By Arisa R. Marshall
On Friday, a federal judge temporarily enjoined part of a new Alabama law that would make it a felony for physicians to provide gender-affirming care to trans youth. The law had been in effect for less than a week.
This is only the most recent development relating to a raft of anti-trans legislation sweeping the country. More than twenty bills that would impose life-changing healthcare restrictions on transgender children have been introduced in statehouses nationwide over the past two years, threatening the wellbeing of transgender youth and communities. Most of these bills aim to entirely ban gender-affirming medical care for minors, including surgeries, prescription puberty blockers, and hormone replacement therapies.
These laws are detrimental to the mental, physical, and social health of children. They are dismissive of the experiences of transgender children and teenagers, misleading, and manipulative.
The language in many of these bills reflects the bias of their sponsors. For example, Alabama House Bill 150, which was introduced in January 2022, states, “A substantial majority of children who experience discordance between their sex and identity will outgrow the discordance once they go through puberty and will eventually have an identity that aligns with their sex.” Evidence offered to support HB 150’s assertions, along with those in more than twenty other similar bills, posits that the best course of treatment for children seeking gender-affirming care is to withhold treatment altogether, because children will outgrow their gender nonconformity. Yet, nowhere in the supporting evidence is any mention of the extensively documented adverse effects that withholding gender-affirming care can have on children and families. In fact, the research on rates of “desistance,” a term referring to transgender and gender-nonconforming children who grow up to identify as cisgender, has not only been greatly critiqued regarding the validity of reported numbers of children who “desist” as referenced in HB 150, but recent research also suggests that desistance research is not relevant in determining the clinical treatment of transgender and gender-nonconforming children due to the potential risks associated with withholding gender-affirming treatment.
Interventions like puberty blockers, which delay menstruation or voice deepening, give kids time to figure out their gender identities and develop on their own timelines. Although denied to transgender youth by the legislation, puberty blockers could still be prescribed to cisgender children, those whose gender identity aligns with their gender assigned at birth, for the purpose of delaying puberty—a common practice among pediatricians whose patients are experiencing “precocious,” or early, puberty symptoms. These bills, then, would create a discriminatory reality in which pediatricians can prescribe cisgender kids medications that they would be criminalized for if they prescribed them for transgender kids, even if parents wanted the kids to receive treatment. In some states, including Alabama, treating trans minors with gender-affirming medical interventions would be a class C felony, which allows for prison sentences of ten years or more if convicted.
Despite what bill sponsors claim, gender-affirming care can have a very positive impact on the mental health of transgender youth, lowering their risk of anxiety, depression, and suicide; the bills fail to mention this. Pediatric medical organizations agree that laws like this threaten the safety, wellbeing, and mental health of transgender children and their families, increasing the risk of suicide among trans high school students by nearly 70%. In fact, the potential risks of gender-affirming treatment on youth who initially decide to receive puberty blockers or hormone therapy but ultimately decide to stop their treatment are very small, compared with the harms that delaying gender-affirming care can result in.
These bills carry titles like the Oklahoma Save Adolescents from Experimentation (SAFE) Act and the Alabama Vulnerable Child Compassion and Protection Act (V-CAP). These titles are manipulative, inaccurate, and dangerous. Using language like “saving” children from “experimentation” plays at emotion rather than reason. Additionally, these titles discount the autonomy of transgender youth, invalidating patient experience by discrediting the assuredness with which minors understand their own gender identities. Yes, transgender children are part of a vulnerable population; however, denying them the care and treatment their families and they are fighting for is not compassionate protection and can be extremely harmful. The language in the bills does not reflect the lived experiences of youth seeking gender affirming care. Instead, it discounts the risks to children that these bills will create and villainizes providers trying to support the families of youth seeking gender-affirming care.
Legislators and voters considering these bills should read the content for themselves and dedicate adequate time to learning how these bills would affect transgender youth, their families, and their communities at large if passed. The titles and contents of these bills trade on misinformation, deception, and manipulation. More importantly, these bills do not reflect the perspectives and realities of the people who would be most affected by their passage. These bills, if passed, will cause harm to children who are questioning their gender identities. In their pediatricians’ offices, they will not be able to receive validating treatment or even have frank discussions with their doctors, even if their doctors want to support them. In school, the children may be subject to disproportionate bullying and ridicule as they enter puberty. Don’t be fooled by the savior titles and biased “evidence;” these bills are neither compassionate nor protective.
Arisa Rei Marshall is a senior at the University of Washington, Seattle. She is currently an intern with the NYU Division of Medical Ethics at the NYU Grossman School of Medicine. Her areas of interest include health equity, bioethics, and patient-centered clinical care.