Dr. Karla Solheim was hardly an obvious candidate for a clash with the American College of Obstetricians and Gynecologists.
The board-certified OB-GYN is a lesbian, a mother and a lifelong Democrat. She had performed gender-transition procedures herself and held a leadership position as chair of ACOG’s Iowa chapter. Shortly before leaving that position, she says the organization was recognizing her work with awards.
But Solheim says that after she began publicly questioning the evidence supporting certain gender-transition procedures, ACOG presented her with a choice: stop criticizing its reliance on guidelines from the World Professional Association for Transgender Health, or resign her leadership position.
“Rather than hear my concerns and take them seriously, my national medical association chose to silence me,” Solheim wrote in an August 5 essay for The Free Press. “They chose to be complicit in a campaign to promote ideology in medicine over evidence-backed science.”
According to Solheim, her doubts developed gradually after years of treating patients.
In 2019, she began working several times a month at UnityPoint LGBTQ+ clinic in Waterloo, Iowa. She expected much of the practice to involve lesbian and gay patients. Instead, she said, patient after patient sought treatment for gender dysphoria.
“The clinic, I learned quickly, didn’t predominantly serve the needs of lesbian or gay patients,” she wrote. “It was, by and large, a gender clinic.”
Initially, Solheim participated in transition-related treatment, including performing hysterectomies.
Then a patient in her early 20s came to her seeking a hysterectomy despite being physically healthy and not intending to undergo what Solheim described as a complete medical transition.
The request forced her to confront an apparent contradiction.
“Why was it that for a healthy young person it would be nearly impossible to get their uterus removed without an underlying medical issue, but if one were simply to identify as a man with no other plans to transition — or even just say they are nonbinary — the surgery is freely available?” she wrote.
Solheim took her questions to a Facebook community of OB-GYNs.
She says some physicians responded that the procedure was medically necessary and pointed to ACOG and WPATH guidance. Others accused her of ignorance or transphobia.
What she says she did not receive was the answer she wanted most: strong evidence demonstrating why removing the healthy organ would improve that particular patient’s long-term medical outcome.
Solheim declined to perform the operation.
Even then, she says she worried about publicly explaining her reasoning because of the possible consequences for her medical practice.
Another encounter pushed her questions further.
A woman who had previously taken testosterone while identifying as male came to Solheim’s office after discontinuing testosterone and once again identifying as a woman.
Solheim said the encounter surprised her because she had understood detransition to be exceptionally uncommon. She subsequently began examining the medical literature more closely.
She expected to find extensive long-term evidence supporting interventions such as cross-sex hormones and surgery.
“I couldn’t find a single good long-term, longitudinal study on the health outcomes of transgender patients who underwent treatments including hormone replacement therapy and surgery,” she wrote.
Solheim also read Hannah Barnes’s Time to Think, an investigation of Britain’s Tavistock gender clinic, and watched a July 2025 Federal Trade Commission hearing concerning evidence and practices in gender medicine.
She emerged convinced that the evidence underlying important parts of transgender medicine was substantially weaker than she had previously believed.
Some of Solheim’s strongest characterizations — including her claim that parts of the research were “fraudulent” — are her own conclusions and remain part of a contentious medical and political dispute. The larger debate over gender medicine includes disagreements over evidence quality, appropriate patient selection, risks and benefits, and differences between treatment of minors and adults.
For Solheim, however, the next question concerned her own professional organization.
In December 2025, she published an essay titled “Physicians Must Demand Answers from WPATH,” publicly challenging ACOG’s reliance on the organization’s standards.
Then came the confrontation.
Solheim says ACOG Vice President Rachel Pittman emailed her on February 4, telling her that the article “raises concerns” because of her “public expression of dissatisfaction with ACOG’s inclusion of WPATH in its clinical guidance.”
A March 10 meeting followed.
According to Solheim, Pittman told her she could resign as Iowa chair or stop publicly criticizing ACOG’s endorsement of WPATH guidance. Solheim says she was warned beforehand that the roughly 20-minute meeting would not include “a full discussion on the issue.”
“The choice was easy,” she wrote.
She resigned.
The timing made the episode particularly striking. Solheim says that on the same day she was pushed out of the leadership position, ACOG gave its Iowa section a State Legislative Advocacy Award recognizing work she had done recruiting and retaining OB-GYNs. A week earlier, she says, ACOG had recognized her with a service award and invited her to present her work to physicians in Washington, D.C.
Her dispute, in other words, was not over her competence as an obstetrician or her effectiveness as an organizational leader. According to Solheim’s account, the conflict arose specifically from her public challenge to ACOG’s position on WPATH.
