States Wage Battle to Ban Treatments for Transgender Youth

A number of states are pushing for laws that would criminalize treating transgender minors with gender-affirming medical care.

The latest bill, South Dakota’s HB 1057, would have imposed a one-year jail sentence and a fine of up to $2,000 for those who provide gender-transitioning medical treatments for youth under 16 years old. The bill passed the state’s House 46-23, but its Senate killed it last month, at least for now.

Similar bills have been filed in at least eight other states including Colorado, Florida, Illinois, Kentucky, Missouri, Oklahoma, South Carolina, and West Virginia. Lawmakers in two more states, Texas and Georgia, have vowed to introduce similar bills. All seek to ban gender-transitioning treatments including puberty blockers, hormone therapy, and genital surgery for youth under 16 or, in some states, youth under 18.

“This legislation is an example of politics getting in the way of clinical care,” said Jack Drescher, M.D., who co-wrote APA’s 2012 and 2018 position statements on transgender individuals’ access to care. He is a clinical professor of psychiatry at Columbia University and served on the DSM-5 Work Group on Sexual and Gender Identity Disorders. “These decisions are not being made out of medical necessity, but to placate a political base that doesn’t understand the clinical issues involved.

“This kind of interference with the treatment of transgender youth could be actually life threatening. For some children, puberty blockers can be a life-saving treatment because the onset of puberty can bring on suicidality and panic attacks.”

In fact, transgender youth are among those with the highest risk for suicide compared with their peers. The National Transgender Discrimination Survey found that 41% of transgender respondents attempted suicide, compared with 1.6% of their cisgender peers. Mounting evidence suggests that pubertal suppression for transgender adolescents who want this treatment is associated with improved mental health outcomes.

A study of nearly 21,000 transgender young adults in last month’s Pediatrics found that those treated with puberty blockers were one-third less likely to have lifetime suicidal ideation, compared with those who wanted pubertal suppression but did not receive it. However, researchers found that just 2.5% of transgender individuals who wanted puberty blockers received this treatment.

When called for, puberty blockers are typically administered at around age 10 or 11 and are fully reversible, according to the Endocrine Society’s evidence-based practice guideline. The medicines have been used safely for decades in children with other medical conditions, including precocious puberty (puberty that begins before age 8 or 9).

Blocking pubertal hormones delays the development of irreversible secondary sex characteristics such as facial hair and Adam’s apple in males or breast growth in females. The medications give children with gender incongruence more time to explore their options.

Drescher said for some individuals with gender dysphoria, it resolves by age 14 or so, in which case their puberty blockers can be removed, allowing puberty to begin. For those with persistent gender dysphoria, use of puberty blockers results in less need for gender-conforming medical intervention later, he added.

An 18-month public custody battle in Texas courts over which parent should receive custody of a 7-year-old with gender dysphoria ignited the nationwide debate over youth transgender treatments. In that case the mother respected the child’s gender identity, allowing her to live as a girl; the father disagreed and allegedly shaved the child’s head, trying to force her to live as a boy. The parents were eventually awarded joint custody.

Drescher has another theory as to why this issue has arisen. “Since the religious-, social-, and gender-conservative movement lost the gay marriage battle, it has now set its sights on members of the transgender community,” he said.

The legislation follows a movement to legally prohibit transgender individuals from using public restrooms consistent with their gender identity and is still being fought in some courts and school districts. “It’s a way of expressing their social disapproval against those whose very existence is offensive to them.” ■

APA’s position statement on access to care for transgender and gender diverse individuals is posted here.

The Pediatrics study is posted here.

The Endocrine Society practice guideline is posted here.