As health advocates, we have spent the past year fighting for the relief our communities needed while combatting the impacts of the COVID-19 pandemic. This included more affordable health insurance, broadened access to telemedicine, improved access to behavioral health services, and more. While we work to improve services for our communities, conservative legislators in 20 states have introduced legislation to ban access to medically necessary, gender-affirming care for transgender and non-binary (TNB) youth. These proposals run counter to current medical guidance and contradict the principles of the Biden administration – which on day one made clear through executive action that every person, of every gender identity, should have access to health care.
The Bans on Care: What We Stand to Lose
On Monday, March 29, Arkansas became the first state to prohibit doctors from providing gender-affirming health care to TNB youth. Lawmakers voted 28-7 in favor of the bill, but on April 5, Governor Asa Hutchinson vetoed the bill. While this is promising news from the governor, the bill could still become law should the state Senate and House of Representatives override the governor’s veto with a simple majority vote.
Gender-affirming health care offers developmentally appropriate health services oriented toward understanding a young person’s gender experience. According to the American Academy of Pediatrics, this often includes a collaboration between medical, mental health, and social services, including specific resources and supports for parents and families. This process allows families with TNB members to communicate with providers to fully understand the benefits and risks of specific medical services required by a TNB person. These services can include, but are not limited to:
reversible hormone blockers to delay the onset of secondary sex characteristics
behavioral health services to allow young people and families to explore feelings that come up regarding gender identity and navigate the impacts of transphobia
hormone replacement therapies
These services are medically necessary to alleviate the psychological and physical harm caused by going through puberty on hormones that don’t align with one’s gender. If legislation like the bill just passed in Arkansas continue to move forward, medical professionals could face up to 12 years in prison, and loss of their license, for providing – or referring young people to – these gender-affirming services. Some of these bills seek to limit access even further by allowing private insurers to refuse to cover gender-affirming care for people of any age. This will decimate the availability of vital health services for TNB people who are already three times more likely than their cisgender peers to travel 50 miles or more to access health care.
The Harm: Impacts on Young People and their Families
Pediatric providers have an essential role in helping families navigate challenging medical decisions for their children. They hold the knowledge to help families evaluate the benefits and risks of complex diagnoses and extensive medical interventions. This is no different for treatment options for TNB youth. Pediatric providers are able to paint a full picture of medical outcomes, which includes input from behavioral health and social services professionals. These conversations help parents understand the options available to their children and discuss the services they need. By banning these informed conversations, families will be left without accurate medical information and forced to navigate their children’s gender experiences without support.
The children at the center of these discriminatory laws have the most to lose should this type of legislation continue to move forward. Some TNB youth experience gender dysphoria, which is a medical diagnosis for people who experience psychological distress as a consequence of the incongruence between their assigned sex and their gender identity. Hormone blockers and hormone replacement therapies have been proven to alleviate symptoms of gender dysphoria, which can harm mental and physical wellbeing when left untreated. Delaying treatment not only exacerbates these symptoms and stressors but exposes TNB youth to high rates of bullying and trauma and leads to dropping out of school at younger ages than their cisgender peers. For TNB children of color, this marginalization can be even more extreme as they simultaneously experience racism, transphobia, and sexism.
The Way Forward: What the Experts are Saying
Numerous medical experts and associations have spoken out in support of gender-affirming health care by outlining the harm this type of legislation would cause. In March of this year, the American Academy of Pediatrics released a statement opposing these bans stating that these bills not only ignore medical recommendations but undermine them. They’ve underlined that these bills would interfere with the physician-patient-family relationship, and when a global pandemic has exacerbated mental health concerns, TNB youth are in even greater need of competent and compassionate health care.
They are not alone, the American Medical Society, American Academy of Child & Adolescent Psychiatry, and Endocrine Society have all spoken out against these bills. They all underline that the current health care models for TNB youth are evidence-based and vital for the youth who need them. TNB youth have also spoken out again and again about the negative consequences these bills would have on their lives. As the individuals who have the most to lose, know how the systems in place work for them, and understand what they need from the health system, it’s imperative we listen to and understand how this legislation will change their lives.
In order to advance a health justice movement, we need to continue to speak out against barriers to health care for everyone in our communities. As harmful legislation like this moves through states, we need to prioritize partnerships with state and community TNB-led organizations. This means we must elevate the needs of TNB people who will be directly impacted by this harmful legislation, especially TNB people of color, as we continue our fight for health justice.