Pediatrician and South Carolina Democratic Senate candidate Annie Andrews has made a point of saying she does not support gender-transition surgeries for minors and has never performed one. She has also said she does not support biological males in women’s sports.
What she has not done is give a clear, on-the-record accounting of her position on the puberty blockers and cross-sex hormones she previously defended—or of the bone-density losses and fertility risks those treatments carry.
In 2022 Andrews stated she opposed surgery under 18 while supporting “evidence-based medical care, with parental consent,” for teens with gender issues. She later told CNN that puberty blockers and hormones reduce suicide and suicidal ideation in trans youth and are used only for a subset after extensive evaluations. She has not, in the statements reviewed, specifically addressed the documented effects of those same interventions on bone accrual during the critical adolescent window or on future fertility.
Recent systematic reviews, including a 2026 JAMA Pediatrics analysis of ten cohorts, show lumbar-spine bone-density z-scores drop during suppression and recover only partially after hormones begin—leaving a residual shortfall whose long-term significance remains uncertain. The Endocrine Society itself flags infertility risk, especially when blockers start early and are followed by hormones, and urges fertility-preservation counseling.
Voters have every right to be skeptical when they hear Andrews use the vague term “evidence-based medicine.” That was the exact term used by American clinicians who performed far larger numbers of these interventions, including surgeries, before state legislatures began restricting them.
All those claims rested heavily on guidelines from the World Professional Association for Transgender Health (WPATH). Internal WPATH discussions later leaked showed members privately acknowledging risks of infertility, sexual dysfunction, and incomplete informed consent while publicly maintaining that the treatments were safe and necessary. The organization has since faced an FTC lawsuit alleging deceptive claims about the necessity, safety, and suicide-prevention benefits of pediatric medical transition. In contrast, the UK’s Cass Review and subsequent systematic reviews in Europe found the evidence base weak, leading NHS England to end routine use of puberty blockers and several countries to sharply restrict hormones for minors.
Andrews has walked back the most politically toxic parts of her earlier record. She has not walked back—or even publicly detailed—her support for the medications that remain the core of medical transition for minors.
South Carolina voters are entitled to a direct answer on whether she still endorses those interventions, how she weighs the bone and fertility consequences against the claimed benefits, and whether she accepts the European evidence that has led other systems to reverse course.
So far, that is what Annie won’t say.
