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Home » Gender Affirming Healthcare Is Under Attack — This Is What’s At Stake

Gender Affirming Healthcare Is Under Attack — This Is What’s At Stake

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Raydra Hall’s son Quill tried to kill himself twice by the time he was 16. That’s when he started seeing a therapist and came out as trans.

Louisiana state law required that Quill complete a year of therapy before pursuing hormone treatment, which helps align the body’s physical characteristics with a person’s gender identity.

The promise of receiving the gender affirming medication became a light at the end of the tunnel for Quill.

“We immediately started doing our own research on the effects and side effects [of testosterone treatment], because we wanted to be as knowledgeable as possible,” Hall says.

Hormone therapy had an enormous effect on Quill’s life.

“He was a different kid — happier, more able to be himself — the improvements are amazing,” Hall adds.

Quill is now 20 and works as a bartender, a people-person job he never would have been comfortable with before, Hall says.

In March of 2022, however, Louisiana joined a growing number of states that have, over the past few years, proposed banning gender affirming care for minors. This is a legislative assault with life threatening consequences.

“If my son hadn’t been able to get treatment and be on testosterone, he would have still been suicidal,” Hall says.

Gender affirming healthcare refers to an array of medical treatments that support an individual’s gender identity. For young people, that most often includes mental health services and pharmaceutical intervention, similar to what Quill received.

“The approach to gender affirming care is individualized to each person’s needs,” says Kareen M. Matouk, PhD, an instructor in medical psychology in Columbia University’s gender identity program.

Matouk notes that integral components of gender affirming care can include:

  • age-appropriate psychoeducation about gender and sexuality
  • family support
  • guidance around social interventions
  • gender affirming medical interventions for those interested in medical transition

For kids who have not yet reached puberty, medications known as puberty blockers can delay the process and give patients and their families time to consider how to proceed, according to Planned Parenthood. Blockers can keep someone from experiencing puberty for a gender they don’t identify with, a process that can be deeply upsetting.

After the age of puberty, a person can use hormone therapy treatment to help align their body with their gender identity, the American College of Obstetricians and Gynecologists (ACOG) says. One example is when a trans boy takes testosterone to help develop a deeper voice and facial hair.

Both puberty blockers and hormone therapy are considered effective treatments for gender dysphoria. This refers to the distress experienced when someone’s body doesn’t align with their gender identity, according to 2022 research.

Medical guidelines generally do not recommend gender affirming surgeries before a child reaches age 18, though there are exceptions.

On the other hand, the use of puberty blockers and hormone therapy for trans youth is strongly supported by leading medical organizations, including the American Medical Association and the American Academy of Pediatrics. Plus multiple studies have confirmed their positive health effects, including one from 2019 and one from 2022.

Gender affirming care is very often lifesaving for trans and nonbinary youth, more than half of whom have seriously considered suicide, according to The Trevor Project. In fact, receiving gender affirming care has been associated with nearly 75 percent lower odds of suicidality among trans and nonbinary young people.

But a growing onslaught of state legislation aims to criminalize this lifesaving care.

An Alabama law that went into effect in May 2022 makes providing gender affirming treatment to trans youth a felony punishable by up to 10 years in prison.

Texas has proposed classifying gender affirming care as “child abuse.” At least 22 states have introduced similar bills, according to the Movement Enhancement Project. This puts nearly 60,000 kids at risk of losing essential care, based on a 2022 study.

The growing attacks on healthcare for trans youth go directly against the medical evidence that proves its benefits, targeting healthcare professionals and supportive parents for acting in children’s best interests.

“To me, it’s a life or death issue,” says Hussein Abdullatif, MD, co-lead of the University of Alabama’s pediatrics’ gender health team, which provides young trans patients with care recently outlawed by the state’s ban.

“Failing to provide affirming care is like a death sentence to these kids,” Abdullatif says.

Mental and emotional distress is often what leads trans youth to seek out care. Abdullatif says he regularly receives people admitted to the hospital for self-harm.

Withholding gender affirming care can make health conditions worse or lead to other conditions, including:

  • anxiety
  • depression
  • substance use
  • eating disorders

These conditions can persist well into adulthood and require ongoing treatment.

“My biggest fear of not providing [gender affirming] medications is that someone will end up dying by suicide because of loss of hope,” Abdullatif says.

Supportive medical care can also help kids understand gender dysphoria and see a path forward they may not have known existed.

“Being from a small town, the term ‘transgender’ never even hit our radar,” says Damien Connor, who sought counseling and hormone treatment around age 16. In his home state of Tennessee, multiple bans on gender affirming care have been proposed over the last 2 years.

“We didn’t know why he was so miserable in his body, we didn’t know that’s what dysphoria was,” says Damien’s mom, Candace Johnson. “We thought, ‘He’s a sad kid, and I hope he makes it through. What do I do?’”

A turning point came when Damien was around 15 and decided to cut his hair short.

“I liken it to when Frosty the Snowman puts on that magic hat,” Johnson recalls. “It was so phenomenal, it changed his whole demeanor. He was happier, and being happy felt good.”

That’s when Johnson started researching why a change in gender expression could cause such a positive shift.

“We didn’t know how to get from point A to point B,” she says, and it was through supportive healthcare professionals that they came to realize Damien was trans.

“My counselor really helped me navigate and understand what I was feeling in more detail, and let me know it was OK to feel this way, because it is normal,” says Damien, who’s now 22.

“Having the resources that we needed to move forward, honestly, we’ve been really lucky,” he says. “But the legislation that’s being pushed through now, I hate what’s happening because it’s so unfair. Not everyone gets to have an easy transition.”

Johnson also considers that Damien may not have put up a fight had they met with obstacles to receiving gender affirming care.

“If he had been shoved down, which a lot of kids and families are, he would have said, ‘OK, I’ll just deal with it and go back to being sad,’” she notes.

That’s another reason providers of gender affirming care are so important to trans kids.

“If there’s a child who needs help, just like I did, neither [they nor their provider] should have to think about consequences,” Damien says.

Some healthcare professionals focus specifically on the needs of trans and nonbinary youth. These specialists include therapists, pediatricians, and endocrinologists who treat patients pursuing medical transition.

Still, it’s important for all medical professionals to create an affirmative environment for gender-expansive patients.

“It’s really important to let these kids know that we’re listening to them, that we’re addressing their concerns with open-mindedness and empathy,” Abdullatif says.

Some healthcare professionals may need to seek out additional information to give their patients the best possible care.

“Our pediatrician didn’t really know much about transgender children,” says Hall. “But she was wonderful, and started doing research of her own so she could be better for him.”

She also referred them to a pediatric endocrinologist.

It’s important for healthcare professionals to take initiative, rather than relying on their patients to educate them about their needs.

“A lot of my early training was talking to my trans patients and learning from them, and that’s not really fair,” said Lori Lawrenz, PsyD, in a Healthline Media physician interview study conducted in July 2021. “They deserve for their providers to know about their situation like we would know about depression or anxiety.”

Conversations between colleagues are the most common means of exposure and education about the needs of LGBTQ+ patients, so encouraging communication among healthcare professionals is an important step forward.

Cultural competency, or knowing how to address and affirm gender diverse patients, can help every provider better serve their needs, even if those people are later referred to a specialist for particular care.

Every contact a patient has in the process of seeking care needs to be supportive as well.

“It doesn’t matter how knowledgeable I am as a physician if the front desk staff isn’t equipped to handle diverse patients,” Mia Armstrong, MD, said in the Healthline Media physician interview study. “The patient won’t trust me if they didn’t feel welcome upon entering.”

Trans youth often face bullying, discrimination, and harmful attacks — increasingly from politicians who don’t understand them or their needs.

These kids are especially vulnerable right now. They need support from loved ones, medical professionals, and everyone who has a voice in our democracy.

Get involved

Use this tracker from Freedom for All Americans to see where anti-trans legislation has been introduced, and find out how to get involved.

Identify candidates who affirm trans rights, support their campaigns, and vote for them in November.

You can also donate to the American Civil Liberties Union or the Human Rights Campaign, which are actively fighting anti-trans legislation in court.

Speak up

“I tell people to make this personal,” says Jo Ivester, speaker and author of “Once a Girl, Always a Boy,” a memoir about her son Jeremy, who transitioned as an adult.

If you hear someone make a transphobic comment, tell them, “I know someone who’s trans, or I know someone who has a trans son, and they’re deserving of dignity and respect,” says Ivester, who also serves on the board of Equality Texas, an advocacy group for LGBTQ+ rights in the state.

Express support

“Sharing online messages of support, especially that uplift trans and nonbinary voices and highlight trans resilience, is one way of standing in solidarity with the community,” Matouk says.

Let the people in your life know where you stand and mobilize them to get involved, whether by signing petitions to legislators or getting out the vote.

“If there are any trans and nonbinary people in your life, this is especially a good time to reach out and check in on how they are doing and show love, support, acceptance, and respect,” Matouk says.

Trans and nonbinary youth are among the most likely to experience poor mental health and suicidality, according to 2020 research.

Many may face lots of obstacles to their well-being, including family rejection, social ostracization, and, increasingly, legislative attacks.

Gender affirming care has been proven to save young people’s lives — and protecting their right to access the help they need is essential.

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