States pass laws limiting access to gender affirming health care

States pass laws limiting access to gender affirming health care

Rhianwen Watkins

Last week Arkansas and North Carolina passed bills which limit access to gender affirming care for transgender youth. This year, a similar bill was presented to the New Hampshire House to “categorize sex reassignment surgeries and treatments performed on minors as child abuse,” according to the Concord Monitor

The Arkansas House and Senate last Tuesday, voted to override Gov. Asa Hutchinson’s veto of House Bill 1570, which bans doctors from providing trans youth under the age of 18 with hormone therapy, puberty blockers, gender-affirming surgery and from making referrals to other medical providers, according to the Arkansas State Legislature. 

Last Monday, North Carolina passed House Bill 514, which prohibits medical providers from providing health care services to trans youth under the age of 21, and also defines sex as “genetically encoded into a person at the moment of conception, and it cannot be changed,” according to the North Carolina General Assembly. 

House Bill 1570 passed 28-7 and is the first bill limiting access to health care for transgender individuals to officially become a law in the United States according to the Human Rights Campaign.  

So far, the U.S. is considering a total of 192 anti-LGBTQ bills, out of which 101 target the transgender community. Thirty bills prohibit transgender individuals from accessing necessary medical care, according to the Human Rights Campaign. In New Hampshire, House Bill 68 would “consider any child ‘subjected to drug treatments or surgery in an attempt to alter the sex of the child assigned at birth’ to be an ‘abused child’ in the eyes of the law,” according to the Concord Monitor. 

“These bans are terrible. They are blocking trans youth from accessing life-saving health care. Gender affirming health care is life-saving health care,” said Dallas Ducar, CEO of Transhealth Northampton and clinical lead for mental health services at the MGH Transgender Health Program.  

According to House Bill 1570, there are many health risks involved with hormone therapy and puberty blockers and states that “the prescribing of puberty-blocking drugs is being done despite the lack of any long-term longitudinal studies evaluating the risks and benefits of using these drugs for the treatment of such distress or gender transition.”  

“This unproven, poorly studied series of interventions results in numerous harmful effects for minors, as well as risks of effects simply unknown due to the new and experimental nature of these interventions,” states North Carolina’s Bill 514. 

“There are a lot of myths that these bills put forward,” said Ducar. “One is medical banned bills claim that gender affirming care is experimental. It’s not, at the core of this bill, HB1570, and other course health care bans, there’s a dangerous misrepresentation of the medical care that we clinicians with expertise in caring for transgender youth provide with scientific research supporting our practice.” 

Many health organizations devoted to children’s health care openly oppose these bills including the American Academy of Pediatrics, the American Association of Child and Adolescent Psychiatry, and the National Association of Social Workers, among others, according to the Human Rights Campaign.  

The Family Council, a conservative education and research organization based in Little Rock Arkansas supports the bill, calling it a “really good bill protecting children from dangerous gender reassignment procedures,” according to their website.  

Ducar adds that another common myth surrounding bills opposing gender affirming care, is that clinicians are handing out prescriptions for gender related medications, hormones, and puberty blockers. She stated that this is not the case, and that clinicians only provide these after intense discussion with mental health providers, medical providers and patients. 

According to AMA Journal of Ethics, the Informed Consent Model was created as an alternative to the Standard Model of Care, which requires a formal diagnosis of gender dysphoria by a mental health professional to assess whether the individual needs gender affirming therapies such as surgeries and hormone treatments. The Informed Consent Model by contrast, requires in-depth explanation on part of the medical provider to the patient of all the possible risks and benefits involved, but allows for more autonomy in that no formal diagnosis by a mental health professional is needed for individuals to receive these treatments.  

Dr. Robert Kelly, primary care provider with Core Physicians in New Hampshire who specializes in LGBTQ Health, said he practices the Informed Consent Model, to provide a clear explanation of these therapies as well as all risks and benefits involved, so that his patients enter into agreements with full understanding of what they’re going into. “What a lot of people don’t understand is that those effects of those medications are reversible,” Kelly adds. 

 “No medication really is without risks,” said Kelly. He adds that for these people, gender affirming treatments can be lifesaving. He added that suicide rates are extremely high among the transgender population and that in many cases, gender affirming care has decreased the need for any mental health medications that these individuals were previously on, allowing them to live happy, productive and fulfilled lives. 

Ducar adds that another myth surrounding laws like these, is that they are protecting youth by stopping them from obtaining these treatments. Kids are smart; they will go to black market meets, websites where they will find different information on medication and hormone dosing, according to Ducar.  

“This, in my belief, wholeheartedly equates to genocide. It is actually really trying to limit the definition and control the dialogue on who is transgender and define transgender people out of existence,” said Ducar. “Genocide’s defined as the deliberate and systematic destruction of a racial, clinical and cultural group.”  

Ducar explains that these bills are also affecting trans people of color, non-binary individuals and the neurodiverse community within the trans population, so these bills have an intersectional impact.  

“While there’s still barriers that exist, we are making grounds. We are creating a more patient centered health care approach. It’s ever evolving,” said Ducar. “It’s time to humanize health care.” 

Photo courtesy of NHPR.