Experts say that gender-affirming care bans amount to 'abuse.' Why won't lawmakers listen?

A new article by doctors at the Seattle Children’s Hospital details exactly how bans on gender-affirming care for minors “amount to state-sanctioned medical neglect and emotional abuse.”

The report, published by the American Academy of Pediatrics, is the latest piece of evidence demonstrating that restrictions on puberty blockers, hormones, and other care for transgender youth "deny children access to routine health care that has been shown to decrease dramatically high rates of suicide and depression."

Yet conservative state legislators are unrelenting. More than 550 anti-LGBTQ+ bills were introduced across the U.S. in 2023, and 80 were passed into law, according to the Human Rights Campaign. Just weeks into 2024, 285 anti-LGBTQ+ bills have been introduced. The majority of the bills target transgender minors, whether they be bans on gender-affirming health care, laws mandating that they use bathrooms and school facilities contrary to their gender identity, or policies forcefully outing them to their families.

"These legislative efforts operate under the guise of protecting children," the AAP article states, and they do so in spite of all available data. The American Medical Association, the American Psychiatric Association, the American Academy of Pediatrics, the American Academy of Child & Adolescent Psychiatry, the World Medical Association, and the World Health Organization all agree that gender-affirming care is evidence-based and medically necessary not just for adults but minors as well.

Medical professionals say gender-affirming care has become more heavily scrutinized than other areas of medicine. To Dr. Carl Streed Jr., president of the U.S. Professional Association for Trans Health, this is not because of the actual science behind the treatment but instead due to "ideological" bias.

"The goalposts continue to be moved," he said at the HRC 2024 State Legislative Press Briefing. "It's one of those situations where I often will ask people if you can tell me honestly what evidence you need to consider changing your mind. And if they cannot do that, I definitely know they're not thinking about the facts. They're definitely thinking about this from an ideological perspective."

The recent legislation wave is not just anti-science, added Cathryn Oakley, state legislative director and senior counsel at HRC — it is also legally unsound. Regarding the bills that have been passed into law, one aspect she flagged was "how often our opponents have to cheat in order to win."

"Some of the worst bills that passed last year passed after a circumvention of the usual process. So they passed because the rules were suspended, they passed in the last several hours or last hours of a [legislative] session, they passed after having cut off testimony contrary to the usual rules and public comment," she explained.

Oakley attributes the sudden attention placed on transgender issues in legislatures, in part, to the culture war. Instead of leaving health care decisions to medical professionals, she said politicians have taken it upon themselves to "use transgender folks as a political wedge."

"They do not really have any subject matter expertise at all," she continued. "And in fact, when people are trying to offer subject matter expertise, [they are] absolutely rebuffed and rejected. These are folks who are doing what they're doing because they perceive this to be their path to power."

While the bans are hastily pushed through in many cases, they bring devastating consequences for the transgender residents of their states, young and older. As trans minors lose access to critical treatment, Streed said the restrictions also "continue to affect the science and affect our ability to continue to do research," as they "get in the way of us being able to disseminate information effectively."

This allows for misinformation about transgender health care to spread, much of it perpetuated by the same politicians seeking to outlaw it. By flooding the public discourse with their own confirmation bias, the conversation stalls at the talking points they've manufactured.

If evidence is not enough to change their minds, what is?

Streed noted that "some of the easiest ways to combat misinformation is actually sharing narratives," which data also supports. Several studies have shown that knowing a transgender person, whether in real life or in media, can increase support for transgender rights and decrease prejudice.

"We always like to say evidence changes minds, narratives change hearts," Streed said, adding, "We need more people to feel comfortable, and we need to provide them protections and support in sharing their experiences around this."

This rings true for Minna Zelch, a member of the leadership team at Trans Allies of Ohio, whose 19-year-old daughter is transgender. Zelch shared that after the state where her daughter was attending college passed anti-trans laws, she had to switch to a university in another state for her safety.

Many transgender people and their families have been forced to relocate in order to live unrestricted lives, and even the ability to move is a privilege not afforded to all. To be able to openly share one's narrative is also a privilege, Zelch noted, which makes it all the more crucial to speak out if you can.

"As parents one thing we constantly tell our legislators is we are the first people to say there needs to be more research on this. We need more information, but these laws will make sure that never ever happens. And it's very frustrating for for them to just to just dismiss it completely," she said. "And so that's why so many of us have chosen to risk our safety to tell our stories."

The Advocate's Christopher Wiggins contributed to this report.