Arkansas became the first state in the U.S. Tuesday to prohibit physicians from providing gender-affirming treatment for trans people under age 18. As legislators target the rights of young transgender people — in gender confirming treatments or surgery and participating in sports — Northwestern University experts weigh in how on discrimination impacts young trans people and what gender-affirming medical care looks like for young people.
The experts
TJ Billard is an assistant professor in the School of Communication at Northwestern University, where they are affiliated with the Center for Communication and Public Policy and the Institute for Sexual and Gender Minority Health and Wellbeing. Billard is a leading expert on transgender politics and the media.
Steven Thrasher is the Daniel H. Renberg Chair of social justice in reporting at Medill School of Journalism, Media, Integrated Marketing Communications and is an assistant professor of journalism and core faculty member of the Institute of Sexual and Gender Minority Health and Wellbeing at Northwestern University.
Lauren Beach is a research assistant professor of medical social sciences and a researcher at the Institute for Sexual and Gender Minority Research and Wellbeing at Northwestern University Feinberg School of Medicine. She investigates the epidemiology of chronic physical health conditions over the life course among diverse sexual and gender minority populations.
Dr. Raina Voss is an assistant professor of pediatrics at Northwestern University Feinberg School of Medicine and an attending physician at Ann and Robert H. Lurie Children’s Hospital of Chicago.
What will be the effect of the new Arkansas legislation prohibiting physicians from providing gender-affirming treatment for trans people under age 18?
TJ Billard: “What is happening in Arkansas is merely the latest instance of conservatives weaponizing health misinformation against transgender communities to justify discrimination. Arkansas legislators called their bill the Save Adolescents from Experimentation Act, but the fact is gender-affirming care for transgender youth is safe and it is necessary. And outlawing that care will cost trans lives. Doctors know this. Trans people know this. Arkansas legislators know this. But conservatives exploit public unawareness of the intricacies of transgender medical care, peddle misinformation and then use that misinformation to justify prejudicial legislation.”
Steven Thrasher: "The passage of the anti-trans law in Arkansas by way of legislative override is heart breaking, and it will cause various forms of harm. It is dangerous for trans youth in Arkansas — especially those who may have already begun gender-affirming treatment which is now illegal — and it is dangerous for anyone who depends upon making intimate, important decisions about health with their health care provider, without a state legislature stepping in.
“At the same time, it is significant that Republican Gov. Asa Hutchinson did veto the legislation and attempt to stop it. While the imminent harm to the trans youth of Arkansas is immediate, Hutchinson's reasoning was sound, and mirrored what many of my colleagues and I have found in our research: that denying trans care will cause harm; that pushing people in supervised medical treatment will result in patients seeking unsupervised ‘street’ treatment, which will increase risk of exposure to viruses like HIV and Hepatitis C.”
How does the umbrella of discrimination psychologically impact young transgender people?
Beach: “Stigma and discrimination are toxic for the health of transgender youth. Studies have shown that misgendering is associated with increased levels of mental distress and suicidality among transgender youth. When transgender youth are referred to by their correct pronouns, however, this increased risk of suicidality drops dramatically.”
Voss: “Trans youth experience rejection and victimization from all sides. They experience family rejection, bullying at school and increased rates of sexual violence. We talk to kids and families regularly in the clinic about the impact of policies telling them that their identities are wrong. These policies and messages ask them to doubt the validity of their own identities, which takes a toll on their overall wellbeing and their mental health in particular.
“Implementation of laws that outlaw the medical treatment of gender dysphoria is a way of telling transgender youth that they are not worthy of being helped or cared for, and that they are not believed. This is a form of systemic invalidation. And of course, many are scared that these policies will soon extend to their own state, which is extremely anxiety provoking.”
How will the policies related to sports participation affect transgender youth?
Voss: “Trans youth already don’t participate in as much physical activity as cisgender youth. There are a number of reasons – uniforms that don’t feel right on their bodies, limited access to locker rooms where they are comfortable and/or welcome. Adding to that the idea that they are not welcome on a sports team is discrimination and will close doors for trans youth to feel included, physically healthy and part of a community.
“There is almost no strong research looking at the athletic differences of transgender youth and cisgender youth. An effort to make policies based on no evidence is truly transphobic discrimination.”
What does gender-affirming medical care looks like for young people?
Beach: “Gender-affirming medical care for transgender youth looks like health systems that have invested in making sure every clinical and non-clinical employee has been trained to use the correct name and pronouns for transgender youth. It also looks like ensuring all clinical providers are trained to provide affirming care to their transgender patients.
“Whether going to the emergency room for a broken arm, to a primary care visit for asthma or to a medication management visit for puberty blockers or gender-affirming hormones, transgender youth need access to affirming health systems and care teams.”
Voss: “One key thing is helping youth address the distress they experience due to their bodies (and how others perceive their bodies) and not feeling comfortable due to gender dysphoria. That may mean suppressing the unwanted changes of pubertal development, which can bring young people relief and help them to be perceived by others as their affirmed gender. It may mean use of hormone therapy or surgical care to help address areas of deep distress and allow young people to transition or experience their body in the way that feels most consistent with their gender identity.”
“It’s also important to connect youth to a mental health provider as they make decisions about medical interventions. General health care needs to feels safe, affirming and understanding.”
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