Arkansas became the first state on Monday to pass a bill prohibiting doctors from providing gender-affirming medical care to transgender children, treatments that major medical organizations describe as essential to the mental health of an already vulnerable community of young people.
The legislation is the first to pass among a series of similar bills introduced by Republican lawmakers in more than 17 states so far this year, part of a growing effort by politicians to restrict the rights of transgender young people across America — in both doctor’s offices and high school sports teams.
The bill will now be sent to the desk of Arkansas Gov. Asa Hutchinson (R), who last week signed a law banning transgender girls from competing in school sports teams consistent with their gender identity. He also signed legislation last week allowing doctors to refuse treatment to a patient based on religious or moral objections.
During Monday’s Senate vote, one of the bill’s Republican sponsors, state Sen. Alan Clark, described gender-affirming treatments as “at best experimental and at worst a serious threat to a child’s welfare.” He argued the bill would “protect children from making mistakes that they will have a very difficult time coming back from.”
“I know that their parents are looking for any kind of answer, and my heart truly goes out to them,” he said. “But this is certainly not the answer.”
But major medical organizations including the American Academy of Pediatrics and the Endocrine Society have supported access to treatments such as puberty blockers and hormone treatments for children diagnosed with gender dysphoria, defined as the distress caused by a mismatch between one’s sex assigned at birth and one’s gender identity.
Many pediatricians and endocrinologists say these bills are rooted in misinformation about transgender medical treatments. Under medical guidelines in the United States, doctors do not perform most gender-affirming surgeries on transgender minors, requiring that they wait until they are 18. Doctors do not recommend any medical interventions before a child reaches puberty.
Once reaching puberty, medical guidelines say transgender children can consider puberty blockers, which are reversible treatments that pause puberty and give transgender children time to decide what to do next. Later in their teenage years, transgender adolescents can consider hormone replacement therapies, such as estrogen for trans girls and testosterone for trans boys, which create more permanent changes to their bodies.
Research on these medications is limited, due in part to the nascent nature of the treatments, the challenges of performing studies on children, and the small size of the transgender youth population. But several studies on puberty blockers have found that transgender young people who were treated with the medications showed lower rates of depression and anxiety and demonstrated better global functioning. A study from the Harvard Medical School and the Fenway Institute published in the journal Pediatrics last year showed that young people who wanted a puberty suppressant and were able to access it had lower odds of considering suicide.
Lee Beers, president of the American Academy of Pediatrics, spoke in opposition to the Arkansas bill in a news conference before Monday’s vote, describing it as “discrimination by legislation.” She pointed out the high rates of suicide for transgender youth, mental health concerns that have been exacerbated in the pandemic. A survey conducted online among a non-random volunteer sample of 27,715 transgender people found that 40 percent of respondents had attempted suicide in their lifetimes, eight times the rate of the general population.
“This bill is harmful in two ways,” Beers said. “One, it threatens the health and well-being of transgender youth, and two, it puts politicians rather than pediatricians in charge of a child’s medical care.”
Under the legislation, titled the Save Adolescents from Experimentation (SAFE) Act, the state would prohibit public funds from being granted to organizations or entities that provide gender-affirming procedures to people under 18. It would ban state-owned facilities from providing transition-related care and would prohibit Arkansas’s Medicaid program from reimbursing or providing coverage for gender-affirming care to people under 18. If the bill is signed into law, doctors who provide gender-affirming care to minors would be subject to losing their licenses.
In a Senate committee hearing last week, one of the bill’s Republican sponsors, state Rep. Robin Lundstrum, compared gender-affirming treatments to surgical and chemical “mutilation,” and said children should not be allowed to make such decisions before they turn 18.
“This is about protecting minors,” she said. “Many of you, I would hazard to guess, did things under 18 that you probably shouldn’t have done … why would we ever even consider allowing a sex change for a minor?”
But parents of transgender young people in Arkansas and across the country have described treatments such as puberty blockers and hormone therapies as lifesaving medications for their children.
Joanna Brandt, the mother of a transgender 15-year-old in Arkansas, said allowing her child to undergo hormone therapy was a choice she did not make lightly. After her son, Dylan, came out as a transgender boy, she took him to many therapy appointments and doctor’s visits. And after extensive research and consultation with medical professionals, she decided to allow him to begin the hormone treatment. Now, 18 months later, “Dylan is happy, healthy, confident and hopeful for his future,” Brandt said in a news conference Monday. “His outside now matches how he feels on the inside.”
Losing access to these treatments “would be heartbreaking not only for him but for all of the other trans youth in Arkansas that depend on this care,” Brandt said. While the bill’s sponsors have said mental health therapy would still be allowed under the legislation, Brandt said that “therapy alone is not enough for these kids.”
“No amount of therapy will help them when they realize that the government that seems to oppose their existence is now in control of their bodies,” Brandt said.
Evelyn Rios Stafford, a county justice of the peace and Arkansas’s only openly transgender elected official, described the legislation as “a national embarrassment for Arkansas.”
“I’m hearing from trans people who are wondering whether they need to move out of the state,” she said.
But if the bill is signed into law, lawyers with the American Civil Liberties Union have vowed to challenge it in court.
“It violates the Constitution. It singles out a group of young people solely because you do not understand them and because you find them to be politically unpopular,” said Chase Strangio, deputy director for transgender justice at the ACLU. “The litigation will be costly and it will painful for the young people who have to endure it. But we will be standing with them … and we will take this to court as soon as we have to and as fast as we have to.”