In 25 states, transgender people under the age of 18 face laws that prevent them from accessing gender-affirming health care. Just a few years ago, no state had such a law.
The Supreme Court has agreed to consider a Tennessee case in its next session that challenges that state’s ban on rehabilitative care for youth.
“The pressure has been building for the Supreme Court to rule on this issue,” says Lindsey Dawson, director of LGBTQ health policy at the health research organization KFF.
Most of the state bans have been challenged in court, Dawson notes, and 20 of them are currently in effect. “We’ve seen split decisions in the appeals courts, which is always a sign that an issue could end up in the Supreme Court.”
The details of state bans vary, but laws generally prohibit transgender minors from accessing puberty blockers, hormones, and surgery (which is very rare for minors).
In the program
Oral arguments in the Supreme Court case will take place in the fall. U.S. Solicitor General Elizabeth Prelogar will defend transgender rights in Tennessee before the justices. Republican Tennessee Attorney General Jonathan Skrmetti will defend the law.
Bans on gender-affirming care across the country “create profound uncertainty for transgender adolescents and their families across the country — and inflict particularly serious harm in Tennessee and other states where the laws have been allowed to take effect,” Prelogar’s request for the justices to take up the case reads.
Skrmetti wrote in a statement: “We fought hard to defend Tennessee’s law protecting children from irreversible gender-based discrimination. I look forward to finishing the fight in the U.S. Supreme Court. This case will provide much-needed clarity on whether the Constitution contains special protections for gender identity.”
What sparked all these new laws restricting gender-affirming care? “I can’t point to any specific external event,” Dawson says. “But it’s almost like these policies caught on like wildfire: Once a handful of states adopted them, more states followed.”
Conservative groups like the Alliance Defending Freedom and the Heritage Foundation have encouraged state lawmakers to address the issue. “The experimental gender transition procedures being forced on our children are often irreversible,” ADF’s Matt Sharp wrote last year. “And not only are these drugs and procedures dangerous, they are also experimental and unproven.” ADF did not respond to NPR’s request for comment for this story.
The American Principles Project calls the bans “an effort to curb the predatory transgender industry,” President Terry Schilling wrote in a statement this week. The American Principles Project did not respond to multiple requests for comment from NPR for this story.
‘Nothing has changed’
Those claims, and the speed with which lawmakers acted on them, baffle Dr. Kade Goepferd, chief education officer and medical director of the Gender Health program at Children’s Minnesota. Goepferd has been providing the same type of care to gender-diverse children for 20 years.
“We haven’t taken a new approach to care. We’re not using new drugs. There haven’t been any groundbreaking research studies. Nothing has changed,” they say. “Instead, care has become more standardized and more guideline-based.”
All major U.S. medical organizations, including the American Medical Association, the American Academy of Pediatrics, the Endocrine Society, and the American Psychological Association, support gender-affirming care as safe and necessary.
Erin Reed, a journalist and transgender activist, has been closely following these laws as they have moved through state legislatures.
“I’ve watched thousands of hours of legislative hearings on this topic. There’s probably no other topic that’s getting as much legislative time in the United States right now in state legislatures across the country,” she says. “Legislation targeting queer and trans people seems to come in waves throughout American history. This is not an isolated incident.”
Nor does it come from a groundswell of public concern, she says: “Despite what people personally feel about transgender care, they don’t want lawmakers to spend time on it.”
She cites a NORC-LA Times poll released in June, which found that 77 percent of Americans agreed with this statement: “Elected officials are primarily using debates about transgender and nonbinary people to distract from more pressing priorities.”
There is also a religious aspect to these laws. “When God created us, he created us male and female, and that’s it, there’s no other choice,” South Carolina Republican House Majority Leader Davey Hiott told reporters in January. “We have to stand up to all these people who want to change that from birth or throughout their lives.”
In May, South Carolina became the 25th state to enact a ban on gender-affirming care for young people.
Traveling for treatment
Dawson points out that the laws target the use of various medical interventions, not the interventions themselves, so she questions arguments that medications or hormone treatments are unsafe.
“There are exceptions for young people who need to access these services – the same services that are prohibited – for health care purposes that are not related to gender affirmation,” Dawson notes. Nearly all of the restrictions include penalties for health care providers; several target parents, teachers and counselors.
For Goepferd’s clinic in Minnesota, lockdowns in neighboring states have led to a roughly 30% increase in patient calls.
“Even though we’ve added medical and mental health staff to try to keep up, our waiting list is still over a year long,” they say, which is a long time when it comes to puberty.
Patients traveling to Minnesota every three months from other states are a logistical nightmare and complicate insurance coverage, Goepferd adds. “We’re really set up to take care of Minnesotans, but not really set up to take care of the entire Midwest.”
Health care laws aren’t just about transgender people, says Kellan Baker, executive director of the Whitman Walker Institute, an LGBTQ rights research and advocacy group. “New restrictions are being proposed and passed every day on how transgender people can move through the world, not just in terms of access to health care, but also, for example, in terms of going to school or playing on a sports team,” he says.
Baker said state lawmakers who are passing these laws are “targeting children to score political points and taking advantage of the fact that many people may not know a transgender person,” he said. “There aren’t that many transgender people — the best estimates we have are that about 0.6 percent of the U.S. population identifies as transgender.”
