Anti-trans bills aim to make it a crime to medically treat transgender youth. Experts say it will have 'deadly consequences.'
While testifying before the Texas State Senate on Monday to speak out against that state's proposed anti-trans bill, fourth-grader Kai Shappley didn’t pull any punches.
"I've been having to explain myself since I was 3 or 4 years old. Texas legislators have been attacking me since pre-K,” said the practiced self-advocate, appearing with her mother, and many other families, at the Senate Committee on State Affairs hearing. "When it comes to bills that target trans youth, I immediately feel angry. It's been very scary and overwhelming. It makes me sad that some politicians use trans kids like me to get votes from people who hate me just because I exist. … Bullying is bad. Please stop."
It doesn't seem likely to end anytime soon, though, as the measures being considered by Texas legislators, including House Bill 2693 and Senate Bill 1311, would make it a license-losing offense for a physician to provide gender-affirming care to transgender people under the age of 18, including prescribing puberty blockers and hormones. Additionally, House Bill 68 would reclassify gender-affirming care from a doctor or therapist as child abuse.
Texas is far from alone in its targeting of transgender youth. A record number of other states are forging ahead too, with similar bills introduced in at least 21 states this year (not to mention those advancing laws that ban transgender girl and women athletes from girls' or women’s sports teams, introduced in 30 states and passed in four, and prompting the NCAA to say it will pull championships from states that pass them). That includes North Carolina, South Carolina, Louisiana and Alabama, which would also force school authorities to out trans kids to their parents and, at least in the case of a just-passed Arkansas law, would cut off current trans patients from their medical care, including the sudden stoppage of hormone treatments.
"I don't think I ever imagined a world where we would start ripping health care away from people, essentially forcing them to de-transition by government coercion," attorney Chase Strangio, deputy director of the American Civil Liberties Union’s LGBTQ and HIV Project, told NBC News regarding that lack of a grandfather clause in the Arkansas House Bill 1570 — which was passed, then vetoed by Republican Gov. Asa Hutchinson, then overrode by legislators, making it now illegal for physicians to provide trans kids with gender-affirming medical care in that state.
"H.B. 1570," Hutchinson said of the bill in an April 8 opinion piece for the Washington Post, "puts the state as the definitive oracle of medical care, overriding parents, patients and health-care experts. While in some instances the state must act to protect life, the state should not presume to jump into the middle of every medical, human and ethical issue. This would be — and is — a vast government overreach."
Hutchinson's veto had provided those fighting the bill with a day of joy and relief, but it was short-lived when the Arkansas state legislature overrode the veto, ignoring the opinions of not only the governor but of major medical organizations — including the American Academy of Pediatrics (AAP), the American Medical Association, the Endocrine Society and the American Psychiatric Association.
"The AAP recommends that youth who identify as transgender have access to comprehensive gender-affirming and developmentally appropriate health care provided in a safe and inclusive clinical space,” said Dr. Lee Savio Beers, president of the American Academy of Pediatrics, at a news conference addressing the Arkansas bill. "The bill advancing through Arkansas legislature not only ignores this recommendation but undermines it."
The bills have also been opposed by 70 major corporations and more than 1,000 child welfare agencies, and are being driven by national anti-LGBTQ groups, according to the Human Rights Campaign.
While the various state bills often use language such as "child compassion and protection" and "save adolescents,” experts in the field say these inaccurate, discriminatory proposals, if made law, would do just the opposite.
"This bill will drive families, doctors and businesses out of the state and send a terrible and heartbreaking message to the transgender young people who are watching in fear," Strangio noted in an ACLU statement following passage of the Arkansas law. And for the families of trans youth who cannot just pick up and move out of state, it could leave them without a safety net when it comes to much-needed medical care and support. "Gender-affirming care," he said, "is lifesaving care, and banning that care will have devastating and, in some cases, deadly consequences."
The truth about gender-affirming care
So, what's the reality when it comes to medical care sought out by and provided to transgender youth, and how are these bills distorting the truth?
"There is a significant misconception that the gender-affirming treatment is permanent surgery, and that's not the case,” says Dr. Karen Tang, a Philadelphia-based gynecologist who often treats transgender patients and who has become an outspoken supporter of trans youth on her popular TikTok as well as Instagram, where she recently had a myth-busting interview with Strangio about the misleading language of the various state bills.
For transgender youth seeking treatment, Tang says, "it's almost all supportive care, counseling and medical treatments … like pubertal suppressants or gender-affirming hormonal treatments, which almost always are reversible. And they decrease the distress of the gender dysphoria, so children or adolescents can have time to confirm their gender identity and make decisions about things that are permanent, like surgery."
Most important, notes Tang about prescribing pubertal suppressants — technically called gonadotropin-releasing hormone analogues (GnRHas), which work by temporarily pausing development in children who have entered puberty — "it's well established that it’s lifesaving." That's according to research including a 2020 study published in the journal Pediatrics, which found, in a large sampling of transgender adults, that use of puberty blockers were associated with decreased odds of lifetime suicidal ideation. That's because their use, she explains, "allows time for patients to solidify their gender identity and make a decision later on."
Dr. Caroline Salas-Humara, a pediatrician at NYU Langone's Transgender Youth Health Program, which treats patients from 8 to 25 years old, tells Yahoo Life that when a transgender child or adolescent comes in for care, they are met with an entire team of experts focused on treating the patient in the most supportive, individualized way. "It's a collaborative approach," she says. "It's not just me making a decision."
Instead, patients are typically met by experts including a social worker and mental health team, a pediatric endocrinologist and a medical provider who prescribes hormones, such as herself, Salas-Humara says, while older patients may be referred to even more specialists, such as a fertility doctor who can assist, for example, with egg freezing or sperm banking before starting hormone treatments.
"We help these patients navigate whatever unique needs they are having for their journey," she explains. "By and large, what I see are kids who, unfortunately, come in anxious and depressed, particularly regarding impending puberty, because their sex assigned at birth, related to their chest or genitals, doesn't match their identity."
And the options for care include "the use of medications to help alleviate that anxiety and dysphoria," she says. "So, for a young person who has started puberty, we can pause it where it’s at to prevent secondary sex characteristics — chest developing, period, and, for birth-assigned males, the Adam’s apple, growth spurt, facial hair. It's all reversible and doesn't affect fertility, though you can't be on them forever because it can affect the strength of your bones."
After a patient goes on puberty blockers, she says, the care team decides what's next, which can sometimes mean going off them in order to allow the body's natural production of estrogen or testosterone — or it could lead to going on "to use the gender-aligning hormone … and once you start that hormone it helps build the bones." Before starting the hormones, there is a "readiness assessment" by a mental health provider.
Also "just false" in these bills, says Salas-Humara — is the narrative that the treatments are somehow "experimental" — as put forth in the name alone of Arkansas’s Save Adolescents From Experimentation (SAFE) Act.
"Puberty blockers been around for over 30 years, and have historically been used in people who have early, or 'precocious,' puberty, like at 6 or 7, because they could be too short. [The blockers] close the growth plates," she says. "They have also been used in fertility treatments, for prostate cancer. … Medical treatments to affirm gender are not experimental. They are well studied, have been supported by scientific evidence for decades … and correlate with improved mental health."
But what about surgery?
"Typically, over the age of 18 is when gender-affirming surgeries are done, though there are some exceptions for chest masculinization surgery," also known as top surgery, says Salas-Humara, which involves a double mastectomy and pectoral-shaping procedure for patients assigned female at birth but who identify as male. "It's case by case, but it's not by and large what happens."
Tang agrees, noting that "the one thing that can be done under 18 is chest surgery, or top surgery, because chest dysphoria can be very severe and is hard to mask … and that can be very distressing, so we sometimes see this at, for example, age 16."
The bottom line, says Salas-Humara, is that "I think my job is to take care of people and make sure they're safe and healthy — and taking this away from them would do the opposite. It's precisely why we provide the care."
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