Legislation proposed or under consideration in 19 states since early 2020 aims to prohibit access to gender-affirming care for minors. Several of these laws even threaten legal action against the clinicians who provide such care.
These bills would revoke the rights of patients and their parents to make decisions with their medical providers about their care. One issue is the use of puberty blocking medications. This intervention, which is reversible, pauses puberty to give young people and their families time to explore gender identity. Delivery of these medications should occur immediately following the first signs of puberty because they are unable to reverse any puberty-related changes that have already occurred.
Forcing youths and their families to wait until age 18 for gender-affirming care can result in unwanted physical changes and worsening mental health. The bills also demonstrate a profound disregard for the recommendations of every relevant medical association, including the American Academy of Pediatrics, as well as an increasing body of scientific literature demonstrating that gender-affirming care saves lives.
Being a gender diverse young person today isn’t easy. They often experience bullying, discrimination, and violence, which contribute to the significant mental health burdens that many of them face. These include having three times higher rates of suicidal thoughts than their cisgender peers.
Restrictive legislation would further threaten the health of gender diverse youth.
In a new study we published with several colleagues in the Journal of Adolescent Health, parents of gender-diverse youths from 43 U.S. states emphasized that gender-affirming care is lifesaving. They were also explicit in expressing fears that their children would face worsening depression and may even attempt suicide as a direct result of legislation that would prevent them from accessing care before age 18.
The mother of a transgender son from South Dakota shared that these laws, including legislation that passed in the South Dakota House early this year, would “mean I have to start fearing, again, that my son will try to take his life because his dysphoria is so bad, and he does not have his blocker to stop his body from betraying him. I asked him the other night how he thinks his life would look without them. Without needing to think about it, he said, ‘I’d probably be dead.’ He’s 14.”
We are pediatricians with more than two decades of medical training between us. Supporting gender diverse youth continues to be the most rewarding part of our careers, and one that has the greatest impact. As subspecialists and experts in this field, we have the knowledge and skills to provide what we know is lifesaving treatment, and improving health outcomes for gender diverse youth is our number one priority.
We frequently use puberty blockers to give our patients time to explore their gender identity before committing to other medical or surgical interventions. Parents like the mother from South Dakota often share that these medications allowed them to see their happy, joyful children again after watching them fall further into depression due to experiencing puberty that didn’t align with who they are.
The proposed South Dakota law, as well as those in numerous other states, would make prescribing a puberty blocker or gender-affirming hormones to adolescents with parental consent a crime and make criminals of those who have dedicated their lives to improving health outcomes for gender diverse youth.
Our goal in doing this study was to elevate the voices of parents whose ability to consent to gender-affirming care for minors was being attacked. Another participant in our study, the mother of a nonbinary child from Washington state, emphasized why this is so important: “The legislators who have proposed these laws most certainly are not listening to the people who have personal lived experience as members of the trans/nonbinary community and their families,” she wrote. “Many of us have been trying to share our stories in hopes that lawmakers will listen, but we’re being ignored.”
While these bills have not yet become law in any state, they will likely continue to be proposed in future legislative sessions. As physicians, we aim to lift up the voices of our patients and their families and encourage others to do the same to protect access to gender-affirming care. These amazing young peoples’ lives depend on it.
Kacie Kidd is an internist, pediatrician, and adolescent medicine fellow at UPMC Children’s Hospital of Pittsburgh, where she specializes in gender-affirming care for youths. Gina Sequeira is a pediatrician, adolescent medicine physician, and pediatric gender specialist in Seattle.
If you or someone you know is considering suicide, contact the National Suicide Prevention Lifeline at 1-800-273-8255 (Español: 1-888-628-9454; deaf and hard of hearing: 1-800-799-4889) or the Crisis Text Line by texting HOME to 741741.