Physicians say they're worried political attacks will make it harder for patients to access gender-affirming care.
Physicians who provide gender-affirming care for trans adults and minors say that they see connections between political attacks on this necessary medical care and attacks on abortion care, and are concerned that the attacks will harm patients in similar ways.
Anti-LGBTQ groups and GOP legislators and state officials, relying on misleading claims about the so-called harms of gender-affirming care for minors, have set out to stigmatize and criminalize all forms of it, despite the fact that medical experts have debunked those claims.
In a complex and lengthy process prior to receiving care, trans youth first speak with pediatricians, who then connect them with clinics staffed with pediatric psychiatrists, pediatricians, and endocrinologists to determine whether a patient is in fact a good candidate for it. Professional medical organizations and associations, including the American Psychiatric Association, American Psychological Association, the American Academy of Pediatrics, and the Endocrine Society have all issued policies in support of age-appropriate gender-affirming care.
But Republican lawmakers have introduced bills across the country to ban such care for minors. Some of the bills allow parents and young people, once they are the age of majority in their state, to sue their doctors afterwards, and others prohibit the use of public funds for gender-affirming care or provide for heavy criminal penalties for physicians who practice it.
Trans kids and their families in Texas are involved in an ongoing legal battle over gender-affirming care. In February, Texas Attorney General Ken Paxton (R) said such care for minors was a form of child abuse, and Texas Gov. Greg Abbott (R) told the commissioner of the Texas Department of Family and Protective Services that instances of it should be reported to the agency as such. Families of trans youth in Texas say they are being investigated or are worried they will be in the near future.
The American Civil Liberties Union and Lambda Legal, an LGBTQ advocacy group, challenged these investigations in Texas' 201st District Court, where Judge Amy Clark Meachum granted a restraining order and then blocked Abbott's directive altogether. Paxton filed an appeal, claiming that the "Democrat judge's order permitting child abuse is frozen." The ACLU and Lambda Legal issued a statement in response that said, "We consider the appeal baseless. ... we do not believe that this new appeal has any merit or that it should affect whether the injunction can remain in place. The court's decision makes clear how harmful and lawless the state's actions are, and we will fight to ensure the properly issued injunction remains in place."
Dr. Bhavik Kumar, who provides abortion care at a Planned Parenthood clinic in Houston, is qualified to provide gender-affirming care for minors, but his clinic does not currently provide it. Kumar, who does provide such care for adults, is the medical director for primary and trans care at a second Planned Parenthood clinic and also serves as the Texas lead for the Committee to Protect Health Care. He told the American Independent Foundation that the tactics for undermining transition-related care are similar to those used in undermining abortion rights, including a rejection of science and research and the sowing of fear among the affected population: "There's the chilling effect that comes from that which is difficult to predict and sort of takes on a life of its own. ... Even folks that are 18 and older are calling and asking, 'What does this mean?'"
Dr. Angela Kade Goepferd, medical director of the Children's Minnesota Gender Health program, said they see other connections between anti-abortion movements and movements against gender-confirming care:
I think there's a similarity there with reproductive rights and women, and women having historically had less access and less rights and less financial and geographical flexibility. The tactics and the groups that are involved are similar. There's very polarizing language, inflammatory language, and a lot of misinformation.
However, I do think that generationally, um, those who are in medical training now are very aligned with the science behind providing gender affirming care both to kids and adults. I also think that the stigmatization that has existed for decades around abortion care doesn't exist in the same way around transgender medicine and the more that transgender people become visible in our society, there's always going to be backlash. But there's also been some really great strides made in terms of acceptance and understanding.
Lawmakers have also made comparisons to abortion during hearings on bills aimed at banning gender-confirming care. Arizona Republican state Sen. Nancy Barto brought up abortion on Feb. 9 during a hearing on S.B. 1138, which, as originally introduced, would have banned doctors in Arizona from providing such care to anyone under 18, comparing the work of her committee on abortion to its current debate and relying on assertions not based on the science: "We're constantly at work in this committee to update our laws based on new evidence. Just take abortion policy in itself. Once we saw what ultrasound revealed about human life in the womb, our laws had to follow, because you can't deny life, and you can see movement and pain. Anyway, I think health regulation is what it is."
Idaho House Bill 675 has listed as its purpose: "This legislation would amend the existing state ban on female genital mutilation to also include puberty blockers, cross-sex hormones, and sex reassignment surgeries when administered to children struggling with gender dysphoria. Like FGM, these medical interventions are almost always irreversible; some render the patient sterile, while others unnecessarily mutilate healthy body organs." During a hearing on March 8, Idaho state Rep. Julianne Young (R) argued for it in terms that recall anti-abortion arguments, speaking of children that would not be born: "We're not talking about the life of the child, but we are talking about the potential to give life to another generation. I don't see it as a contradiction."
Experts have pointed out the similarity between the anti-abortion movement's tactics, including protests targeting providers and the spread of misinformation, and those now being deployed against gender-confirming health care.
Kumar says he is worried that the attacks could harm physicians' ability to practice and the ability of future physicians to be trained in the field.
"When we have intrusions like this that become politicized, that becomes stigmatized at a higher level, it becomes difficult to do the work. And I think it gets people concerned and worried about their own safety, right? Folks have families and they have other things to worry about. It also gets people worried about what they can say and can't say," he said:
They might have to talk to, you know, administrators and lawyers and whoever else about what they can and can't do. And then the same thing trickles down into future providers in medical school and residency training and whether they even get exposed to [gender-affirming care] in training or not. And then what we'll see with time is there's less and less people interested or willing to do this work. And we've seen the same thing with abortion care.
While Goepferd is not as concerned about a future lack of physicians trained in such work, they do note that bans targeting health care providers result in fewer and fewer options for transgender kids seeking their care.
"Similar to reproductive care, if only certain locations and only certain states offer support of gender-affirming care for kids and teenagers, then that means that there we're going to widen the disparities in who can and can't access care that currently exists right now," they said. "There are lots of programs to help care for kids on both the West Coast and the East Coast. In the middle of the country down to the South, there's not, and that's only going to get worse if this pattern continues so that similar to reproductive care, kids and families just aren't going to have access to the care where they live."
Dr. Gina Sequeira, a co-director of Seattle Children's Gender Clinic, told Time magazine that she received posters opposing gender-affirming care in an unmarked letter last year.
"I was taken aback, and really kind of fearful," Sequeira said. "It really made me wonder what the future of our work looks like."
Published with permission of The American Independent Foundation.