In recent months, multiple states, including Texas, Alabama, and Arizona, enacted legislation that seeks to significantly limit access to—and, in some cases, criminalize—the practice of gender-affirming healthcare, especially for trans youth.
These developments raise questions as to how we address legislation that is in complete opposition to medical standards of best practice. A preponderance of evidence supports the conclusion that gender-affirming care is a life-saving necessity for trans youth. Almost every major medical organization in the US recognizes that gender-affirming care significantly lowers rates of suicidality in trans youth. Medical practices that are safe, effective, and necessary must not be used as political fodder when the cost is the lives of trans youth.
Trans youth are one of the most at-risk demographics in the US. Transgender students are significantly more likely to experience substance use, violent attacks, and suicidality. People who identify as transgenger are over three times more likely to struggle with mental health issues. Almost 40 percent of trans people experience serious psychological distress, and a similar proportion reported suicide attempts, according to the US Transgender Survey. The Trevor Project also conducted a survey which revealed that over two-thirds of trans youth exhibit symptoms of depression, and over 50 percent of trans youth seriously consider suicide at some point. Incidences of anxiety and eating disorders are also significantly higher in trans youth than in the general population. These statistics indicate a mental health epidemic within the trans community that should be of serious concern to medical and public health professionals.
Gender-affirming medical care, time and time again, has proven effective in reducing the impact of mental health conditions on trans individuals. A meta-analysis conducted by Cornell University’s Center for the Study of Inequality revealed that in 93 percent of studies reviewed, gender transition improved the lives of transgender individuals. The remaining 7 percent reported mixed results. The review found no indication that transitioning has an overall harmful impact on wellbeing. Trans individuals who transitioned reported increased relationship satisfaction and self-esteem, and decreased rates of depression, anxiety, substance use, and suicidality. Additionally, extremely few individuals expressed regrets about transitioning, and these incidences have decreased over time. For these reasons, the American Medical Association, American Academy of Pediatrics, and the American Academy of Child and Adolescent Psychiatry all agree that legislation limiting gender-affirming care poses a direct threat to the safety and medical welfare of trans youth.
Why then, in spite of the prevailing, evidence-based, medical recommendations, do legislators continue to propose and advance this kind of legislation? The individuals crafting and proposing these bills have no medical training or expertise whatsoever.
In February, Texas officials issued directives pushing the state Department of Family and Protective Services to conduct child abuse investigations of families who seek gender-affirming care for trans children. Since the directives were introduced, multiple Texas medical providers have already scaled back gender-affirming care for fear of retribution.
Arizona Governor Doug Ducey signed SB 1138, which specifically prohibits gender-reassignment surgeries for trans-identifying individuals under the age of eighteen. Ducey cited “the ability of that individual to become a biological parent later in life” as the rationale for restricting access to these procedures, but even this statement is in no way fact-based. “Top surgeries,” which involve mastectomies or breast augmentations, have absolutely no impact on a trans individual’s ability to have children and can significantly positively impact the mental health of trans youth. It should also be noted that genital surgery is not performed on trans minors to begin with; the bill is not aligned with its stated purpose, further marginalizes trans youth, and restricts their access to gender-affirming care.
This April, Alabama passed SB 184, which criminalizes gender-affirming care, targeting parents of trans youth as well as medical providers. The bill proposes a penalty of up to ten years in prison. With this bill signed into law, doctors could be penalized for as little as suggesting that gender-affirming care is the best available treatment option for trans youth. This bill directly prevents providers from being transparent with patients about their best, evidence-based treatment options and from practicing medicine in concordance with the guidelines set forth by the American Medical Association. The restrictions in this bill are contrary to every piece of medical evidence available regarding the safest practices for trans youth.
While the United States prides itself on being a country that produces experts, states continually defer to politicians with ulterior motives instead of medical professionals.
One motivation for the increase in this type of legislation is, unsurprisingly, political influence. Many large conservative groups have provided support to candidates supporting legislation restricting gender-affirming care. They undermine candidates who support gender-affirming care and pressure candidates into further supporting restrictive legislation. In Texas, the conservative American Principles Project paid for $600,000 of television ads during the most recent primary campaign, which accused Governor Greg Abbott of failing to “protect our children”.
These bills stoke fears about the trans community by labeling doctors and parents who support gender-affirming care for their children as child abusers. This rhetoric also subsequently demonizes supporters of the trans community, framing them as supporters of this supposed abuse. This issue, like many others, has recently been weaponized to increasingly polarize communities and pit liberals and conservatives against one another. However, limiting or prohibiting access to gender-affirming care has dire, directly life-threatening consequences for trans children across the US. Providing necessary medical care that has been proven to save the lives of young people should not be a matter of the liberal or conservative “agenda.” It should be treated like any other life-saving medical treatment and should be accessible to all those who need it.