Patient Management > Prescribing
By Jules Murtha | Fact-checked by Barbara Bekiesz
Published August 26, 2022, MEDLinx
By Jules Murtha | Medically reviewed by Kristen Fuller, MD
Updated August 24, 2022 MDLinx
A wave of federal and state legislation that bans or criminalizes gender-affirming services for transgender youth has spilled over into the exam room, leaving doctors to wonder how to care for these patients without landing in hot water—or even prison.
Their fear is real.
On Aug. 19, Rep. Marjorie Taylor Green (R-Ga) introduced a bill that would make it a class C felony to provide gender-affirming medical care such as puberty blockers or gender confirmation surgery to trans youth—punishable by up to 25 years in prison. She referred to this type of care as “child abuse.”
A number of states including Texas, Alabama, Arkansas, and Arizona, recently enacted laws or policies restricting youth access to gender-affirming care and, in some cases, imposing harsh penalties on doctors and parents who facilitate access (several of these laws have been temporarily blocked by court rulings). Similar policies have been proposed in dozens of other states.
Restrictions like these may contribute to the mental health issues so many trans kids are experiencing, according to many medical experts, trans youth advocates, and many of the nation's most prominent medical societies, including the AMA, APA, AAP, and others.
Mental illness among trans and questioning youthIt's becoming increasingly common for children to openly express gender identities that are incompatible with their assigned gender at birth—to come out as transgender.
Being transgender does not make one mentally ill, the Cleveland Clinic noted. But transgender individuals face unique challenges like discrimination, bullying, and gender dysphoria, which can set the stage for mental illness or suicidal thoughts.
In 2021, 52% of transgender and non-binary youth reportedly considered taking their own lives, according to the Trevor Project’s 2022 national survey on LGBTQ+ youth mental health.
Moreover, 60% of LGBTQ+ kids weren’t able to attain the mental healthcare they wanted, and less than one-third of trans children reported living in gender-affirming homes.
Trans youth have struggled to attain quality healthcare for years. A study published by Pediatrics stated that 62.1% of trans and gender-nonconforming students reported having “poor,” “fair,” or “good” health, as opposed to “very good” or “excellent health.”
Only 33.1% of cisgender youth showed similar results (cisgender refers to individuals whose gender identity aligns with the sex they were assigned at birth).
While clinicians agree that further studies and a wider range of treatment options are needed to better support transgender youth, they are concerned that politicization of this issue harms trans youth and medical professionals.
Response from major medical associationsIn the heat of this controversy, a wide consensus is growing among major medical associations, which are speaking out against efforts to ban or make it a crime to provide these services.
The AMA, the APA, the AAP, the American Academy of Child and Adolescent Psychiatry, the American Psychological Association and the Endocrine Society, among others, have issued public statements that recognize the medical necessity of gender-affirming care for youth and outline the negative impacts of denying access to these services. They also decry the intrusion of government into medical practice.
“Evidence has demonstrated that forgoing gender-affirming care can have tragic consequences,” the AMA wrote in an April 2021 letter to the National Governors Association.
“Transgender individuals are up to three times more likely than the general population to report or be diagnosed with mental health disorders, with as many as 41.5 percent reporting at least one diagnosis of a mental health or substance use disorder,” the letter said, pointing to stigma and discrimination as linked causes.
“Because of this stress, transgender minors also face a significantly heightened risk of suicide.”
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