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Yale Integrity Project and transgender people

by Andrea James Reviewed October 22, 2026 10 min read

The Integrity Project is a research initiative housed at Yale Law School that publishes reports, journal articles, amicus briefs and editorials summarizing medical research for courts, legislators, regulators and journalists. They have published several works on trans healthcare for young people.

The Integrity Project was co-founded by Yale law professor Anne Alstott and pediatrician Meredithe McNamara of the Yale School of Medicine. In 2022, they published an important white paper criticizing Florida’s GAPMS report. The project became widely known in 2024 for a white paper criticizing the 2024 Cass Review. The Integrity Project white papers were cited in US litigation and attacked by anti-transgender activists.

The original website’s content was drastically reduced in 2024. This profile preserves the original content for historical purposes.

Background

The project grew out of a 2022 collaboration between Yale Law School and clinicians at the Yale School of Medicine and Child Study Center, responding to new state actions against affirmative models of trans healthcare.

The Integrity Project was active from 2022 through 2024. After 2024, the project page was streamlined, primarily hosting an archive of four reports not otherwise available.

White Papers

* = available via Integrity Project archive after 2024

Critiquing the Cass Review*: an evidence-based critique of the Cass Review, an independent review central to U.S. litigation over care for transgender youth.

  • Integrity Project document (undated) [live in 2026] https://law.yale.edu/sites/default/files/documents/integrity-project_cass-response.pdf
  • McNamara affidavit (dated July 1, 2024 via CourtListener)
  • https://storage.courtlistener.com/recap/gov.uscourts.almd.77755/gov.uscourts.almd.77755.629.7.pdf
  • Integrity Project document (dated July 11, 2024) [removed] https://law.yale.edu/sites/default/files/documents/cass-response-7.11.24.pdf [archive]

Biased Science in Texas & Alabama*: a report examining the scientific claims Texas Attorney General Ken Paxton made in arguing that certain medical procedures are child abuse under the Texas Family Code.

  • Integrity Project document (dated April 28, 2022) [live in 2026]
  • https://law.yale.edu/sites/default/files/documents/documents/pdf/biased_science_texasalabama_4.8.22.pdf
    • original url [removed]
    • https://files-profile.medicine.yale.edu/documents/98a6e83f-d1ac-4098-b67a-25be370aec2b [archive]
  • Integrity Project document (via SSRN, posted May 16, 2022)
  • https://doi.org/10.2139/ssrn.4102374
  • Integrity Project page (undated, published ~May 15, 2024) [removed]
  • https://medicine.yale.edu/lgbtqi/clinicalcare/gender-affirming-care/biased-science/ [archive]

Flawed Medicaid Report in Florida*: an analysis and public comment letter to Florida’s AHCA criticizing the GAPMS report, created as a pretext to ban transgender healthcare. The eight authors oppose a proposed regulation as discriminatory under the U.S. and Florida Constitutions and federal law.

  • Integrity Project public comment (dated July 8, 2022) [live in 2026]
  • https://law.yale.edu/sites/default/files/documents/documents/pdf/critical_review_florida_medicaid_report_7.8.22.pdf
    • original urls:
    • https://medicine.yale.edu/lgbtqi/clinicalcare/gender-affirming-care/alstott et al full comment proposed rule re gender dysphoria_443049_284_55174_v3.pdf [archive]
    • https://medicine.yale.edu/lgbtqi/clinicalcare/gender-affirming-care/florida%20report%20final%20july%208%202022%20accessible_443048_284_55174_v3.pdf [archive]
  • Integrity Project page (undated, published ~May 14, 2024) [removed]
  • https://medicine.yale.edu/lgbtqi/clinicalcare/gender-affirming-care/florida-medicaid/ [archive]

Report Challenges Court Decision on PrEP and Public Health*: a report challenging the federal court decision in Braidwood on Pre-Exposure Prophylaxis (PrEP) for HIV prevention.

  • Integrity Project document (dated February 13, 2023) [live in 2026]
  • https://law.yale.edu/sites/default/files/documents/pdf/prep_report_final_feb_13_2023_rev.pdf

Amicus Briefs

Amicus Brief Filed to Defend Gender-Affirming Care in Alabama: concerns the District Court’s preliminary injunction blocking Alabama’s ban on gender-affirming care for adolescents under 19.

  • Integrity Project brief (via GLAD Law)
  • https://www.gladlaw.org/wp-content/uploads/2022/08/eknes-tucker-v-marshall-scientists-amicus.pdf
  • Integrity Project page (undated, published ~May 14, 2024) [removed]
  • https://medicine.yale.edu/lgbtqi/clinicalcare/gender-affirming-care/defending-gender-affirming-care-in-alabama/ [archive]

Amicus Brief Filed in a Florida Lawsuit: filed in Dekker v. Weida, which challenges Florida’s ban on Medicaid payment for gender-affirming care

  • Integrity Project brief (via CourtListener)
  • https://storage.courtlistener.com/recap/gov.uscourts.flnd.443916/gov.uscourts.flnd.443916.169.0.pdf

Amicus Brief Filed Regarding Florida’s SB 254: filed in Doe v. Ladapo, U.S. District Court for the Northern District of Florida.

  • Integrity Project brief (via Equality Case Files)
  • https://files.eqcf.org/wp-content/uploads/2023/12/50-Abdul-Latif-et-al-Amicus-Brief.pdf

Amicus Brief Filed Regarding a Florida Administrative Rule and State Statute: filed in Dekker v. Secretary, Florida Agency for Health Care Administration.

  • Integrity Project brief (via Equality Case Files)
  • https://files.eqcf.org/wp-content/uploads/2024/02/71-Abdul-Latif-et-al-Amicus-Brief-iso-Affirmance.pdf

Other (Testimony)

U.S. House of Representatives Energy and Commerce Committee: Meredithe McNamara’s testimony at the hearing “Examining Proposals that Provide Access to Care for Patients and Support Research for Rare Diseases.”

  • Integrity Project document (June 14, 2023)
  • https://law.yale.edu/sites/default/files/documents/pdf/mcnamara_testimony_us_house_of_representatives_june_14_2023.pdf [archive]

Before the U.S. House of Representatives Oversight and Reform Committee: Meredithe McNamara’s written testimony at the hearing “The Rise of Anti-LGBTQI+ Extremism and Violence in the United States.”

  • https://law.yale.edu/sites/default/files/documents/pdf/written_testimony_of_meredithe_mcnamara.pdf [archive]

Before the Florida Boards of Medicine and Osteopathic Medicine: testimony on proposed practice standards for treating gender dysphoria.

  • https://law.yale.edu/sites/default/files/documents/pdf/fl_testimony_mcnamara.pdf [archive]

Journal Articles

Shuster, S. M., & McNamara, M. (2024). Troubling Trends in Health Misinformation Related to Gender‐Affirming Care. Hastings Center Report, 54(3), 53–55. https://doi.org/10.1002/hast.1590

Alstott, Anne, Melisa Olgun, Henry Robinson, and Meredithe McNamara (2024). “‘Demons and Imps’: Misinformation and Religious Pseudoscience in State Anti-Transgender Laws.” Yale Journal of Law and Feminism, vol. 35, pp. 223 ff. https://openyls.law.yale.edu/entities/publication/c789695f-5d6c-44dc-a28d-a86e0b8e5b53

McNamara, M., Barondeau, J., & Brown, J. (2024). Mental Health, Climate Change, and Bodily Autonomy. Pediatric Clinics of North America, 71(4), 729–744. https://doi.org/10.1016/j.pcl.2024.05.004

McNamara, M., Gentry, K. R., Sequeira, G. M., & Kidd, K. M. (2024). State-Level Bans on the Care of Transgender and Gender Diverse Youth in the United States: Implications for Ethics and Advocacy. The Journal of Pediatrics, 274, 114182. https://doi.org/10.1016/j.jpeds.2024.114182

McNamara, M., McLamore, Q., Meade, N., Olgun, M., Robinson, H., & Alstott, A. (2024). A thematic analysis of disinformation in gender-affirming healthcare bans in the United States. Social Science & Medicine, 351, 116943. https://doi.org/10.1016/j.socscimed.2024.116943

McNamara, M., Abdul-Latif, H., Boulware, S. D., Kamody, R., Kuper, L. E., Olezeski, C. L., Szilagyi, N., & Alstott, A. (2023). Combating Scientific Disinformation on Gender-Affirming Care. Pediatrics, 152(3). https://doi.org/10.1542/peds.2022-060943

McNamara, M., Sequeira, G. M., Hughes, L., Goepferd, A. K., & Kidd, K. (2023). Bans on Gender-Affirming Healthcare: The Adolescent Medicine Provider’s Dilemma. Journal of Adolescent Health, 73(3), 406–409. https://doi.org/10.1016/j.jadohealth.2023.05.029

Paltiel, A. D., Ahmed, A. R., Jin, E. Y., McNamara, M., Freedberg, K. A., Neilan, A. M., & Gonsalves, G. S. (2023). Increased HIV Transmissions With Reduced Insurance Coverage for HIV Preexposure Prophylaxis: Potential Consequences of Braidwood Management v. Becerra. Open Forum Infectious Diseases, 10(3). https://doi.org/10.1093/ofid/ofad139

McNamara, M., Lepore, C., & Alstott, A. (2022). Protecting Transgender Health and Challenging Science Denialism in Policy. New England Journal of Medicine, 387(21), 1919–1921. https://doi.org/10.1056/nejmp2213085

Lepore, C., Alstott, A., & McNamara, M. (2022). Scientific Misinformation Is Criminalizing the Standard of Care for Transgender Youth. JAMA Pediatrics, 176(10), 965. https://doi.org/10.1001/jamapediatrics.2022.2959

McNamara, M., Lepore, C., Alstott, A., Kamody, R., Kuper, L., Szilagyi, N., Boulware, S., & Olezeski, C. (2022). Scientific Misinformation and Gender Affirming Care: Tools for Providers on the Front Lines. Journal of Adolescent Health, 71(3), 251–253. https://doi.org/10.1016/j.jadohealth.2022.06.008

Media Publications

McNamara, Meredithe (March 7, 2024). A huge misconception about medical care for trans kids. The Boston Globe https://www.bostonglobe.com/2024/03/07/opinion/transgender-youth-medical-treatment-misconceptions/

McNamara, Meredithe (November 28, 2023). This Is How to Fight the Disinformation That Fuels Gender-Affirming Care Bans. them https://www.them.us/story/anti-trans-gender-affirming-care-ban-disinformation-myths-debunked

McNamara, Meredithe (January 30, 2023). Florida’s Excuse on Gender-Affirming Care is Troubling. Orlando Sentinel https://www.orlandosentinel.com/opinion/guest-commentary/os-op-florida-flawed-gender-affirming-care-20230130-6yqrknhhsfhplcpo3r53kdavz4-story.html

Alstott, Anne; McNamara, Meredithe (January 22, 2023). LGBTQ Exceptionalism is a Dangerous Double Standard. Peste Magazine https://www.pestemag.com/first-row/lgbtq-exceptionalism-txjga

McNamara, Meredithe; Olezeski, Christy (June 13, 2022). Denying Trans Youth Gender-Affirming Care is an Affront to Science and Medical Ethics. Los Angeles Times https://www.latimes.com/opinion/story/2022-06-13/trans-youth-healthcare-state-bans

Anti-trans backlash

Anti-trans activists put considerable effort into attacking the Yale Integrity Project, particularly after the Cass Review white paper came out in 2024.

Anti-trans groups that attacked the Integrity Project include:

Anti-trans activists who attacked the integrity Project include:

  • Eleanor Hayward

References

Noone, C., Southgate, A., Ashman, A., Quinn, É., Comer, D., Shrewsbury, D., Ashley, F., Hartland, J., Paschedag, J., Gilmore, J., Kennedy, N., Woolley, T. E., Heath, R., Biskupovic Goulding, R., Simpson, V., Kiely, E., Coll, S., White, M., Grijseels, D. M., … McLamore, Q. (2025). Critically appraising the Cass Report: methodological flaws and unsupported claims. BMC Medical Research Methodology, 25(1). https://doi.org/10.1186/s12874-025-02581-7

Rider, G. N., Weideman, B. C. D., Ehrensaft, D., Choudhary, K., Connor, J. J., Feldman, J., Gendernalik, M., John, S. A., Link, C., de Oliveira, L., Panetta, E., Poquiz, J., Pournoor, S. B., Spencer, K. G., & Berg, D. (2025). Scientific Integrity and Pediatric Gender Healthcare: Disputing the HHS Review. Sexuality Research and Social Policy https://doi.org/10.1007/s13178-025-01221-5

Staff report (August 29, 2022). Amicus Brief Filed to Defend Gender-Affirming Care in Alabama. Yale Law School Today https://law.yale.edu/yls-today/news/amicus-brief-filed-defend-gender-affirming-care-alabama

Staff report (July 13, 2022) Team of Experts Provides Critical Review of Florida Medical Report on Transgender Care. Yale Law School https://law.yale.edu/yls-today/news/team-experts-provides-critical-review-florida-medical-report-transgender-care

Staff report (July 11, 2024). White Paper Addresses Key Issues in Legal Battles over Gender-Affirming Health Care. Yale Law School https://law.yale.edu/yls-today/news/white-paper-addresses-key-issues-legal-battles-over-gender-affirming-health-care

Lazine, Mira (July 3, 2024). Yale Researchers, International Experts Release New Paper Rebuking Cass Review.. Erin In The Morning https://www.erininthemorning.com/p/yale-researchers-international-experts

Gavulic, Kyle; Bhat, Shamik; Shanab, Bassel (June 29, 2022). Calling Out Scientific Misinformation and Protecting Transgender Youth. American Medical Student Association https://amsa.org/?p=16696

Srinivasan, Sujata (May 13, 2022). Yale Medical, Legal Experts “Appalled” by Recent Actions Denying Gender-Affirming Care, Issue New Scientific Report. Connecticut Public https://ctpublic.org/news/2022-05-13/yale-medical-legal-experts-appalled-by-recent-actions-denying-gender-affirming-care-issue-new-scientific-report

Ring, Trudy (May 5, 2022). “Science” Behind Texas/Alabama Anti-Trans Policy Is “Full of Errors.” The Advocate https://advocate.com/transgender/2022/5/04/science-behind-texasalabama-anti-trans-policy-full-errors

Kroszner, Debra (May 2, 2022). New Report Refutes Flawed Science of Texas and Alabama Transgender Legal Actions. Yale Law School https://law.yale.edu/yls-today/news/new-report-refutes-flawed-science-texas-and-alabama-transgender-legal-actions

Anti-trans coverage

Levine, S. B. (2025). The Science is Not Settled: An American Skeptic’s View of Trans Care for Youth. Medical Research Archives, 13(7). https://doi.org/10.18103/mra.v13i7.6715

Linehan, Graham (October 28, 2025). Intellectual Quackery: When medical journals won’t publish corrections. The Glinner Update https://grahamlinehan.substack.com/p/intellectual-quackery

Kingdon, C., Stingelin-Giles, N., & Cass, H. (2025). The Cass Review; Distinguishing Fact from Fiction. The American Journal of Bioethics, 25(6), 5–10. https://doi.org/10.1080/15265161.2025.2504397

Staff report (2025). The Yale ‘Integrity’ Project. First Do No Harm Southern Africa https://fdnhsa.org/resources/the-yale-integrity-project/

McDeavitt, K., “Cohn, J.,” & Levine, S. B. (2025). Critiques of the Cass Review: Fact-Checking the Peer-Reviewed and Grey Literature. Journal of Sex & Marital Therapy, 51(2), 175–199. https://doi.org/10.1080/0092623x.2025.2455133

Cheung, C. R., Abbruzzese, E., Lockhart, E., Maconochie, I. K., & Kingdon, C. C. (2024). Gender medicine and the Cass Review: why medicine and the law make poor bedfellows. Archives of Disease in Childhood, 110(4), 251–255. https://doi.org/10.1136/archdischild-2024-327994

Singal, Jesse (December 31, 2024). Yale’s “Integrity Project” Is Spreading Misinformation About The Cass Review And Youth Gender Medicine: Part 3. Singal-Minded https://jessesingal.substack.com/p/yales-integrity-project-is-spreading-dbb

Hayward, Eleanor (October 23, 2024). How the Cass Review has reshaped care for transgender children. The Times https://www.thetimes.com/article/4ae7f8f1-7c44-42ef-9db2-5b3371379c19

Staff report (November 7, 2024). The Cass Review and the BMA: the story of a u-turn. Clinical Advisory Network on Sex and Gender https://can-sg.org/2024/11/07/the-cass-review-and-the-bma-the-story-of-a-u-turn/

Staff report (October 22, 2024; updated February 2025). The Cass Review, the “Yale” Report, and the Importance of Keeping Special Interests at Bay. Society for Evidence-Based Gender Medicine https://www.segm.org/Cass_Integrity_Project_Yale

Singal, Jesse (September 1, 2024). Yale’s “Integrity Project” Is Spreading Misinformation About the Cass Review and Youth Gender Medicine: Part 2 (Corrected). Singal-Minded https://jessesingal.substack.com/p/yales-integrity-project-is-spreading-ba7

Staff report (August 22, 2024). The Yale Integrity Project’s Critique of the Cass Review Critically Examined. Critical Therapy Antidote https://criticaltherapyantidote.org/2024/08/22/the-yale-integrity-projects-critique-of-the-cass-review-critically-examined/

Singal, Jesse (August 19, 2024). Yale’s “Integrity Project” Is Spreading Misinformation About the Cass Review and Youth Gender Medicine. Singal-Minded https://jessesingal.substack.com/p/yales-integrity-project-is-spreading

Sim, Peter (August 8, 2024). An Evidence-Free Critique of the Cass Review. Peter Sim’s Substack https://justdad7180.substack.com/p/an-evidence-free-critique-of-the

Sapir, Leor (August 2, 2024). The Deposition of Meredithe McNamara. City Journal https://www.city-journal.org/article/the-deposition-of-meredithe-mcnamara

“Lal, Mungeri” (July 22, 2024). An evidence-based critique of “An Evidence-Based Critique of the Cass Review.” Democrats for an Informed Approach to Gender https://diagdemocrats.substack.com/p/an-evidence-based-critique-of-an

Resources

Yale Law School (law.yale.edu)

  • The Integrity Project (version as of 2025)
  • law.yale.edu/centers-and-workshops/integrity-project
    • Review of the Cass Report (2024)
    • law.yale.edu/sites/default/files/documents/integrity-project_cass-response.pdf
    • Report on Braidwood decision (2023)
    • law.yale.edu/sites/default/files/documents/pdf/prep_report_final_feb_13_2023_rev.pdf
    • Report on Alabama and Texas (2022)
    • law.yale.edu/sites/default/files/documents/documents/pdf/biased_science_texasalabama_4.8.22.pdf
    • Report on Florida (2022)
    • law.yale.edu/sites/default/files/documents/documents/pdf/critical_review_florida_medicaid_report_7.8.22.pdf
  • The Integrity Project (original version, 2023–2024)
  • law.yale.edu/centers-workshops/integrity-project
    • Our Work [archive]
    • law.yale.edu/centers-workshops/integrity-project/our-work
    • People [archive]
    • law.yale.edu/centers-workshops/integrity-project/people
    • Publications [archive]
    • law.yale.edu/centers-workshops/integrity-project/publications

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