As the attacks continue, our clinicians want to set the record straight on the plain and simple truths of providing healthcare to trans youth.
As of May 12, the ACLU has been monitoring almost 30 bills across the United States aimed at limiting access to healthcare for transgender youth. One has been signed into law in Arkansas. Seven have died and one has been indefinitely postponed And 18 are still ongoing in Alabama, Arkansas, Arizona, Georgia, Iowa, Kansas, Louisiana, Missouri, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Utah, and West Virginia.
In 2019, the Williams Institute of the UCLA School of Law published an important report about the demographics of LGBTQ Americans. They found that the majority (63%) of LGBTQ Americans live in the US South, Midwest, and Mountain regions.
Not only are the rights of youth already limited, but now they’re being restricted or denied further particularly in places that already are lacking in access to care for all trans people.
Legislators are making medical decisions that should be made by a young person with trusted parents or guardians, and with healthcare professionals. That’s not right.
These actions by lawmakers are denying crucial truths that queer-and-trans-affirming healthcare providers center when providing care to youth:
Legislators are perpetuating a misguided and harmful belief that children do not understand themselves. This is fundamentally wrong to what we know about child development. It’s generally agreed upon that children become generally self-aware of their names and what they look like as early as 18 months old, and a latter article has found that gender identity understanding starts as early as age 3. There’s a reason why so many stories of trans adults include harkening back to when they were kids, and the feelings of body and gender exploration that fit outside of their assigned gender.
When children typically begin puberty around ages 11 or 12, the body releases testosterone or estrogen that aids in the development of secondary sex characteristics such as breast development or growth of facial hair. Puberty blockers simply provide time for a child to continue to explore and understand their gender identity, and for them and their family to decide if pursuing further treatment is a next step. Once a child stops taking puberty blockers, the body’s natural puberty will resume its course.
Puberty blockers have been in use since the 1980s to stop "precocious puberty" (or early puberty) in children as young as 6. So the medicines exist, are safe, and are generally used for preventing puberty for seemingly cisgender-identified children. The difference we’re seeing today comes when kids with experiences of gender dysphoria would seek treatment with puberty blockers, or even hormone therapy, to be affirmed in their bodies: as the need to access care is to explore gender, we’re seeing options taken off the table.
Medical transition for children and youth is a multi-disciplinary collaboration and is well studied from this approach. The physical outcomes of supporting trans youth in healthcare access related to their gender results in positive mental health as well. Plenty of studies have found that use of puberty blockers in trans children generally leads to improved psychological functioning in adolescence and young adulthood.
Even in 2008, the Journal of Medical Ethics was writing about treating trans children managing their gender identity: “If allowing puberty to progress appears likely to harm the child, puberty should be suspended. There is nothing unethical with interfering with spontaneous development, when spontaneous development causes great harm to the child. Indeed, it is unethical to let children suffer, when their suffering can be alleviated.”
Hundreds of clinicians around the country have signed on to an open letter in support of care for transgender, non-binary and gender diverse youth. Community leaders like ACLU lawyer Chase Strangio, writer and activist Raquel Willis, and have been sharing clear action items in virally shared posts for individuals to take against these bills. And thousands of individuals have made calls to lawmakers asking for these bills to stop: the governor of Arkansas even vetoed a bill limiting care, calling it ‘overbroad, extreme,’ before Arkansas legislature voted to override the bill.
While the present attacks on healthcare for trans youth are daunting, the support by providers, communities, and allies is vast. We stand with trans youth and are in this for the long-haul.