Republican lawmakers in more than half the states are continuing a party-line push to restrict doctors and other medical providers from offering some gender-affirming health care to minors, even with parents’ consent.
In late January, Utah Gov. Spencer Cox, a Republican, signed legislation making the Beehive State the first this year to ban some medical interventions for patients under 18, including hormone therapy and gender-affirmation surgery. Adolescents who were diagnosed with gender dysphoria — a mismatch between their gender identity and sex assigned at birth — before the law took effect are grandfathered.
Arkansas and Tennessee passed bans on gender-affirming care for minors in 2021; Alabama and Florida also blocked such care last year. The bans in Alabama and Arkansas are now on hold as they’re tied up in the court system.
A review by the American Civil Liberties Union finds that state lawmakers have introduced at least 85 bills this session to restrict gender-affirming health care, up from 43 bills last year and 32 in 2021.
The health care push builds on GOP efforts in recent years to bar transgender girls from competing on girls sports teams; prohibit discussions of gender identity in classrooms; and remove books with transgender themes from school libraries. In some states, GOP lawmakers also have taken aim at drag performances — in which men dress as women —as harmful to children.
From state to state, many of this year’s health-related bills and public statements describe gender-affirming care as “irreversible” and “life-altering,” and question whether science truly supports the procedures.
Generally, medical associations describe such care as including various disciplines, from pediatrics to psychiatry to endocrinology. Young patients might be seen not only by their pediatricians, counselors or family doctors, but also at specialized LGBTQ+ health care centers at major universities and medical complexes.
Puberty-blocking drugs, as well as other hormone treatments, may be offered to adolescents in some cases. Gender-affirming surgery, though rarely performed on patients under 18, may include facial reconstruction and “top” or “bottom” surgery to align facial features, breast shape and genitalia with a person’s gender.
Many U.S. medical professionals endorse puberty blockers as a safe option for adolescents struggling with gender dysphoria. By slowing the onset of puberty, the drugs can ease teens’ anxiety and give them more time to consider their identity and whether they want to pursue a more permanent medical transition. But there are growing concerns among some doctors about the long-term effects of the drugs on patients’ bone density and brain development, according to a recent investigation by The New York Times.
Research on the safety of puberty blockers is ongoing. In the meantime, England’s National Health Service recently proposed restricting the use of the drugs to research settings, and Sweden and Finland also have established new limits on their use, according to the Times.
Polls show that a rising number of Americans know someone whose gender identity differs from their sex assigned at birth. Still, popular opinion on gender identity and gender-affirming health care is complex, according to the Pew Research Center, which last year asked a series of questions on the issue. (Stateline and the Pew Research Center are both supported by The Pew Charitable Trusts.)
Nearly half of Americans, for example, support making it illegal for medical professionals to provide health care to support gender transition for minors, according to the Pew Research Center survey last spring, while 31% said they opposed such efforts. Roughly 6 in 10 participants in the poll said they support requiring transgender athletes to compete on teams that match the sex they were assigned at birth. And 38% said American society has gone too far in accepting transgender people.
But nearly two-thirds of respondents favor laws to protect transgender people in jobs, housing and public spaces.
Many of this year’s bills, filed across more than two dozen states, differ somewhat in efforts to disrupt transgender-related health care for minors. In Wyoming, for example, one bill would declare surgeries and puberty-blocking drugs to be child abuse. Another threatens to revoke medical providers’ licenses and would prohibit insurers from covering the procedures.
In Indiana, one lawmaker has included language that would ban attempts to “change, reinforce or affirm” a minor’s sexual orientation or gender identity through a list of actions that include “subjecting a minor’s genitals to electric current” and “subjecting the minor to an ice bath” alongside “furnishing to the minor a drug to stop or delay puberty.”
Another Indiana bill not only would ban surgeries and puberty-blocking drugs but also would give minor patients at least 20 years — until they’re 38 years old — to file for compensatory damages against a provider of such health care. State Rep. Michelle Davis, the sponsor and a Republican whose transgender sports-related bill became law last year, said in a statement to Stateline she worries about “irreversible” medical procedures.
“We do not know the long-term effects of taking hormones or having a major surgery as an adolescent,” Davis said, adding: “We should continue to support children who may be struggling by ensuring they have access to compassionate mental health care.”
And in North Carolina, a bill that would ban gender-affirming surgeries or drugs says no provider shall offer care “to facilitate the minor’s desire to present or appear in a manner that is inconsistent with the minor’s sex.” As in many other states, the bill would exempt children born with ambiguous physical sex characteristics.
In signing Utah’s health care legislation into law last month, Gov. Cox issued a statement on Twitter suggesting the “permanent and life-altering treatments” need more research before being continued.
“While we understand our words will be of little comfort to those who disagree with us, we sincerely hope that we can treat our transgender families with more love and respect as we work to better understand the science and consequences behind these procedures,” Cox tweeted. The new law also requests a review of medical research by state health officials and a report back to lawmakers.
For years, leading U.S. medical organizations have been outspoken in affirming the need for transgender-related health care.
The Association of American Medical Colleges, for example, said in 2021 that it is committed to ensuring equal health care access for transgender youth and to training professionals on how to provide that care.
“Efforts to restrict the provision of gender-affirming health care for transgender individuals will reduce health care access for transgender Americans, promote discrimination, and widen already significant health inequities,” the group said, adding that such efforts “undermine the doctor-patient relationship and the principle that doctors are best equipped to work with patients and their families to arrive at shared decision-making.”
Some physicians also have pointed out the effects on teens’ mental health. A 2022 survey by the Trevor Project, an anti-suicide group focused on LGBTQ civil rights, found that 93% of transgender and nonbinary youth in the United States worried about access to gender-affirming health care because of state or local laws.
And there has been plenty of pushback this year. In Montana, some 150 people testified in the Senate Judiciary Committee last week about a proposed transgender youth health care ban. That bill, by GOP state Sen. John Fuller, would prohibit puberty-blocking drugs and gender-affirming surgeries for minors and would ban public resources from being used for such care, including for patients on Medicaid.
“Society has a vested interest in protecting children from potentially dangerous actions,” Fuller told the committee, according to the Independent Record of Helena.
The state Senate approved the bill 28-21 on second reading, with five Republicans and all Democrats voting against. Others opposed to the bill included the state medical association, state hospital systems and the state chapter of the American Academy of Pediatrics, as well as young Montana residents who would be affected by the legislation.
“I’m not the monster under your metaphorical bed,” testified 13-year-old River Meury, according to the Montana Free Press. “No one has ever tried to make me this way. … It’s simply who I am.”
This story was originally published Feb. 9, 2023, by Pew Stateline.