June 28, 2023 – In 2021, Arkansas became the first state in the nation to ban gender-affirming medical care for transgender minors. The ban—which did not go into effect because of a court injunction—would have widely impacted youth and their parents, including Brandi Evans, whose son’s severe depression improved when he started receiving hormone therapy.
“A month to two months in, I started seeing that kid come back, come out of his shell, talk to us more, laugh. … This has been the answer all along. Why would anybody want to take that away from him?” Evans said in a Vice News video that was played during a June 22 panel discussion on transgender health care at Harvard T.H. Chan School of Public Health.
Two days before the Harvard Chan event, a federal judge struck down the Arkansas ban, saying that it violated the constitutional rights of transgender youth, their parents, and their medical providers. But Arkansas’ attorney general vowed to challenge the ruling. And the fight over gender-affirming care continues to play out across the nation. Twenty states currently have laws that either completely ban or put restrictions on such care for youth, according to experts who spoke at the event. They discussed the broad impacts of these limitations—on both gender-affirming care and other types of health care—and shared approaches to fighting them.
Care that’s safe, studied, and beneficial
Gender-affirming care for youth is rooted in science and decades of research, said Angela Kade Goepferd, a pediatrician and the chief education officer at Children’s Minnesota, and the medical director of the hospital’s Gender Health Program. Young people and their parents work with medical and mental health professionals for months or years to develop an individualized care plan.
Goepferd explained that non-medical interventions are commonly used, such as affirming an individual’s name and pronouns, adjusting their physical appearance with haircuts or clothing, or training their voice to align with their gender. Medical interventions may include using medications—some of which are reversible—to delay puberty or start a feminizing or masculinizing process, but care almost never involves surgery.
When young people receive gender-affirming care, they have a lower risk of depression and suicidality, as well as improved self-esteem and well-being, Goepferd said. “When they are seen and heard and believed for who they are, when they are able to talk with mental health and medical specialists who can support them, they do better,” they added.
Contrary to the facts about gender-affirming care, some bans contend that it is experimental or prescribed carelessly, according to Arli Christian, a campaign strategist in the National Political Advocacy Department at the American Civil Liberties Union.
“Politicians in the last few years created these bans with really no medical evidence or information,” they said. “The truth is very clear when it’s laid out in the courtroom—that this care is safe, it’s studied, and it is absolutely benefiting these patients. And a state taking that away will cause real harm to real patients and families.”
Furthermore, Christian said that bans are discriminatory, because cisgender people are allowed to receive the very same gender-affirming care. Goepferd gave several examples, such as polycystic ovarian syndrome being treated with estrogen and male hypogonadism being treated with testosterone.
Tactics to limit care
While existing state bans focus on transgender youth, federal and state governments are also taking steps to restrict care for transgender adults, according to Elana Redfield, the federal policy director of the Williams Institute at the University of California, Los Angeles’ School of Law. “The sad reality that most of us are probably aware of is that these attacks on youth often lead to attacks on adults, and that this is really a step in a larger process of trying to come for other protections that allow trans people to thrive,” she said.
States’ tactics include preventing Medicaid or other health insurance from covering care; only allowing doctors to prescribe medical care, excluding other providers like nurse practitioners; and increasing doctors’ liability if the care that they prescribe has negative side effects, according to Redfield. At the federal level, some members of Congress are trying to place limitations on the budget so that hospitals forfeit funding if they provide gender-affirming care—taking the same approach as the Hyde Amendment, which bans the use of federal Medicaid funds for almost all abortions.
All of the experts agreed that bans on gender-affirming care have far-reaching effects on other areas of health care. For example, Goepferd said that if hospitals lose funding because they provide gender-affirming care, they may need to cut back on training new health care providers across all specialties. As a result, communities would have fewer providers, limiting access to health care for everyone.
Another consequence of the bans is that, in states that have enacted them, health care providers and medical students are leaving, according to Andrea Jenkins, president of the Minneapolis City Council. “They are moving to communities where they feel like they can be able to practice the kind of medicine that is comfortable or legal for them, without fear of losing their license or losing their freedom,” she said. Rural communities are particularly affected when health care providers leave because providers are often already in short supply there, she added.
In the face of bans being enacted across the country, Jenkins is working to make Minneapolis a welcoming place for people to receive gender-affirming care. The city’s initiatives include creating a directory of care providers and connecting the transgender community with policymakers. At the state level, Minnesota passed a law in April that protects people who travel there from out of state to receive gender-affirming care or abortions. Jenkins emphasized that transgender and reproductive rights are interrelated, both centering on people’s bodily autonomy.
“I hope that we can see the intersections of these issues coming together, and those advocates, those activists, can join forces and really make this movement stronger,” she said. “At the bottom line, it’s about democracy. It’s about people having access and agency over their own future.”
– Jay Lau