Denying transgender patients best-practice medical care is dangerous and harmful. Yet, state legislators in South Dakota, Florida and South Carolina have introduced legislation that would criminalize medically necessary care for transgender minors.
Gender-affirming care clearly demonstrates positive effects on mental health outcomes and overall psychological well-being, along with decreased suicidality. The proposed bill in South Dakota would make the provision of this lifesaving care a class 1 misdemeanor, threatening doctors with imprisonment. The bill, House Bill 1057, passed in the Statehouse by a vote of 46-23 late Wednesday. It now heads to the state Senate.
And legislators in other states are looking to follow suit. As the medical director at the world's largest suicide prevention and crisis intervention organization for LGBTQ youth, I can tell you that these bills not only contradict reality and majority medical opinion in the United States — they would also put young lives in jeopardy.
At The Trevor Project, we constantly hear from transgender youth in crisis who want nothing more than to be recognized for who they are. Respecting and affirming a young person’s identity is crucial to their health and well-being. Medical organizations have utilized decades of scientific research and on-the-ground experience to shape these evidence-based practices, and each study only adds to a growing consensus. For children who do not identify with their sex assigned at birth, there are well-documented psychological benefits to being allowed to socially transition or to receive appropriate medical care.
The reality is, according to the Centers for Disease Control and Prevention, LGBTQ youth are more than four times more likely to attempt suicide than their peers, and up to 50 percent of all trans people have made a suicide attempt. Our National Survey on LGBTQ Youth Mental Health concluded 54 percent of transgender and nonbinary youth reported seriously considering suicide in the last year, and 29 percent made a suicide attempt.
Bills like the one in South Dakota aren’t just politics as usual. But the scary thing is, they could become the norm. If the South Dakota bill becomes law, we fear it could have a ripple effect. A few years ago, so-called “bathroom bills” swept through state legislatures as conservatives moved to limit transgender access to restrooms and locker rooms. Our concern is that health care for trans youth could become bathroom bills, 2.0.
America’s transgender youth are listening, and harmful public rhetoric and anti-transgender legislation can directly lead youth into crisis. In 2017, The Trevor Project reported that crisis contacts from transgender youth to its suicide prevention lines more than doubled following President Donald Trump’s tweets regarding transgender military service members and the introduction of a “bathroom bill” in the Texas Legislature. An onslaught of new bills aimed at denying medical treatment to transgender youth could prove just as detrimental.
And despite what one might be led to believe by extremist politicians, the primary “intervention” for transgender children involves social transitioning. No 7-year-old is offered hormones, puberty blockers, or surgery. In reality, the American Academy of Pediatrics recommends affirming young transgender children by encouraging them to dress and present themselves in whatever way feels most comfortable to them. A social transition may also include the use of a different name or pronouns.
According to accredited medical organizations like the Endocrine Society, medications may only be offered later if physicians and parents together decide it is helpful to delay puberty and give youths the time to mature and make their own decisions about their bodies. A new study from the journal Pediatrics found that transgender adults who desired puberty blockers as adolescents but did not receive them were more than three times as likely to report lifetime suicidal ideation compared to those who did receive the puberty blockers. When medical providers use these best practices, they are able to offer the highest level of care to their patients through collaboration with patients and their families. Politicians have no role in this intensely personal process.
It is outrageous to force a doctor to risk losing their license — or their freedom — for following professional best practices. This legislation sets a dangerous precedent of not only ignoring but actively contradicting evidence-based medical recommendations. It would also inadvertently hurt parents by restricting their ability to support the health and well-being of their transgender child with the medically necessary care they need. Research tells us transgender youth whose families support their gender identity have a 52 percent decrease in suicidal thoughts, a 48 percent decrease in suicide attempts, and significant increases in self-esteem and general health.
We all agree that our nation’s youth deserve to be protected. In order to thrive, young people should be loved and provided for, with the care and support that they need — not used as political pawns to forward a fear-mongering agenda. We must listen to medical professionals, educate parents and legislators on the health of transgender youth, and correct the misinformation circulating on this issue. Affirming transgender youths saves lives.