The American Medical Association is urging governors across the country to oppose legislation prohibiting transition-related care for minors, calling such proposals “a dangerous governmental intrusion into the practice of medicine.”
In an open letter Monday to the National Governors Association, the association's CEO, James Madara, cited evidence that trans and nonbinary gender identities “are normal variations of human identity and expression” and said decisions about care belong in the hands of health care providers and families, not lawmakers.
“As with all medical interventions, physicians are guided by their ethical duty to act in the best interest of their patients and must tailor recommendations about specific interventions and the timing of those interventions to each patient’s unique circumstances,” Madara wrote on behalf of the organization’s members. “Such decisions must be sensitive to the child’s clinical situation, nurture the child’s short and long-term development, and balance the need to preserve the child’s opportunity to make important life choices autonomously in the future.”
Citing studies tying gender-affirming care for children to a decrease in anxiety, depression and suicide attempts, Madara said it was inappropriate for any state to limit options for physicians and families.
Earlier this month, Arkansas became the first state to ban transition-related care for transgender minors, when the GOP-controlled state Legislature overrode a veto by Gov. Asa Hutchinson, a Republican. Sponsors of the Save Adolescents From Experimentation (SAFE) Act compare the restriction to other limitations placed on minors.
"They need to get to be 18 before they make those decisions," said state Rep. Robin Lundstrum, a Republican.
At least 14 other states are considering similar legislation, according to the American Civil Liberties Union.
Such efforts “would insert the government into clinical decision-making and force physicians to disregard clinical guidelines,” Madara warned in the letter.
“Transgender children, like all children, have the best chance to thrive when they are supported and can obtain the health care they need,” he continued. “It is imperative that transgender minors be given the opportunity to explore their gender identity under the safe and supportive care of a physician.”
The AMA, which has previously supported insurance coverage for transition-related services and opposed conversion therapy for gender identity or sexual orientation, joins other major health care associations in recognizing the medical necessity of transition-related care, including the American Academy of Pediatrics, the American Psychological Association, the American Academy of Child and Adolescent Psychiatry and the Pediatric Endocrine Society.
Debi Jackson, a Missouri mother of a 13-year-old transgender girl, said she was relieved to hear that the AMA had taken such a public stance.
“Any parent who has worked with a doctor knows this is the best standard of care universally,” Jackson said. “We’ve been praying for letters from these organizations. If anyone can explain why [these bans are] dangerous to lawmakers, it’s health care providers.”
At the same time, she said, “this is not something that should be political in the first place."
"Defending your job and your knowledge is an uncomfortable position to be in," she said, referring to doctors who would face criminal penalties under some of the state proposals.
A bill before the Texas state Senate would define providing gender-affirming care as child abuse, potentially sending parents to prison or removing children from their custody.
In Missouri, state Rep. Suzie Pollock, a Rerpublican, has sponsored a bill that would revoke the license of doctors who prescribed puberty blockers or hormones to minors.
“They can go to all the counseling and dress and change their name and whatever they want to do,” Pollock said, according to The Kansas City Star. “I just don’t want them medically treated with drugs. In what other area do we allow children to make those decisions so young?”
In 2016, Jackson’s trans daughter, Avery, appeared on the cover of National Geographic’s “Gender Revolution” issue. Since then, Jackson said, her family has received support from medical providers across the country.
“We have had multiple doctors in other states reach out and say, ‘I want you to know we will take care of your kids,’" Jackson said. “They’re willing to put their neck out, because they care about these kids. Anyone who is offering transition care to kids is doing it because they really understand and are passionate about making sure these kids are healthy."
Pollock’s bill has stalled in committee, but Jackson said she wouldn’t hesitate to leave Missouri to ensure Avery got the care she needed if it passes. (She is one of several parents who told NBC News they would consider moving if such medical bans passed in their state.)
“Go ahead and charge me with child abuse — I will take care of my daughter,” Jackson said. “I think a lot of politicians think they can intimidate us, but I don’t know a single parent of a trans kid that wouldn’t go to the ends of the earth for them.”