New Report Examines Bans on Medical Care for Transgender Youth

(April 28, 2021) - Today the Movement Advancement Project (MAP) released a new policy spotlight report, Efforts to Ban Health Care for Transgender Youth. In 2021 alone, legislatures in 22 states have introduced bills to ban best practice medical care for transgender young people with one state, Arkansas, passing such a bill into law.

This new report provides an overview of the legislative environment across the country and the harmful impacts these bills could have on transgender youth. The report also includes a summary of the best practice medical care for transgender youth that is recommended by leading medical organizations including the American Medical Association and the American Academy of Pediatrics.

Resources for journalists:

• MAP Report: Efforts to Ban Health Care for Transgender Youth
• Report Infographics
• Equality Map on Medical Care Bans

"Bills banning best practice medical care for transgender youth represent one of the most extreme and coordinated political attacks on transgender people in recent memory," said Logan Casey, senior policy researcher at MAP. "Transgender kids, like any child, have the best chance to thrive when they're supported and have access to the health care they need. Ultimately, medical decisions are best left to patients, their families, and their health care providers, in accordance with medical best practices. Politicians shouldn't interfere in these decisions."

Nearly Half of States Have Considered Harmful Legislation Banning Medical Care for Transgender Youth

In 2021, at least 22 states have introduced such legislation, with several states considering multiple bills with a range of harmful impacts. These bills reflect a new and coordinated effort to specifically target transgender youth's access to best practice medical care. This new policy spotlight report emphasizes that prior to 2020, no state had introduced this type of legislation. The report outlines these and other legislative developments:

• In April 2021, Arkansas became the first state in the nation to enact this type of law, with the legislature overriding a veto by the Republican governor.
• Bills in at least 13 states would create criminal penalties for medical professionals who provide health care to transgender youth, even though this care adheres to guidance from leading medical organizations and is based on rigorous research.
• Other consequences for healthcare providers include revoking medical licenses, charging steep fines, and allowing individuals to sue them for providing this health care.
• Under bills in at least seven states, parents could face criminal charges of child abuse or other consequences for helping their child access best practice medical care.

Legislation Seeks to Undermine Best Practice Medical Care

This new report emphasizes the extent to which these legislative efforts undermine best practice medical care for transgender youth. These bills display a fundamental lack of understanding about transgender children, as well as a lack of understanding about lifesaving, best practice medical care for transgender youth. This health care is supported and recommended by every major medical association in the United States, including the American Academy of Pediatrics, American Medical Association, American Psychological Association, Endocrine Society, American College of Obstetricians and Gynecologists, and World Professional Association for Transgender Health.

For transgender youth, the widely endorsed and research-backed method known as the "gender-affirmative care model" refers to a set of best practices and recommendations for medical providers, parents, and caregivers of transgender youth. These recommendations focus on creating a safe and affirming environment for youth to express and understand their own gender. This can include, for example, wearing different clothes or hair styles. For those youth who, over time, are "insistent, consistent, and persistent" about their gender identity, the affirming model of medical care can include beginning to live consistently as the gender they know themselves to be.

As they reach adolescence, some transgender youth-in consultation with their doctor and family-may choose to take medication that temporarily delays puberty. This medication is safe and simply pauses puberty. If a young person decides to stop taking this medication, puberty will resume and there is no impact on their future ability to have children. This medication is important for many reasons, including that it effectively buys time for transgender adolescents to gain a deeper understanding of who they are and to allow them to wait to make further decisions until they are older. However, these bills aim to take these choices away from transgender youth, even despite the clear harms that come from denying best practice care.

Harmful Impacts of Banning Medical Care for Transgender Youth

MAP's new policy spotlight report also compiles existing research about the extent of harm from banning best practice medical care for transgender people. According to the Williams Institute, an estimated 64,700 transgender youth (ages 13-17) live in the states considering this type of legislation in 2021 and thus are at risk of losing access to critical, often life-saving medical care. Additionally, when transgender youth are unable to access medically necessary care, there are concrete harms. For example:

• Research published in Pediatrics found that transgender people who received puberty delaying medical care during their youth were significantly less likely to have suicidal thoughts and behaviors, compared to transgender people who wanted this medication but did not receive it. This is true regardless of support from family.
• Denying best practice medical care and support to transgender youth can be life-threatening. This contributes to depression, social isolation, risk of self-harm, and suicidal behavior, among other negative impacts. Specifically, transgender youth whose families support their gender identity have a 52% decrease in suicidal thoughts, a 46% decrease in suicide attempts, and significant increases in self-esteem and general health.

MAP maintains LGBTQ Equality Maps that track these healthcare bans, but also nearly 40 other state laws and policies. These maps are updated in real-time and can be accessed here: lgbtmap.org/equality-maps

About MAP: MAP's mission is to provide independent and rigorous research, insight and communications that help speed equality and opportunity for all. MAP works to ensure that all people have a fair chance to pursue health and happiness, earn a living, take care of the ones they love, be safe in their communities, and participate in civic life. www.lgbtmap.org