2023 is only halfway over and so far, 17 states have passed laws targeting transgender youth and their access to gender-affirming care. In the years before 2023, three states banned gender-affirming care which brings the grand total of states to 20. Additionally, several states are currently considering gender-affirming care bans that may potentially pass in the future (Movement Advancement Project).
What is gender-affirming care?
Gender-affirming care is a broad term encapsulating many services that can include anything from mental health support to medical interventions. Individuals experiencing gender dysphoria, or a sense of distress resulting from one’s gender identity not aligning with their sex assigned at birth, often seek gender-affirming care as a step towards living their lives as authentically and happily as possible (Human Rights Campaign). The efficacy and necessity of gender-affirming care is supported by nearly every major medical association, representing almost 1.3 million medical professionals working in the United States (Human Rights Campaign). Gender-affirming care is highly individualized and involves a lengthy process of figuring out what is best for each person based on conversations with the individual, their family, and their medical team. Gender-affirming care bans, however, have added politicians and the public to this group of decision-makers in private healthcare journeys.
What are gender-affirming care bans?
No two gender-affirming care bans are exactly alike. However, the one similarity between all bans that have been enacted in the U.S. is that they target minors and prohibit their access to at least one form of gender-affirming care. Arizona is the only state that solely prohibits surgical-based care, meaning the vast majority of states have prohibited minors’ access both to surgical and non-surgical care. Common surgical options include facial reconstruction, top surgery, and bottom surgery (Cleveland Clinic). Non-surgical care is broader in nature and can include puberty blockers, hormone replacement therapy, physical therapy, and speech or voice therapy (Hopkins Medicine).
The state of Florida’s bill stretches its transphobia to adult care, limiting access to gender-affirming care via telehealth. Other states’ bills also target coverage or provision of care or both. Coverage refers to whether public or state funds can be used to cover the cost of gender-affirming care, which impacts both minors and adults. Provision refers to the providers of the care, which would primarily mean doctors, who in some states can face felonies for providing safe and medically necessary gender-affirming care, or are at risk of losing their medical license and facing costly fines. It should be noted that a few bans are currently temporarily and/or partially blocked, including Arkansas, Florida, Indiana, Alabama, Oklahoma, and Texas (Movement Advancement Project). Arkansas’s ban was the first to pass in 2021 and is also the first to be struck down.
The hypocrisy of gender-affirming care bans
Supporters of bans often call gender-affirming care “experimental” or choose to use more inflammatory language that is largely devoid of true meaning but is intended to pack an emotional punch such as “mutilation” or “sterilization.” They frequently refer to potential side effects of gender-affirming care, the risk that people may regret their transitions later in life, and the notion that minors cannot give informed consent to medical treatment.
It is incredibly hypocritical to focus on gender-affirming care and possible side effects while simultaneously turning a blind eye to the extensive list of side effects that come with medication/treatment (like birth control). Many of these dangerous medications are prescribed to children, meaning that society, generally speaking, approves of this and the fact that the child’s parents are in full capacity to consider the effectiveness and worthiness of the medication. Yet, parents’ ability to make these same choices along with their children and medical professionals somehow does not apply when that medicine is under the umbrella of gender-affirming care. Similarly, birth control and breast augmentation procedures, both of which are associated with detrimental side effects, have no legal minimum age requirement for cisgender women seeking those treatments. In many states, people can still access the exact same hormone therapies and puberty blockers that have been purported as experimental and sterilizing only if they are not used for explicitly gender-affirming purposes. In Arkansas, this clear and discriminatory discrepancy was highlighted in a recent lawsuit that struck down Arkansas’s gender-affirming care ban (ABC News).
Further, parents play a major role in dictating their child’s medical life and choices until they reach the legal age of 18 until gender-affirming treatment is what they seek for their child. Parents entrust doctors and other medical professionals to provide medical care to their children under the premise that these experts are highly qualified individuals who underwent years of rigorous education and training. If parents can decide to trust a doctor’s opinion of their child’s needs for any other type of medical service, why is gender-affirming care any different? Involving politicians, who are not required to undergo any type of formal medical training to hold their elected positions, in the medical decision-making process undermines the expertise and knowledge of experts who have rightfully earned their qualifications. Holding these highly standardized qualifications should mean that medical experts then have the freedom to consider a wide array of evidence-based care to properly fulfill their duties to their patients and assist them as comprehensively as possible. Thus, gender-affirming care bans hinder medical professionals from utilizing the fullest extent of the knowledge they have earned through their education and hinder parents from being able to trust their child’s doctor to provide the most comprehensive and accurate care possible.
Not only are gender-affirming care bans clearly harmful to a population that already experiences an alarmingly elevated rate of violence, this type of legislation sets a dangerous precedent for governmental involvement in healthcare choices for everyone. We now live in a world where private health decisions can be interfered with and taken away just because someone may disagree with them on a moral or religious basis. The existence of gender-affirming care does not mean that every child is booking surgeries to validate their identities but rather, there are options available that can be considered over a length of time alongside experts and family members. Even if the banning of gender-affirming care does not personally impact you or someone you know, we must think about the possibility of losing a healthcare option solely based on disagreement from strangers. Judges who ruled to block the bans have emphasized their unconstitutionality and the degree to which they are a government overreach. Yet, more and more states continue to seek to pass their own bills and hundreds of hours will be spent in court debating, passing, and blocking them, all while transgender youth and their families suffer with a looming question of whether their options will be taken away.
As more bans are introduced into legislation or lawsuits against them move forward, you keep track of them to stay aware using this map which is frequently updated: https://www.lgbtmap.org/equality-maps/healthcare_youth_medical_care_bans!
“Equality Maps: Bans on Best Practice Medical Care for Transgender Youth.” Movement Advancement Project, https://www.lgbtmap.org/equality-maps/healthcare_youth_medical_care_bans.
“Gender Affirmation Nonsurgical Services.” Hopkins Medicine, https://www.hopkinsmedicine.org/health/wellness-and-prevention/gender-affirmation-nonsurgical-services.
“Gender Affirmation (Confirmation) or Sex Reassignment Surgery.” Cleveland Clinic, https://my.clevelandclinic.org/health/treatments/21526-gender-affirmation-confirmation-or-sex-reassignment-surgery#:~:text=Gender%20affirmation%20surgery%20refers%20to,health%20and%20quality%20of%20life.
“Get the Facts on Gender-Affirming Care.” Human Rights Campaign, https://www.hrc.org/resources/get-the-facts-on-gender-affirming-care.
“Judge strikes down gender-affirming care ban in Arkansas.” ABC News, https://abcnews.go.com/US/judge-strikes-gender-affirming-care-ban-arkansas/story?id=100257964#:~:text=A%20federal%20district%20court%20judge,parents%20and%20their%20medical%20providers.