How Expert Medical Witnesses and Health Misinformation Are Fueling the Debate Around Trans Kids Access to Healthcare
James Cantor, a Canadian psychologist who has never treated a trans kid, has served as an expert witness in dozens of U.S. cases about trans issues.
James Cantor grew up as a drama kid on Long Island, N.Y., where he served as the president of a student-run theater company in college. “I do enjoy the stage, I enjoy the music,” he says. “If I could sing, I'd be on Broadway.”
Cantor never made it to Broadway, but on the morning of May 5, 2022, he found himself outside an Alabama courtroom preparing to play the very real role of an expert medical witness in Boe v. Marshall, a district court case challenging Alabama’s Vulnerable Child Protection Act, a law which bans gender affirming healthcare for transgender youth.
How the court ultimately resolves the case will have intense consequences for the children involved. But in an interview with Uncloseted Media, Cantor spoke about feeling like a character playing a role. He says he has “just the right amount of age, gray hair, a bit of an accent,” to make him look like Central Casting’s idea of a medical expert.
Cantor is not a medical doctor, but rather a psychologist whose work has primarily focused on pedophilia as well as unconventional sexual behavior like kink and BDSM. He has drawn controversy for his beliefs, including advocating for the addition of “P” for pedophilia to the LGBTQ acronym and for the legalization of child-like sex dolls. He lives in Toronto, Canada.
Although he has testified under oath that he has never treated a single transgender child, he has written a report criticizing the American Academy of Pediatrics for endorsing gender-affirming care for minors. In court, he often cites his proximity to former colleagues like Ray Blanchard, whose theories about transgender women have been widely criticized; and Kenneth Zucker, whose clinic closed after accusations that it was performing conversion therapy on trans kids.
Cantor says his perspective on trans issues made him “marketable” to America’s conservative movement. That’s one reason he believes he was first hired in 2021 by Alliance Defending Freedom, the self-described Christian legal group that is famous for opposing marriage equality, favoring conversion therapy and defending laws that prohibit sodomy.
Cantor isn’t an unusual case. Rather, he’s part of a slew of doctors and psychologists who are hired by ADF and other far-right organizations and politicians to defend trans healthcare bans in court. For example, there’s Paul McHugh, who favored shutting down the first gender-affirming surgery clinic in the U.S. in 1979; and Michael Laidlaw, who does not specialize in gender-affirming medical care, but has stated in leaked emails that that his ultimate goal is “to make sure that the Endocrine Society is embarrassed, publicly humiliated, and sued mercilessly” for supporting trans healthcare. These expert witnesses often have little to no experience in the field of trans healthcare, and often base their testimony on unsound science.
In an email to Uncloseted Media, Laidlaw said he had “no comment.” McHugh did not respond.
“The ADF is smart,” says Heidi Beirich, the co-founder and chief strategy officer at the Global Project Against Hate and Extremism. “They understand they’ve got to create their own experts because what they believe is not in line with commonly accepted science,” she says, referring to the idea that they hire people who don’t have specific expertise regarding trans healthcare but rather agree with an ideology as it relates to transgender people.
ADF is one of the most vigorous supporters of many of the more than 500 anti-LGBTQ bills sweeping through state legislatures right now, of which 78 would restrict access to healthcare for transgender youth.
ADF was founded in 1993 by Alan Sears, who co-authored “The Homosexual Agenda: Exposing the Principal Threat to Religious Freedom Today.” In 2016 it was designated an anti-LGBTQ hate group by the Southern Poverty Law Center. Over the last decade, ADF, with revenue of nearly $102 million according to its 2023 990 tax return, has promoted experts like Cantor to help argue their cases.
“The far right and particularly the anti-LGBTQ movement have been perfecting this model for decades,” says R.G. Cravens, a political science professor at California Polytechnic State University, San Luis Obispo.
After ADF hired Cantor as an expert witness on a trans-focused lawsuit in Kentucky, he says he was invited to ADF conferences where he spoke to hundreds of people—including politicians and lawmakers from Attorney Generals’ offices—about his perspectives on gender affirming healthcare and other trans issues. While he wasn’t paid for his speeches, Cantor says it was worth it “for the networking with the people in the audience.”
These appearances paid off. Since 2021, he has been hired by more than ten state Attorney Generals to serve as an expert witness in dozens of cases that focus on trans issues. He’s been flown from Canada to testify in West Virginia, Tennessee, Idaho, and beyond.
“ADF is quite clever with this, because by getting the AGs to take these issues up, they’re even further in the background,” says Beirich. “It makes the cases look more legitimate. Because they’re coming from an attorney general at the state level.”
ADF did not respond to a request for comment.
Cantor’s role in many of these cases—including Alabama’s Boe v. Marshall—is to provide scientific expertise in support of state laws which ban trans kids' access to gender affirming healthcare, which includes access to puberty blockers and hormones. The laws also ban gender-affirming bottom surgery, which is almost never performed on minors, and top surgery, which is performed in very rare cases on minors aged 15 and older.
The stakes in these cases are extremely high. A new report published in August by the Centers for Disease Control and Prevention found that more than 40 percent of LGBTQ kids in the U.S. considered suicide in the last year.
Cantor, a self-described “loudmouth New Yorker theater Queen,” compares his testimony to Marisa Tomei’s feisty character in “My Cousin Vinny,” and references “Ally McBeal” and musical comedy “Schmigadoon!” as theatrical elements involved in being an expert witness.
“The first time I was going in court, we were just laughing,” says Cantor. “It was just teasing about how I love being a performer on stage enjoying an audience, and here I’m doing it in a courtroom.”
“It’s ridiculous and it makes you want to laugh, but none of this is a joke,” says Beirich. “The fact that he would be treating it like he’s a character in Ally McBeal is outrageous. There are real-world consequences here for trans kids.”
Cantor says he makes $400 an hour, which has garnered him a salary around $150,000 a year—enough for him to mostly shut down his private practice in Toronto.
“It’s just dumb luck on my part,” he says, referencing the opportunities to testify in these cases.
In the Alabama case, the state spent nearly a million dollars on lawyers and more than $500,000 on expert witnesses like Cantor. These are taxpayer dollars. Multiple experts received $75,000 contracts for their testimony.
Gender-affirming healthcare for adolescents has been endorsed by several leading U.S.-based healthcare organizations, including the American Academy of Pediatrics and the World Professional Association for Transgender Health. And while there has been some nuanced debate around this topic, Beirich says the medical experts supporting this legislation on American soil are playing a different game.
“I am certainly not saying that this isn’t a complicated issue and that there aren’t legitimate medical discussions to be had, but what ADF is doing is stacking the deck with junk science,” says Beirich. “Their goals are not to have a sophisticated conversation about gender transitioning care. Their goal is to pass terrible punishing laws that hurt trans kids and their families.”
In addition to hiring experts like Cantor, ADF has commissioned notoriously anti-LGBTQ groups to produce studies which they use to oppose gender-affirming healthcare.
In a leaked email from 2014, they asked the American College of Pediatricians—also a Southern Poverty Law Center designated anti-LGBTQ hate group that was formed in 2002 in an effort to stop gay couples from being able to adopt children—to produce research “written in a manner that the general public can easily digest” that can “substantiate the psychological harm that can befall both sexes (but girls/women especially) by having their right to bodily privacy invaded by males,” and “that it is normal during adolescence for children to go through a phase when they identify (to some degree) with the opposite sex.”
They also requested a paper that shows that “those who have undergone hormone therapy and genital change surgery… are no happier even though they took these drastic measures.”
“This isn’t science, this is an agenda,” says Beirich. “In science you hypothesize about things and you test them with an open mind, whatever the outcome is.”
The ACPeds did not respond to a request for comment.
According to a 2023 report by the Southern Poverty Law Center that looked at anti-LGBTQ pseudoscience, much of the research cited by these expert witnesses was written by the same small network of scientists, including Cantor and numerous members of the American College of Pediatricians and other SPLC designated anti-trans groups, such as Genspect and the Society for Evidence-Based Gender Medicine.
"These groups have intentionally sounding scientific names as an effort to try to make sure that they're able to disguise the ideology that motivates them," says Cravens, the editor of the SPLC’s report.
The report also found that half of the most commonly cited papers by expert witnesses testifying in favor of these laws were not primary studies but rather opinion pieces, some of which were not subject to peer review. Many studies cited to prove that most trans youth eventually stop being trans were based on data collected as early as the 1970s, which often include participants who were not confirmed by the researchers to actually be trans in the first place.
“It was amazing to us how frequently letters to the editor of scientific journals showed up in case briefings,” says Cravens. “Members of this anti-LGBTQ network will write a letter to the editor of another scientific journal and it’s basically a statement of their opinion. It has nothing to do with scientifically proven evidence.”
One of the more commonly-cited sources, for example, is a six-page criticism of the American Academy of Pediatrics written by Cantor himself, which cites only two studies and was initially published on Cantor’s personal blog. Another is a 2018 study that suggests kids develop a trans identity through so-called “Rapid-Onset Gender Dysphoria,” where they become trans by being exposed to trans people online. The study has been widely criticized for being largely based on interviews with parents contacted through anti-trans websites. The paper’s publisher has since issued corrections to some of its conclusions and “Rapid-Onset Gender Dysphoria” has been widely discredited by mainstream scientists.
“They were recruiting people from websites that were basically parents not wanting their kids to be trans,” Cravens said. “When you go looking for an answer, you're probably going to find it.”
In spite of this, Cantor still firmly believes in this research.
“We have five percent of the entire population [who are transgender] which came out of nowhere when smartphones were invented,” he says. “They are not trans, they just hate their own bodies.”
Cantor says he was personally advised by his ADF “trainer” on how to testify effectively. One of their key tips was to focus on casting doubt on the opposing expert witnesses’ testimony, rather than trying to convince the judge.
“It’s really probably not going to happen that the judge listens to me and decides, ‘Oh, that’s the scientifically superior argument,’” says Cantor. “Usually, it just boils down to experts on the one side, experts on the other side, and everyone else knows they don’t know. So really, the job is to tie myself up with dynamite and throw myself on the other expert and neutralize us both.”
This scientific manipulation is one of the key components—alongside testimonials from detransitioners—of a legal strategy which has brought ADF much success. After over a year of legal battles, a federal judge allowed the state of Alabama to enforce its Vulnerable Child Protection Act. While LGBTQ advocates have continued to appeal this decision, the law has been in effect since August 2023.
Cantor is still very active. Two months ago, he testified in favor of an Ohio law that bans gender-affirming healthcare for kids and prohibits transgender athletes from competing in girls sports. The state—and Cantor—won that case at the trial court as well, though the ACLU says they plan to appeal the decision.
And while countless Ohio youth lost access to what many scientists describe as critical healthcare, Cantor still got to enjoy the spotlight.
“In Ohio, there was a television camera for the news at the courtroom. The next day on social media, all I kept hearing was what a good hair day I was having.”
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What an awful person Cantor is.