Alarm grows over impact of states banning trans youth treatment

Medical experts and LGBT advocates are sounding the alarm over the physical and mental health risks to the transgender community after at least 19 state legislatures, including Arkansas, have proposed or passed bills seeking to ban trans youth treatment. 

Proponents of the bills have argued that the legislation is in place to protect children from making irreversible decisions about their bodies. 

But earlier this week, doctors and LGBT organizations defended treatments such as puberty blockers and hormone therapy, and warned about a potential increased suicide rate among trans youth if such legislation is enacted.

Arkansas on Tuesday became the first state to pass a law prohibiting treatment for trans individuals younger than 18. The bill passed after the state legislature overrode Gov. Asa Hutchinson’s (R) veto against the bill. The law does not address what happens to children who have already started trans treatment, which experts warned could be dangerous. 

Several states are close behind Arkansas. The Alabama Senate passed a bill that makes providing treatment like puberty blockers or hormones to minors a felony. 

The American Civil Liberties Union (ACLU) has tracked at least 25 bills specifically targeting trans youth health care, proposed in at least 19 states this year. 

Rodrigo Heng-Lehtinen, deputy executive director for the National Center for Transgender Equality, said that just the act of lawmakers proposing this legislation poses a mental health threat to transgender youth and the community as a whole. 

“In the past when states have floated anti-trans bills, we’ve seen calls to the trans lifeline as much as triple,” Heng-Lehtinen said, recounting calls placed to suicide lifelines following North Carolina’s so-called bathroom bill, H.B. 2. 

“That really shows the extreme mental health harm inflicted on trans people of all ages. They really send a message to all trans people about whether or not your government cares about you,” Heng-Lehtinen said.

The American Academy of Pediatrics, the American Psychiatric Association, the Endocrine Society and several other large medical groups have publicly opposed bills outlawing trans youth treatment. 

Robert Garofalo, the division head of adolescent and young adult medicine at Lurie Children’s Hospital in Chicago, called the Arkansas legislation “not just anti-trans” but “anti-science” and “anti-public health.”

“These are not experimental treatments,” he said during a press conference with the Human Rights Campaign ahead of the Arkansas legislature’s override. “They’ve been well-studied, and they’re well-supported by scientific evidence that has been conducted globally.”

“There’s a need to really understand that there are many studies that detail the very benefits of these treatments, and almost none of them suggest that there’s any harm in accessing care,” he added. 

Jack Turban, a fellow in child and adolescent psychiatry at the Stanford University School of Medicine, pointed to research that “consistently shows” how health care for trans minors “results in better mental health outcomes.” 

“Kids who want these interventions but can’t access them have higher rates of a whole range of mental health problems, including considering suicide,” he said at the HRC briefing.

“My fear, and the fear among a lot of doctors and parents and researchers in this area, is that if these bills were to pass, we’re going to be throwing away decades of medical progress and really putting the health of these vulnerable people at risk,” he added. 

Kansas Rep. Stephanie Byers (D), the first transgender lawmaker to serve in the Kansas legislature, pushed back on the notion that treatments such as puberty blockers cause irreversible change and suggested access to such treatment supports youth mental health.

“It’s a misdirection,” she said during an interview with The Hill. 

She added that these treatments give children a head start and make it so that they are “not having to combat a body that’s developed backwards from where they need to be,” she said.

Medical experts recommend puberty blockers and hormone therapy as the best way to give adolescents more time before making more permanent decisions, such as surgery. 

More than half of trans and nonbinary youth, aged 13 to 24, already report that they had seriously considered suicide, compared to 34 percent of cisgender LGBT youth, according to The Trevor Project’s 2020 National Survey. 

Crisis line supervisors at the Trevor Project, a crisis and suicide prevention organization for LGBT youth, have already received calls from youth and family in which they ask what they can do about losing “life-saving” care, said Casey Pick, the senior fellow for advocacy and government affairs.

“When you take away that hope of treatment, you increase a sense of hopelessness,” she said. “You increase a sense of lack of control over their own lives. And all of these are negative factors when it comes to an individual’s mental health and to potential suicidality.”

Pick said she’s concerned the Arkansas law will cause a “domino” effect of other successful legislation in other states. 

The ACLU has committed to legal action to prevent the Arkansas law from being enforced 90 days after the state’s legislative session. 

Arli Christian, a campaign strategist with the ACLU’s National Political Advocacy Department, said the union is “determined to continue to fight this bill.”

“If our Arkansas legislature cannot have the decency to understand that this is flying in the face of medical science and experts, and it is discriminatory, then we will bring that to the courts and show that this is pure and simple discrimination against transgender people and transgender youth specifically,” Christian said. 

The legislation barring treatment for trans youth are not the only bills proposed this year that target transgender individuals. Various state lawmakers have also proposed a series of legislation that prevents transgender girls from participating on middle school, high school and college sports teams aligned with their gender identity, including bills enacted in Arkansas, Tennessee and Mississippi. 

Arkansas Rep. Robin Lundstrum (R) sponsored the health care legislation that made it to Hutchinson’s desk but initially received a veto instead of a signature. The governor labeled the bill as “well-intentioned, but off course,” saying it amounted to government overreach.

Lundstrum has asserted that the state bill was designed to ensure the safety of children, saying “they need to be protected” from transgender treatments. 

“Even medicine sometimes is wrong,” she said, according to the Arkansas Democrat Gazette. “We should never experiment on children. Ever.” 

Arkansas Senate Republican leader Scott Flippo predicted that the state legislature is “going to be on the right side of history” with the bill, adding “this is in line with Arkansas values,” according to the newspaper. 

But advocates argue that it is medical professionals, along with trans youth and their parents, who should be making decisions about health care. 

“We know that people are able to live their best lives and be productive and find joy when they are treated with dignity and respect and have support,” Kierra Johnson, executive director of the National LGBTQ Task Force, told The Hill. 

“These anti-trans bills are creating barriers to just that. It interrupts the opportunity for physicians to make the best recommendations for the child.” 

As state legislatures battle over whether to restrict trans health care, President Biden issued the first presidential proclamation officially recognizing Transgender Day of Visibility last month. 

His administration includes the first openly transgender official in a Senate-confirmed position. Assistant Secretary of Health and Human Services Rachel Levine faced questions on trans youth treatment during her confirmation hearing from Sen. Rand Paul (R-Ky.), who said Levine backs surgeries for trans minors in a misleading claim.

“Transgender medicine is a very complex and nuanced field with robust research and standards of care that have been developed,” Levine said to Paul, without specifically answering his question.

Despite efforts in state legislatures, critics say that one way to change the conversation surrounding transgender treatment as a whole in the U.S. is to increase visibility. 

Sasha Buchert, a senior attorney at Lambda Legal, said that many of these bills are “preying on a misunderstanding and fear about who trans people are.” 

But, she argues, humanizing trans people will inform the public about the trans community and the challenges they face. 

The more visible the trans community is to others, she says, the more “the personal experiences they’ve had with trans people has shifted them and their views.”