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Proposals to Limit Health Care for Trans Youth Are a Problem. Will They Pass?

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Key Takeaways

  • This year, 35 bills have been proposed in states across the country to limit access to medical care for transgender and nonbinary minors.
  • Many of these seek to restrict adolescents’ use of puberty blockers and hormone therapies.
  • Research shows youth who receive gender-affirming care are less likely to have poor mental and physical health than those who are denied it.

Across the U.S., health care for transgender and non-binary youth is under threat. So far this year, more than 18 states have considered at least 35 bills to limit or ban gender-affirming medical care for transgender minors, according to the Human Rights Campaign.

The proposed bills differ by state. Some make it illegal for clinicians to provide puberty blockers and hormone therapies to trans minors. Others, like one Texas bill, define these treatments as child abuse.

In April, the Arkansas state legislature passed HB 1570, which makes it illegal for clinicians to provide puberty blockers and hormone therapies. This is the first bill in the U.S. to effectively ban gender-affirming care for trans youth.

“This is not really motivated from any kind of science," Jason Klein, MD, a pediatric endocrinologist and assistant director of the Transgender Youth Health Program at Hassenfeld Children’s Hospital at NYU Langone, tells Verywell. "This is motivated by people who don't understand or [are] not compassionate for and don't really want to accept that trans people and non-binary folks exist and have always existed."

Experts warn that any move to limit access to medical care for transgender youth could have serious effects on both their physical and mental health. Trans youth already disproportionately experience mental health issues.

“If we were really, really interested in safety and protection, we would be validating medical treatment for trans and non-binary individuals, making it easier for them to access, well trained, well-educated providers, and resources for them to be able to get the care that they need,” Klein says.

How Gender-Affirming Treatments Work

About 1.8% or 300,000 of American high schoolers identify as trans, according to the last Centers for Disease Control and Prevention (CDC) Youth Risk Behavior Survey, published in 2019.

For many transgender and non-binary minors, the first medical step in their transition process is to take puberty blockers. These medications, which have been used safely and effectively for both transgender and cisgender minors for 40 years, halt puberty by inhibiting hormones like estrogen and testosterone. Pausing the development process in this way is reversible and gives the child and their family more time to transition in a way best for them.

Once a person is 16 years old, they may begin hormone therapy. During this treatment, the patient takes medications that change the balance of hormones in their body. This can affect their facial and body hair, face shape, height, breast development, and more.

Affecting a person’s hormonal balance in adolescence, while they are still developing, means they may grow into a body that better aligns with their gender identity. Klein says that when people are forced to wait until they are 18 years old to receive gender-affirming treatments, they often miss the opportunity for puberty blockers and hormonal treatments.

Some policymakers aim to prevent minors from accessing hormone treatments. But if a patient undergoing taking estrogen or testosterone suddenly stops their treatment, their body may have severe reactions and revert to their pre-transition state.

“You've forced them to have their body undergo puberty changes that are not concordant with who they are," Klein says. "And so just that process itself can be very damaging."

For instance, someone who is assigned female at birth might take puberty blockers and then start testosterone treatment so they may grow up to become a man.

“If we forced them to stop taking the hormone therapy at 15 or 16, they would develop breasts and then need surgery in the future to correct that, when that could have all been avoided if they had just been allowed to continue their medicine,” Izzy Lowell, MD, a family medicine physician based in Atlanta, tells Verywell. Lowell is the founder of QMed, an organization that provides medical care to the trans community in ten states in the Southeast U.S.

People who are suddenly cut off from their estrogen treatment can also experience severe menopause-like symptoms. While women tend to experience menopause over several years, young people who are cut off from their estrogen treatment may experience it much more quickly as their body adjusts to the hormonal changes.

“[Transwomen] would go through menopause pretty much overnight, with all of the symptoms of that—irritability, hot flashes and mood swings,” Lowell says.

In many cases, when minors are allowed to go through hormone treatment, they may avoid riskier treatments and operations in the future. They may, for instance, develop a face shape or breast tissue that better aligns with who they are. This could preempt the need for more complex and risky surgeries after they’re fully developed as an adult.

“There are so many bad things that could happen to these teens if we don't give them access," Lowell says. "It's just unfathomably dumb to me why someone would think that this is a good idea."

What This Means For You

While many state legislatures have proposed restrictions on health care for trans minors, Arkansas is the only one that has passed highly restrictive measures. If you're looking for a trans-friendly healthcare provider you can search for care in your area here.

Looking Closer at Proposed Legislation

Much of the proposed legislation, Klein says, is based on the notion that restricting hormonal treatments for trans youth is a protective measure. But the process is usually slow and thorough.

Transitioning youth may start with reversible steps, like choosing outfits and using nicknames that match their gender identity or going on puberty blockers. It’s only after a long process—often involving physicians, mental health professionals, and a patient’s family—that adolescents can receive hormone treatments.

“We know from studies that trans youth and young adults have to go through multiple doctor's visits and appointments, and oftentimes feel very frustrated with how slow the process is,” Klein says. “These are not decisions that are made lightly.”

Some proponents of the bills claim that minors are too young to know what they want and may grow to regret gender-affirming treatment. Lowell says that just as many cis children know their gender from a young age, so do trans and non-binary youth.

“In many cases, patients have known they were a girl or they were a boy since as far as they can remember,” Lowell says. “Families come in and they say, ‘Oh yeah, we've known he's a boy since he was four. And now we just need to make sure that he grows up to be a man.’”

How Proposed Legislation Could Affect Access to Care

Some of the proposed bills bar clinicians from both providing and referring patients to other clinics for hormone therapy and puberty blockers.

Several organizations have stepped in to provide medical assistance to the trans community. QMed, Lowell’s organization, is based in Atlanta but offers pop-up clinics in cities throughout the Southeast. This can cut patients’ travel time significantly and make hormone therapy much more accessible.

Earlier this year, the Alabama state legislature considered a highly restrictive medical bill for trans minors. It didn’t pass, but QMed was prepared to set up clinics in Georgia near the Alabama border. In some states, a patient just needs to be in the state on a given day to receive care, even if they live elsewhere. The provider must be licensed in the state, but in the case of a telemedicine appointment, is not required to be there at the time of the appointment.

This means groups like QMed can offer services just over the border for people who live in states with medical restrictions. Still, traveling across state lines every few months for visits and drugs is restrictive and costly.

Remaining Optimistic

Some advocacy organizations are stepping in to combat anti-trans medical legislation. The American Civil Liberties Union (ACLU) announced a lawsuit against Arkansas, saying the state’s restrictive law violates the Constitution.

When it comes to supporting trans and non-binary youth, Lowell says that she will continue providing the best care she can.

“Day-to-day I get to see people, thriving and doing really well on these treatments,” Lowell says. “That's just a gift in itself.”

For people who are worried about how they may be impacted by more restrictive medical laws, Lowell says to remain optimistic. She says it’s “heartening” to see that despite a large number of proposed bills, the law passed in Arkansas appears to be the only highly restrictive one that has been successful.

“Just like the bathroom bills came and went, this will come and go,” Lowell says. “I don't know how long it will take, but eventually, we'll come around to the correct side of this…Hang in there, be who you are, and try to figure out ways to get your needs met.”

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