t explain what makes a GI discrimination claim successful.
But Wait, What About …
You may recall that President Joe Biden tried to force doctors to practice gender medicine under the sex discrimination clause of Obamacare. His regulations, which relied on the dreaded Bostock, were struck down in court. James could emulate his arguments anyway since she’s enforcing a different law – but it’s even more attenuated than her GI argument. None of Biden’s Bostock-based trans discrimination arguments prevailed in court (except in a curious Alabama decision about school bathrooms, but that was reversed on appeal).
California AG Rob Bonta just sued a children’s hospital for dropping its PGM practice. But that’s not a discrimination case. Bonta is arguing the hospital violated terms of its merger with another hospital, which apparently required it to keep transing kids unless the AG granted it permission to stop.
Last week a Westchester jury awarded $2 million to a detransitioner who’d had a mastectomy at age 16. A friend told me about a conversation she’d had with a lawyer – he said it was wrong to sue gender doctors in New York because they didn’t have a choice. Refusing to practice gender medicine, he said, was illegal in that state.
So apparently Letitia James’s disinformation campaign is working. I wrote this post to counter it. State law doesn’t require New York doctors to trans kids. When they inject a teenage lesbian with anabolic steroids or block a boy’s puberty because he likes dolls, that’s on them.
To A.G. Leticia James re Glenna Goldis
Dear A.G. James,
I think it was a big mistake to fire Glenna Goldis. Ms Goldis was stating the need to protect children from needless trauma and surgery. It is becoming more and more apparent the irredeemable damage being done to women and children by the sexual fetishists of transgender ideology. Young people are more likely to be suicidal and commit suicide AFTER cosmetic surgeries which mutilate their bodies and foreclose chances for a healthy future. The majority of people know this and more are realizing the terrible harm this is inflicting on women's rights, women's shelters, sports, rape crises centers and prisons. Unfortunately, you are supporting a losing cause that puts sexual fetishists ahead of the safety of women and children. Sincerely, Betsy Warrior
Great article. I was reading it while at a new doctor’s office where the doctor asked why I didn’t fill in my “gender.” I asked if they wanted my gender or my gender identity (it was the latter). I said I have a philosophical issue with the question and can't see the relevance of my thoughts or feelings to the doctor. She said it’s medically relevant because then they can offer changes to my body - so are they asking this question to drum up business??? Unrelated to your article - but sort of related.