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The nation’s association for physicians had stern words Wednesday for Defense Secretary James Mattis over his recommendation to President Trump against transgender military service, saying his findings “mischaracterized and rejected” medical research.

In a letter dated April 3 and made public by Politico, James Madara, executive vice president of the American Medical Association, said Mattis distorted medical research in his determination transgender people are ineligible to serve in the U.S. armed forces.

“We believe there is no medically valid reason — including a diagnosis of gender dysphoria — to exclude transgender individuals from military service,” Madara said. “Transgender individuals have served, and continue to serve, our country with honor and we believe they should be allowed to continue doing so.”

The AMA already came out against banning transgender people from the U.S. military in the days before the Obama administration lifted the prohibition on their service. (Trump would later reverse this policy change.) In 2015, physicians who comprise the House of Delegates of the AMA approved a resolution that found “no medically valid reason to exclude transgender individuals from service in the U.S. military.”

Mattis came to his conclusions on transgender military service — which allows currently serving openly transgender people to remain in the military, but disqualifies new enlistments and expels those who come out at a later time — after an eight-month study that Trump directed after he pledged on Twitter to ban transgender people from the U.S. military “in any capacity.”

Despite the overwhelming consensus from the medical and psychological experts that being transgender isn’t a disease and transition-related care, including gender reassignment surgery, is appropriate for transgender people, Mattis cites anti-transgender junk science to conclude transgender people are ineligible for military service.

“While there are numerous studies of varying quality showing that this treatment can improve health outcomes for individuals with gender dysphoria, the available scientific evidence on the extent to which such treatments fully remedy all of the issues associated with gender dysphoria is unclear,” Mattis’ study concludes.

That determination, Madara writes, is contrary to conclusions of medical experts and “mischaracterized and rejected

the wide body of peer-reviewed research on the effectiveness of transgender medical care.”

“This research, demonstrating that medical care for gender dysphoria is effective, was the rationale for the AMA’s adoption of policy by our House of Delegates in 2015, that there is no medically valid reason to exclude transgender individuals from military service,” Madara writes.

Madara continues the AMA backs public and private funding for transition-related care, including gender reassignment surgery, and the findings of the 2016 RAND Corp. during the Obama years that found the cost of transgender people in the military is “negligible and a rounding error in the defense budget.”

“It should not be used as a reason to deny patriotic Americans an opportunity to serve their country,” Madara said. “We should be honoring their service.”

Last month, Trump directed the Pentagon to implement Mattis’ recommendation against transgender military service. The Defense Department, however, has insisted it will follow court orders against the transgender military ban as result of litigation filed by LGBT legal groups after Trump announced his ban.

The AMA comes on the heels of a statement from the American Psychological Association against the transgender military ban as well as a repudiation from former U.S. Surgeons General M. Joycelyn Elders and David Satcher, whose objections are cited in the AMA letter.

LGBT rights groups praised the AMA for speaking out against the transgender military ban, saying the Trump administration should reverse the policy.

Ashley Broadway-Mack, president of the American Military Partner Association, said the letter proves the transgender military ban is based on junk science.

“The medical experts have made it clear to the world that Donald Trump and Mike Pence are making up ‘alternative facts’ in order to implement their unconscionable transgender military ban,” Broadway-Mack said. “History will look back on this administration in disdain for their blatant discrimination against brave American heroes. We will not rest until our military families are protected from this indefensible assault.”

Aaron Belkin, director of the San Francisco-based Palm Center, said the AMA letter “underscores the expert consensus that transition-related care is reliable, safe and effective.”

“The rationale for the transgender ban has now been repudiated by the American Medical Association, American Psychological Association, American Psychiatric Association and two former U.S. surgeons general,” Belkin said. “The administration tried to reverse-engineer a rationale for the ban, but the President and the Defense Department are on the wrong side of science.”

The Washington Blade has placed a comment in with the Pentagon seeking a comment in response to the letter.