Minor Gender-Affirming Care Bans: Legislators Know Best

The 2023 legislative session saw many states enact restrictions or outright bans on gender-affirming care for minors, and one state that managed to heavily restrict care for adults, as well. Despite the testimony of parents, patients, mental health professionals, and physicians as to the safety, efficacy, and necessity of having access to this sort of care, many of these bans passed through the state legislatures with surprising ease. But what is gender affirming care and why did the threat of its outlaw illicit such emotional testimony from so many people?

Quoting the Association of American Medical Colleges (AAMC), the professional organization through which every physician in the country has obtained their medical license: “Gender-affirming care, as defined by the World Health Organization, encompasses a range of social, psychological, behavioral, and medical interventions ‘designed to support and affirm an individual’s gender identity’ when it conflicts with the gender they were assigned at birth. The interventions help transgender people align various aspects of their lives — emotional, interpersonal, and biological — with their gender identity. . . . The interventions fall along a continuum, from counseling to changes in social expression to medications (such as hormone therapy). For children in particular, the timing of the interventions is based on several factors, including cognitive and physical development as well as parental consent.”

Most of the state actions focus on one particular therapy under the gender affirming care umbrella: hormone-related therapies designed to delay puberty or promote development of masculine or feminine sex characteristics.

Why do youth seek these sorts of treatments? Some children sense an incongruence between their assigned-gender-at-birth and their gender identity. Those who end up seeking gender affirming care are often experiencing “gender dysphoria,” a condition recognized by the American Psychological Association as a source of clinically significant psychological distress. “The symptoms include ‘strong’ desires to have the primary or secondary sex characteristics of another gender and to be treated as another gender, as well as ‘significant distress or impairment in social, occupational, or other important areas of functioning.’”

Transgender youths are also significantly more likely to experience depression, emotional distress, bullying and other forms of violence, and suicidal ideation and suicide attempts. A study led by the University of Minnesota of nearly 82,000 students in Minnesota found that 61% of transgender youths reported having experienced suicidal ideation, more than three times higher than the rate that their cisgender counterparts experienced. When it comes to getting help, the Mayo Clinic in Minnesota notes: “Accessing health services and mental health services can be difficult due to fear of stigma and a lack of experienced care providers.”

So, does hormone therapy help reduce these symptoms? A study from the Stanford University School of Medicine concluded that those who began hormone therapy in adolescence experienced less suicidal ideation, fewer mental health disorders, and less substance abuse than those who began such therapy later. “Providers attest to seeing positive changes in their patients from gender-affirming care. ‘Most of them are happier, less depressed, and less anxious,’ says Adkins at the Duke Child and Adolescent Gender Care Clinic. ‘Their schoolwork often improves, their safety often improves.’”

These bans passed despite opposition from just about every major medical organization, including The American Medical Association, The American Academy of Pediatrics, and The American Psychiatric Association. Numerous studies inform their support, enumerated and explained in this article from Psychology Today.

However, despite this overwhelming support from the medical community, conservative lawmakers and attorneys general remain unconvinced. The Attorney General of Texas, Ken Paxton, declared gender affirming care, including but not limited to hormone therapies, “child abuse” and in 2021 directed the Texas Department of Family and Protective Services to begin investigating families who have sought this life-saving care for their children. This, among similar policies in other conservative-controlled states, has driven families with transgender members out of there homes, seeking refuge in sanctuary states, or states that have passed explicit protections for transgender youth in response to the bans.

These policies have created two, distinct Americas for transgender adults and youth, and conservative legislators are forcing families to make hard decisions about their children and futures.

The views and opinions express in this blog post are solely those of the author and do not necessarily reflect the official policy or position of Mississippi College, Mississippi College School of Law, or the Law Review. The author is solely responsible for the content of this post. The information provided in this post is for general informational purposes only and should not be construed as legal advice.