Health care access for transgender youth: Dozens of states propose or enact legislation to make it tougher

Mississippi’s Republican Governor Tate Reeves signed a bill earlier this month that prohibits trans girls from participating in girls’ sports. Similar bills were signed in Tennessee and Arkansas. Also in Arkansas, state lawmakers sent a bill to the governor earlier this week that would ban doctors from providing health care like puberty blockers and hormone therapies to transgender youth. It’s all part of a push in more than 25 states that restrict access to health care for transgender youth.

Press Play talks about this with four guests:

Jules Gill-Peterson is a professor of English and gender, sexuality, and women's Studies at the University of Pittsburgh, and author of the book “Histories of the Transgender Child.”

Dr. Jack Turban is a child and adolescent psychiatry fellow at Stanford University, and co-editor of “Pediatric Gender Identity: Gender-affirming Care for Transgender and Gender Diverse Youth.”

Samantha Schmidt is a reporter who covers gender and family issues for the Washington Post.

Chris Attig is an Arkansas resident and father of a transgender son.

According to Attig, the Arkansas bill would restrict his son’s insurance company from providing any gender affirming care, and he’s afraid his family won’t be able to afford health care moving forward.

Attig says hormone blockers can greatly benefit transgender or nonbinary youth as they discover more about their identity.

He adds that this type of legislation might condone hate or discrimination towards the transgender community.

“It’s sending a message to the people of Arkansas that it's okay to persecute, bully, beat, and as we learned recently with one of our residents up in Pennsylvania, to murder individuals who are transgender. And so there's a lot of fear in the transgender community,” Attig says.

If the Arkansas bill passes, Attig says his family might be forced to move to another state where health insurance and health care would be available to his son.

The origins of the anti-trans bills

In general, two types of anti-trans legislation have emerged nationwide, according to Schmidt: medical and high school sports-based bans. And last year, the Supreme Court voted to affirm the rights of trans people in the workplace.

Schmidt says that conservative organizations like the Liberty Council, Kelsey Coalition, and Heritage Foundation have pushed a lot of the anti-trans rhetoric that is fueling legislation.

“There's an effort across the country by conservatives to push these issues. And even if you just look at these bills, a lot of them have similar names and language,” she points out. “When you actually talk to these lawmakers, a lot of them will say they don't actually know of any issues in their states. I mean, a lot of them don't even know transgender people. ... It's clear that this is a coordinated effort among many different groups.”

Gill-Peterson points out they could also be an example of a Republican midterm strategy.

“We could analyze it in terms of sort of a cold political calculus, that this seems to be a conservative or GOP strategy in terms of fundraising and kind of cultural politics posturing towards the 2022 midterms.”

How the trans community is reacting

Gill-Peterson says the current wave of legislation has blindsided a lot of transgender people nationwide. But she points out that the attack on transgender rights could also have been prevented. She says that for years, trans activists were warning the mainstream LGBTQ activist base to include trans rights in the fight for equal rights.

“A lot of trans activists were putting pressure on and trying to warn broader LGBT activists … that a narrow focus just on the legalization of same sex marriage — which at the time was often accompanied by warnings to trans people that this was not our time, that we needed to wait our turn for civil rights — that if we were to focus so narrowly on that one issue, we would leave ourselves vulnerable,” Gill-Peterson says.

She says that the intent to protect girls and women has gotten lost in the anti-trans legislation. “It's the height of hypocrisy for someone like the governor of Mississippi to claim that what he's doing is protecting women and girls when in fact, he is doing the very literal opposite.”

Turban adds, “There have been these sports bills that have been sending these messages to kids that like, ‘If you're a transgender girl, you're really confused. You're actually a boy, and you're trying to take things away from girls.’ And none of it's based on a real problem. None of it's based on any real science.”

He uses the example of a 2013 California law that allowed transgender girls to compete on a girls sports team, and so far, there have been no problems.

“Every major medical organization has come out and said these legislative attempts to take gender affirming medical care away from transgender kids is dangerous. And from my experience with some of these kids, it could even be potentially fatal.”

Turban says that politicians and political pundits have dominated the conversation around gender identity, and there hasn’t been enough coverage of doctors and trans people themselves.

“We're not hearing from the doctors, we're not hearing from the trans kids themselves as much. We're not hearing from their parents. And if you talk to the people who this legislation really impacts, they pretty much universally will tell you this is a bad idea, and it's dangerous,” Turban says. “It doesn't seem they've gone through the published medical protocols from The Endocrine Society or the American Academy of Pediatrics.

He adds, “And without the relevant experience, they're coming out and saying, ‘You know what, we think these major medical organizations that have been doing research on this for decades are wrong, and we're going to take away all this medical care.’”

The weaponization of scaring parents

Turban says that lots of parents have raised fears of their child mistakenly transitioning and making irreversible decisions like top surgery or taking hormones. But he says those fears are often rooted in misinformation.

In his line of work, Turban offers medical intervention with teenagers during their early stages of puberty. At that point, the only treatment he provides are puberty blockers, which pauses puberty until a family works with doctors and therapists to figure out the next course of action.

Turban says that without medical intervention, some kids can have a strong negative reaction to the development of their bodies. He uses the example of a patient who avoided going to the bathroom as much as possible and developed intestinal damage and needed surgery.

“This is a very careful process. We start from the most reversible intervention, which is a puberty blocker, and save the less reversible interventions like surgery until much later down the line. And none of these are decisions that are made lightly or quickly. And I think that's often what's been lost.”