This year, a series of laws have emerged in the United States that aim to restrict certain gender-affirming care procedures, and additional measures are being considered in various states. These legislations impose criminal penalties on healthcare professionals administering hormone therapy and parents supporting their transgender children in seeking healthcare.
Gender-affirming care encompasses a range of interventions, including psychological, social, behavioral, and medical approaches, which are intended to support and validate an individual’s gender identity. Esteemed medical organizations such as the American Psychiatric Association and the American Medical Association view these treatments as safe, effective, and medically necessary.
According to a recent report, there are approximately 300,000 transgender individuals between the ages of 13 and 17 in the United States. Alarmingly, over 44% of these adolescents, residing across 30 states, have already lost access to gender-affirming care or are at risk of losing it.
The provision of gender-affirming care involves a diverse group of healthcare providers, ranging from mental health professionals to primary care pediatricians and endocrinologists. When these providers are compelled to leave their practices or face uncertainty regarding the care they can deliver, it adversely affects not only transgender patients but also cisgender individuals.
Marci Bowers, MD, a gynecologist and surgeon specializing in gender confirmation surgeries, has received numerous distressing messages from providers in states like Texas and Florida. They express deep fear and concern about the consequences of these restrictive laws. The effects of such legislation reverberate throughout the medical community, with those who treat adolescents experiencing the most apprehension.
The Status of Gender-Affirming Care Bans in the U.S.
Nineteen states have currently implemented bans on best-practice medication and surgical care for transgender youth, with some states even limiting access to care for individuals up to the age of 26. The majority of these bans were enacted this year, leaving nearly 78,000 transgender youth without local access to the necessary care they require. Additionally, seven more states are currently contemplating similar prohibitions on gender-affirming care, as reported by the Human Rights Campaign.
In five states, providing gender-affirming care to minors is considered a felony. In other regions, state licensing boards possess the authority to discipline healthcare providers and revoke their medical licenses. These policies primarily impact pediatric endocrinologists, reconstructive surgeons, and other professionals who prescribe hormonal medications or perform gender-affirming surgeries. However, the vague nature of these laws often leads to confusion even among healthcare practitioners involved in routine care.
Dr. Lauren Wilson, a pediatric hospitalist and President of the Montana Chapter of the American Academy of Pediatrics, has firsthand experience with the consequences of these restrictions. In April, Montana lawmakers signed a ban on gender-affirming care, set to take effect in October. Dr. Wilson, who frequently cares for transgender youth requiring hospitalization, expressed concerns about the potential repercussions. The ban could jeopardize her medical license if she were to reorder medications that these patients currently rely on while in the hospital.
Gender-affirming care typically involves a multidisciplinary team of healthcare professionals, including psychiatrists, endocrinologists, and pediatricians. Dr. Wilson noted that even healthcare providers who do not specialize in transgender care can experience confusion and fear due to these bans. The uncertainty lies in situations where providers need to make decisions about prescribing hormone blockers for conditions like precocious puberty. The burden falls on them to ensure that the child is not transgender or will not transition, which raises concerns about potential criminalization and the vagueness surrounding these laws.
The prevailing sentiment among healthcare professionals is one of apprehension and the desire to avoid criminalization or the revocation of medical licenses based on unclear legal parameters determined by non-medical individuals.
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— BOWERS
Ripple Effects of Gender-Affirming Care Bans on Cisgender Adolescents
The impact of providers relocating or ceasing to offer gender-affirming care extends beyond just those specific services, according to Marci Bowers. When these providers leave, they also take away obstetrical services and primary care services that they were providing, affecting not only the transgender community but also the cisgender population.
Pediatric endocrinologists, for example, play a crucial role in addressing various medical concerns in children, such as metabolic disorders, height issues, and thyroid conditions. Since the 1970s, endocrinologists have been using hormone treatments to delay puberty in certain children who experience its onset much earlier than their peers. These same puberty blockers are also utilized in the care of transgender youth.
In addition to transgender and nonbinary youth, minors who require the expertise of endocrinologists, especially those residing in rural areas with limited healthcare resources, are particularly affected by gender-affirming care bans. The consequences of these laws are not limited to rural areas alone but also impact Native youth and individuals facing difficulties in accessing medical systems. This often includes individuals living in poverty, those with transportation challenges, and individuals already affected by health disparities, such as people of color.
In addition to the restrictions on surgical procedures related to gender dysphoria, these bans can also hinder access to certain reconstructive surgeries unrelated to gender transition. For example, young men with gynecomastia, which involves excessive breast tissue growth, may face difficulties obtaining breast reductions.
While much of the focus is placed on surgical care in discussions surrounding these laws, it is important to recognize that medical care plays a more significant role in gender-affirming care for trans youth. Medical interventions provide individuals and their families with the opportunity to make informed decisions and address dysphoria in a supportive environment. Dr. Wilson emphasizes the importance of considering medical care as the central aspect of the discussion, rather than solely focusing on surgical interventions, which represent a smaller proportion of the comprehensive care typically provided to transgender youth.
In the three years between 2019 and 2021, about 780 trans people age 13 to 17 years old received top surgery nationwide, while fewer than 60 got genital surgery, according to an analysis of insurance claims by Reuters.
Limiting Providers Means Longer Waitlists for Care
The fear for safety, both for clinic staff and their families, has resulted in some healthcare providers leaving their positions even before the implementation of trans health bans. Pediatric providers specializing in transgender care in states like Texas and Florida have departed from their clinics, leaving patients in a challenging situation, scrambling to find alternative care options.
In states where gender-affirming care bans are in effect, some clinics are witnessing a significant decline in patient volume, which has forced them to lay off staff. This situation becomes particularly distressing when LGBTQ+ or gender diverse providers, who previously felt safe and accepted in their roles, are forced out of their jobs.
Moreover, the loss of healthcare providers creates additional barriers to accessing care for everyone. The United States was already facing a shortage of healthcare providers, a problem that has been exacerbated in recent years due to the COVID-19 pandemic.
Even prior to the surge of anti-trans legislation, there was a shortage of gender-affirming care providers, resulting in patients having to endure long wait times, sometimes spanning weeks or months, for evaluations and necessary care.
The presence of anti-trans legislation is also dampening the enthusiasm among health students who were previously interested in pursuing trans care. The potential risks to their families and personal safety have discouraged them from entering a field where they may face such challenges.
Marci Bowers emphasizes the importance of individualized care, highlighting that a single rule cannot apply to every situation. Expertise in the field of gender-affirming care is crucial for providing proper medical care. She questions the legitimacy of legislation being passed by individuals who lack medical training and have no personal connection or understanding of the patients and their families affected by these laws.
Despite the current obstacles, Bowers maintains hope that the political landscape will shift to prioritize and protect the right of all individuals to have access to comprehensive healthcare options. She emphasizes the value and brightness that gender diversity brings to the world and urges against extinguishing that flame.
Conclusion
In conclusion, the wave of legislation prohibiting gender-affirming care procedures in the United States has had far-reaching consequences. These laws have led to the loss of access to vital healthcare services for transgender youth, affecting not only their well-being but also the broader population.
The bans have resulted in providers leaving their practices, causing disruptions in healthcare services and leaving patients struggling to find alternative care. Clinics in states with trans health bans have experienced a decline in patient volume, leading to staff layoffs. The loss of healthcare providers, including LGBTQ+ and gender diverse professionals, further compounds the challenges faced by both transgender and cisgender individuals in accessing care.
The shortage of gender-affirming care providers was already a concern before the implementation of these bans, leading to long wait times for evaluations and treatment. Anti-trans legislation has also dampened the interest of healthcare students in pursuing trans care, due to concerns about the risks and uncertainties associated with such laws.
The individualized nature of gender-affirming care is crucial, and decisions regarding healthcare should be left to medical professionals with expertise in the field. Legislation crafted by individuals who lack medical training and understanding of the needs of transgender individuals and their families can hinder access to necessary healthcare.
Despite these challenges, there remains hope for a shift in the political landscape to protect the right to comprehensive healthcare options for all individuals. The importance of gender diversity and its positive impact on society should not be overshadowed, and efforts should be made to preserve and support it.
In the face of adversity, it is essential to continue advocating for inclusive healthcare and ensure that the flame of equality and access to quality care remains alive.
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