Transgender youth are being increasingly left with few health care options as more and more states ban gender-affirming care.
Data released by the Human Rights Campaign indicates that 50.4% of Transgender youth (aged 13—17) have either lost or are at risk of losing access to age-appropriate, medically necessary gender-affirming care in their state. More than 180 bills targeting Trans and Nonbinary people have been introduced in state legislatures across the nation.
Labeling such treatment as child abuse, Republicans have crafted bills that outlaw the practice and, in some cases, make it a felony for doctors to prescribe puberty blockers or hormones.
"If you are Trans, particularly if you are targeted by legislation like this, I have one request for you: please stay alive," Montana Rep. Zooey Zephyr pleaded from the House floor.
Zephyr, a Trans woman, acknowledged the pain caused by debating the issue and offered lifelines to those struggling with their identities.
"Stay alive, lean on your community in these times. If you are in crisis, call 988 or go to the Trevor Project for support. We will be there for one another through this, and ultimately we will win this fight in the end," she said.
Thirteen states — Alabama, Arizona, Arkansas, Florida, Georgia, Iowa, Kentucky, Mississippi, South Dakota, Tennessee, Texas, Utah, and West Virginia — have passed bans on gender-affirming care for Trans youth. Politicians in Kansas, Oklahoma, South Carolina, and Texas floated bills that would bar this kind of treatment up to the age of 26.
In Florida, where Republicans hold a supermajority, a bill that would restrict gender-affirming care for adults is rapidly advancing.
"It's sad that we have to say this, but our children are not guinea pigs for science experimentation," Gov. Ron DeSantis declared in his State of the State speech.
On a different path
Meanwhile, there are states on a different path. A bill in the Washington legislature, HB 1469, would make the Evergreen State a sanctuary for doctors and patients. In Oregon, lawmakers may include gender-affirming care procedures, such as laser hair removal and facial feminization surgery, on state Medicaid plans.
In public testimony, Dr. Christina Milano of Oregon Health & Science University, refuted accusations of coercion and said a small percentage of Transgender youth make it to the surgery stage.
"I hear a panic that we are opening up the gates, allowing young patients to come in and cajoling them and pressuring them to start pubertal suppression and pursue surgical procedures," Milano said, adding "Our teams work with exquisite caution and thoughtfulness."
A measure like the one proposed in Oregon is already law in Washington, where public and private health care insurers are required to cover counseling, voice therapy, and puberty blockers.
Long history
Advocates for gender-affirming care note that it has a documented history dating back the early 1950s, when actress Christine Jorgensen became one of the first Americans to undergo gender reassignment surgery. Dr. Milton Edgerton is credited with opening America's first Transgender clinic at Johns Hopkins University in 1966, where drugs such as estrogen and progestin were prescribed.
"The first Transgender medical clinic opened in the United States nearly 60 years ago," tweeted Chris Mosier, a Trans athlete sponsored by Nike. "When politicians today refer to gender-affirming care as new, 'untested,' or 'experimental,' they are ignoring the long history of Transgender medicine in the United States."
In Idaho, medical students have spoken out against plans to ban gender-affirming care that Republicans wrapped in a bill called the Vulnerable Child Protective Act. In an op-ed in the Idaho Statesman, Ari Garabedian, Ian Holland, Marisabel Reinhardt, and Sara Meotti, students at the University of Washington in the Idaho WWAMI regional program in Moscow, warned that denying care is dangerous, considering the high rate of suicide consideration (82%) and attempts (40%) by Trans adolescents.
Additionally, bans on gender-affirming care permit politicians to intrude on the sacred doctor-patient relationship, the students wrote. The American Medical Association, the largest and only national association that convenes 190+ state and specialty societies and other critical stakeholders, concurred.
"We believe it is inappropriate and harmful for any state to legislatively dictate that certain transition-related services are never appropriate and limit the range of options physicians and families may consider when making decisions for pediatric patients," wrote AMA CEO James L. Madara in a letter to US governors titled, "Stop interfering in health care of transgender children."