An incarcerated transgender man filed a complaint Wednesday against the Virginia Department of Corrections, or VADOC, for denying him surgery and other treatment for gender dysphoria, according to court documents shared with NBC News.
The lawsuit, brought by Lambda Legal, a legal organization that focuses on LGBTQ rights, is among the first filed by an incarcerated transgender man for denial of treatment for gender dysphoria. A number of lawsuits have been filed — and some won — by trans women inmates in recent years.
The plaintiff, Jason Yoakam, was convicted of first-degree murder in 2004 and has since been incarcerated at the Fluvanna Correctional Center for Women in Troy, Virginia. In 2017, VADOC medical providers diagnosed Yoakam with gender dysphoria, which refers to the psychological distress that results from an incongruence between one’s sex assigned at birth and one’s gender identity, according to the American Psychiatric Association.
Despite that diagnosis, medical providers have refused to provide Yoakam with treatment, including mental health services from qualified providers and a bilateral double mastectomy, or surgical removal of the breasts, according to the complaint, which was filed in the U.S. District Court for the Western District of Virginia. Yoakam’s doctors and a transgender health care specialist requested the treatment, the complaint states.
“The only thing I am asking is to be treated fairly and have access to the same standard of healthcare that other incarcerated people receive,” Yoakam said in a statement. “It has been traumatizing, isolating, and stigmatizing to be denied health care services to treat the gender dysphoria that VDOC’s own providers have diagnosed.”
Lambda Legal argues that denying Yoakam surgery and other treatment for gender dysphoria violates the Eighth Amendment’s prohibition on cruel and unusual punishment and the equal protection clause of the 14th Amendment.
Yoakam is also making statutory claims under the Americans With Disabilities Act, due to his gender dysphoria diagnosis; Section 504 of the Rehabilitation Act, which forbids organizations and employers from denying benefits and services to people with disabilities; and Section 1557 of the Affordable Care Act, which prohibits discrimination in federally funded health care facilities.
The complaint lists 10 defendants, including Harold Clarke, director of the Corrections Department; Mariea LeFevers, warden of the Fluvanna Correctional Center for Women; and other mental health providers for the department.
The defendants didn’t immediately respond to NBC News’ request for comment.
Yoakam’s complaint says that from an early age, he “saw himself as a boy and could not understand why people would see him as a girl.” He also lived as a man and was out to his family, friends and co-workers before his incarceration.
In 2017, after he was diagnosed with gender dysphoria by VADOC medical providers, staff at the Fluvanna Correctional Center for Women provided him with a chest binder so he could compress his chest as treatment for his gender dysphoria, and he began hormone therapy, according to the complaint.
“Since he was issued a binder in FCCW, Mr. Yoakam keeps his binder on throughout all hours of the day, except when he must shower,” the complaint states. “He sleeps in his binder. As noted in his medical records, the binder sometimes is so tight that it cuts into Mr. Yoakam’s skin and causes him to bleed. He has also developed scars, rashes, and acne from the binder. These injuries have also led to infections from the binder. Unless he receives chest surgery, Mr. Yoakam will have to continue to use the binder and suffer the resulting injuries.”
The 5-Year Longitudinal Study is First to Examine Post-Surgical Psychosocial Adjustment, Quality of Life and Long-Term Physical and Emotional Wellbeing of Transgender and Non-Binary Patients.
A lot has been said to condemn transgender surgical procedures, often using a couple of subjects who suffered adverse effects. These people are routinely paraded out when republicans introduce anti-trans legislation as ‘witnesses’ in an effort to criminalize transgender healthcare.
The problem being is that there hasn’t been a long-term study in the US to address the overall success or failure of the surgery in actual patients until now.
The Visiting Nurse Service of New York (VNSNY) Center for Home Care Policy & Research has been awarded a $3.4M grant by the National Institute of Nursing Research (NINR) / National Institutes of Health (NIH) to study the psychosocial well-being and quality of life of individuals after gender-affirming surgery. The landmark study will address a significant gap in the current evidence on best practices to support gender minority individuals during a pivotal life course transition.
The VNSNY Research study will be collaboratively co-led by Miriam Ryvicker, PhD., Senior Research Scientist with the VNSNY Center for Home Care Policy & Research and Walter Bockting, PhD., Director of the Program for the Study of LGBT Health at the Columbia University School of Nursing and the New York State Psychiatric Institute / Columbia Psychiatry.
“This funding helps to strengthen the evidence base for improving healthcare access, outcomes and quality of life and mitigating pervasive disparities affecting this population,” said Miriam Ryvicker.
“Fortunately, in recent years, access to gender-affirming surgery has improved considerably in the United States. This study will examine the impact of surgery on the lives of trans and gender nonbinary individuals, and inform the development of post-surgical care and support services,” said Walter Bockting. “Columbia Nursing is proud to partner with the VNSNY on this pioneering effort.”
The goal of this prospective, mixed-method, longitudinal cohort study is to build a rich evidence base on gender identity development and long-term healthcare needs by examining post-surgical changes in quality of life and relationships with healthcare providers among transgender and non-binary individuals who have had a gender-affirming surgery.
THE CONVERSATION — Transgender people continue to be the focus of political culture wars in the U.S. In the spring of 2021, lawmakers in many states sought to limit or ban transgender youth from accessing gender-affirming care. The laws proposed — and in some cases passed — were written to have a direct effect on transgender people’s ability to access physical and mental health care.
For many people, the medical options available to transgender people may seem foreign or new – unless you know someone who is transgender, you may not know about this type of care. So to better understand who is getting this care and the evidence that supports it, in recent months, The Conversation reached out to three experts who work with and study transgender youth medicine. Here is a roundup of what these experts had to say.
1. Medical options available to transgender youth
The first question we sought to answer was: What does medical care look like for transgender youth?
To answer this, we contacted Mandy Coles, a clinical associate professor of pediatrics and co-director of the Child and Adolescent Trans/Gender Center for Health at Boston University and Boston Medical Center. When young people want to see a doctor and have questions about their gender, they go to someone like Coles.
In her article, Coles explains that medical care for transgender youth who suffer from gender dysphoria — when a person’s gender identity does not match the sex assigned at birth – is much more than just hormones or surgery. Social support can have as big an impact on health as physical interventions and “an important first step is to help parents become allies and advocates,” says Coles.
But, for many of her patients, physical interventions – including puberty blockers, hormone treatments or surgery – are the best way they can align their physical bodies with their gender identity. For transgender people seeking care who haven’t started puberty or are still in its early stages, puberty blockers are often an initial treatment. As Coles explains, “These medications work like a pause button on the physical changes caused by puberty. They are well studied, safe and completely reversible.”
Puberty blockers are only one option available to transgender youth before other, more serious interventions. Taking testosterone, estrogen or other drugs can produce changes in a person’s body that help them look more masculine, feminine or nonbinary – whichever it is the person wants. Every patient is different and “my colleagues and I personalize their treatments to meet their specific need,” says Coles.
Surgery is the most permanent treatment available. It comes with risks and lies at the center of much of the political fighting around transgender care, but as one patient told Coles, gender-affirming care “literally saved my life. I was free from dysphoria.”
2. Younger people are seeking care earlier
With an explanation of what kind of medical care exists, the next question is: Who is getting this care and when?
If you have the sense that young people today are more likely to transition than, say, 20 years ago, in a sense you would be correct. But it is a bit more complicated than simply saying more young people are transgender than older people, says Jae A. Puckett.
Puckett, an assistant professor of psychology at Michigan State University, recently surveyed nearly 700 trans people and published a paper exploring generational differences in when and how fast people reach milestones of their transgender identity and how this relates to mental health. Milestones include identifying as trans, living in an affirmed gender some or all the time and, for some, accessing trans medical care.
Puckett wrote a story for The Conversation that explains that younger generations are more diverse in gender than older generations. Nearly a quarter of Gen Z participants “identified as nonbinary, whereas only 7.4% of boomers identified this way,” Puckett writes. Another interesting generational difference is the age at which people began to pass through the milestones of coming out. On average, people in every generation realized they “felt different” at around 10 to 13 years old. But “boomers reported reaching the other major milestones later than younger groups,” Puckett explains. “For example, boomers were, on average, around age 50 when they were living in their affirmed gender all the time. In contrast, Gen X was 34, millennials were 22 and Gen Z was 17.”
Better access to medical care and greater social acceptance today, compared with the past, might be one reason for this disparity, they write.
Puckett sees a similar trend in how fast people made transitions. “Gen Z and millennials also reported much shorter gaps between reaching milestones. For instance, the boomers group reported an average 24-year delay between starting to identify as trans and living in their affirmed gender. There was just a two- and three-year gap for Gen Z and millennials, respectively.”
3. Uncertainty in care
This increase in young people seeking transgender care means more doctors are being asked to provide it. At the bottom of the political and legal fight across the U.S. around transgender medicine, a fundamental – and often avoided – medical question remains: Does this care work?
stef m. shuster is an assistant professor of sociology at Michigan State University. They recently wrote a book exploring the emergence of trans medicine over the last century and how it is practiced today. In an article for The Conversation, they explain how the contentious social and political fights over transgender care are drowning out much needed nuance in research as well as the care transgender people receive.
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“Blocking people from accessing gender-affirming care creates increased risks for social isolation, suicide ideation and depression,” writes shuster. But they also explain that “little scientific evidence exists to support the use of current trans medical treatments, therapy or decision-making that meets evidence-based standards.”
The key phrase there is “evidence-based standards.” One of the reasons for this lack of evidence that care works is pretty simple, according to shuster. “Randomized controlled trials have been implausible, given that only 0.6% of the population identifies as trans or nonbinary.” This isn’t to say that doctors are flying blind. As Mandy Coles explains, there is a good and ever-growing amount of evidence gathered in other ways to support many types of interventions. But compared with other medical interventions, guidance is murky, says shuster. As they put it: “How might someone who is trained to manage illness and disease ‘treat’ someone’s gender identity, which is neither an illness nor a disease?”
This lack of clear clinical guidelines is compounded by a lack of training. A study in 2016 found that most medical providers only get one day of training on transgender issues. All this adds up to medical providers feeling a lot of uncertainty in the care they give, shuster found in their research.
So what happens next? shuster acknowledges that some portion of the concerns voiced by lawmakers are legitimate. But bans on transgender medical care or polarizing political fights aren’t going to help people that currently experience very high rates of depression, anxiety, self-harm and suicide. The way forward, shuster argues, is through more funding for studies on transgender care and more training for medical providers that are facing complicated situations.
Secretary Denis McDonough is expected to announce that transgender veterans will be offered gender confirmation surgery for the first time according to the Military Times.
“[This is ] allowing transgender vets to go through the full gender confirmation process with VA by their side,” McDonough said in prepared remarks for an event at the Orlando VA Healthcare System in Florida. “We’re making these changes not only because they are the right thing to do, but because they can save lives.”
The National Center for Transgender Equality estimates there are more than 134,000 transgender veterans in America today, and another 15,000 transgender individuals serving in the armed forces.
VA officials estimate that around 4,000 veterans nationwide will be interested in the surgeries. Total cost of the program is not yet known. The department also could not say when surgeries will be available, since officials must first go through a formal rule change process.
McDonough said making the change “will require changing VA’s regulations and establishing policy that will ensure the equitable treatment and safety” of transgender veterans.
“There are several steps to take, which will take time. But we are moving ahead, methodically, because we want this important change in policy to be implemented in a manner that has been thoroughly considered to ensure that the services made available to veterans meet VA’s rigorous standards for quality health care.”
In a statement, House Veterans’ Affairs Committee Chairman Mark Takano, D-Calif. and the first openly gay minority individual elected to Congress hailed the move.
“Veterans in need of gender confirmation surgery should not have to seek healthcare outside of the VA health system or navigate complicated processes to get the care they need,” he said. “VA must be inclusive of all veterans who have served, regardless of their identity.”
Senate Veterans Affairs Committee Chairman Jon Tester, D-Mont., similarly praised the expansion of health care offerings for transgender veterans.
“Every service member and veteran deserves equal access to quality care from VA, and this includes our LGBTQ+ veterans,” he said in a statement. “We must reaffirm our commitment to making VA a more welcoming place for everyone who fought to protect our freedoms.”
The GOP is more than ready for a war on vets now that it is clear legislating against trans children is a fail.
House Veterans’ Affairs Committee ranking member Mike Bost, R-Ill., blasted the announcement as the White House trying to win “the culture wars.”
“This announcement clearly has more to do with advancing a radical liberal agenda than serving veterans,” he said. “It is a disgrace. This administration should rethink their priorities immediately.”
“I worry about what might happen to my patients if these bills are passed and worry about going to jail myself.”
Dr. Stephanie Ho, a family medicine physician in Fayetteville, Arkansas, said she’s had state legislators in her exam room before.
Ho, who has provided gender-affirming care to transgender people in the state since 2015, is also an abortion provider, so she is familiar with lawmakers’ restricting the care she provides. She said she wasn’t surprised when the Legislature overrode Gov. Asa Hutchinson’s veto of a bill last month that would ban puberty blockers, hormones and surgery for transgender minors.
“I think that it’s kind of ridiculous that we’ve gotten to the point that we’re letting politicians dictate how health care is delivered and what kind of care can be given to whom,” said Ho, a fellow with Physicians for Reproductive Health.
“I think the last thing I’ve ever wanted, being an abortion provider or somebody who provides gender-affirming care, is to have a politician in the back of my mind in the exam room making me think about ‘Oh, I wonder if I should do this, if it’s OK,’” she said. “They’re essentially trying to practice medicine without a license. And that’s incredibly wrong.”
Arkansas was the first state to pass a ban on transition care for minors. Tennessee Gov. Bill Lee last week signed a similar bill barring prepubertal youths’ access to transition care like hormone therapy. Advocates say no doctors in the state provide hormone therapy for prepubertal youths, The Associated Press reported.
So far this year, state legislatures have considered 35 bills to ban or limit gender-affirming care for trans minors, according to the Human Rights Campaign. Physicians say that the bills negatively affect their patients’ health before they even become law and that they require doctors to go against medical standards of care. Legal experts say the bans could also open providers and hospitals up to lawsuits or put them at risk of losing federal funding.
Ho is trying to support her patients as best she can until Arkansas’ law takes effect this summer.
“It’s just a matter of making sure that my patients know that, whether I can provide them hormones or not, we’re still here for them to support them in any way that we can,” she said. “Of course, I’m going to practice within the bounds of the law, whether I agree with it or not, because me being in jail doesn’t help any of my other patients at all.”Creating ‘contingency plans’
Some physicians, like Dr. Izzy Lowell, who founded a telemedicine practice called QMed in Atlanta in 2017, started planning for the bills months ago.
In April, Alabama’s Senate passed a bill that would have made it a felony for doctors to provide minors with gender-affirming care. The bill died Monday after the House missed the deadline to vote on it. Lowell said that when it first passed, the minor patients she treats in Alabama were scared and frustrated.
“It was clear that the state of Alabama was coming after transgender teens, and we talked about some contingency plans,” she said. “Based on each case, I tried to give them as many refills as possible and told them: ‘Go pick up as much of your medicine as you can. I don’t know when I’ll see you again.’”
Lowell is licensed and practices in 10 states via telemedicine, so she also talked with her legal team and with patients in states considering bans about how her patients could continue care should their states ban it. She said her patients’ parents would have to drive to other states, which would “place an extraordinary burden on these families.”
“If they were, for example, able to get over the border into Tennessee or South Carolina and sit in a parking lot somewhere, I could see them technically with my South Carolina license or Tennessee license or my North Carolina license and perhaps find a local pharmacy there and have them pick up the prescription, but it would be a day’s worth of driving for them to get somewhere where I could see them legally,” she said.
Many minors whose parents don’t have the time or money to drive out of state would be forced to stop transition care if their states passed laws like Arkansas’, which comes with potentially life-threatening health risks, physicians say.
Major medical organizations, including the American Medical Association, the American Academy of Pediatrics, the Endocrine Society and the American Psychological Association, support gender-affirming care for trans youths and oppose efforts to restrict access.
Supporters of the Arkansas bill argue that transition care for minors is “experimental” and that trans minors often change their minds about their genders and detransition later in life. Medical experts say neither of those claims are backed by scientific evidence. On the contrary, research has found that access to gender-affirming care such as puberty blockers reduces the risk of suicide among trans youths.
Ho said the danger is evidenced by what happened when Arkansas’ bill passed through one legislative chamber. Dr. Michele Hutchinson, a physician at the Arkansas Children’s Hospital Gender Spectrum Clinic, testified before the state Senate in March that there were “multiple kids in our emergency room because of an attempted suicide, just in the last week,” after the House passed the bill.
Ho said that “since then, I have had one of my own patients attempt suicide,” adding that she has talked to her patients about what would happen if a judge doesn’t block Arkansas’ law from taking effect. The law also bars her from referring her patients to other physicians who provide gender-affirming care. Unless her patients were able to leave the state, they would be likely to lose access to hormones, so she talked to them about what that would mean.
Lowell said forcing people who were assigned female at birth to stop testosterone would cause them to suffer symptoms of low testosterone, which include inability to concentrate and low energy. “They would start doing badly in school most likely, until their bodies started producing estrogen a few months later, and then they would restart their periods, restart breast growth, and it would undo all of the changes that we tried to achieve with testosterone.”
If people assigned male at birth were forced to stop taking estrogen, it “would be like going through instantaneous menopause,” Lowell said. For about a year, they could have symptoms like hot flashes, night sweats, irritability and mood swings, among other issues, such as negative impacts on emotional well-being.
Doctors worry that minors who already receive and rely on transition care would get hormones illegally if they had to. Dr. Ricardo Correa, a board member of GLMA: Health Professionals Advancing LGBTQ Equality, treats trans veterans in Phoenix, where, he said, trans people have traveled to the border to buy hormones illegally when they can’t get them. He said state bans would worsen the problem.
“It will just create chaos in the system from black markets that are going to start selling this kind of medication in that state,” he said.
Lowell said that hormone therapy is safe when it is monitored by a doctor but that using it without medical supervision could cause health problems, such as liver failure, kidney failure or heart problems.
“There’s very serious consequences of completely unmonitored, sort of black market medication use in this situation,” she said.‘A form of medical malpractice’
Legal experts and advocates say that in addition to having dangerous health impacts, bans on gender-affirming care for transgender youths could expose health care providers to legal and regulatory problems.
Valarie Blake, a law professor at West Virginia University specializing in health care law, said there’s “a pretty strong case” that Arkansas’ law is discriminatory under Section 1557 of the Affordable Care Act, which protects against discrimination based on sex.
The Biden administration announced this month that it would interpret Section 1557 to protect against discrimination based on sexual orientation and gender identity — reversing a Trump-era policy that cut protections for transgender people.
Hospitals and physicians receiving federal funding, such as Medicare and Medicaid payments, are required to comply with laws like Section 1557, Blake said; otherwise, they risk losing the funding.
Arkansas’ law could trigger that risk by allowing physicians and hospitals to prescribe puberty blockers and hormones to cisgender minors for precocious puberty but not transgender teens.
“If the reason that they’re not doing it for transgender teens is because of the fact that they’re transgender, then there’s a very good case that the reason that they’re refusing the treatment is based on the gender identity and not anything else,” Blake said.
“It really puts health care workers in an untenable position when the federal government makes it plain that this is discrimination and has the money to back it up to basically say, ‘We can pull away all of the resources,’ and yet the state persists,” she said.
“We don’t have clear precedent on the books yet to suggest that LGBTQ categories are fully protected in that manner, which is why we’ve been seeing various kinds of Equal Rights Amendment-type laws trying to work their way through Congress,” she said, referring to the Equality Act, a bill that would protect LGBTQ people from discrimination in housing, employment, public accommodations, education and other areas of life.
The bill passed the House in February, but it has stalled in the Senate. “If something like that passes, then suddenly Arkansas as a state is in big trouble,” Blake said.
Lowell said thinking about the potential legal issues “keeps me up at night.” Physicians are required to give patients several months’ warning when they can’t see them anymore and to do their best to find other providers who can see them if they’re unable to.
But laws like Arkansas’ bar physicians from referring patients to other providers for transition care. “In this case, I can’t do any of those things, and I just have to say, ‘Bye,’ and ‘I’m not allowed to see you anymore,’” she said. “That’s patient abandonment, which is a form of malpractice.”
Lowell said that when the first restrictions were introduced several months ago, she felt angry and anxious all the time.
“I worry about what might happen to my patients if these bills are passed and worry about going to jail myself,” she said. “I struggle with the question of what I would do: continue to support my patients and risk going to jail for years or follow these hateful laws? Thankfully, I have not had to answer this question yet, but I will never abandon my patients.”
Criminalization of Gender-Affirming Care — Interfering with Essential Treatment for Transgender Children and Adolescents
Simona Martin, B.S., Elizabeth S. Sandberg, M.D., and Daniel E. Shumer, M.D., M.P.H.
On April 6, 2021, the Arkansas state legislature overrode a veto by the governor to pass legislation making it illegal for medical professionals to provide gender-affirming treatment to patients with gender dysphoria who are younger than 18 or to refer them to other clinicians for such treatment. Several other states have similar legislation pending. As physicians and a physician-in-training who provide gender-affirming care, we are deeply concerned that these political actions threaten the health and well-being of transgender children and adolescents. We have found that such young people are courageous and resilient, yet profoundly vulnerable. Moreover, they already have higher-than-average risk for suicidality and are disproportionately likely to experience violence.
Gender identity — the deeply felt internal sense of oneself as male, female, or somewhere else on the gender spectrum — may or may not align with the sex one was assigned at birth. When it does not align, the umbrella term “transgender” is often used to denote this incongruence. Although not all transgender young people feel distress related to their gender identity, when distress is present and persistent, a mental health professional with experience in gender-identity evaluations may diagnose gender dysphoria.
Gender dysphoria can be treated with both nonmedical and medical interventions. The former may include therapy, coming out to loved ones, or using a chosen name or pronouns and dressing or grooming in a way that matches one’s gender identity (making a social transition); the latter may include hormonal or (when age appropriate) surgical treatments to bring the person’s physical characteristics more closely in line with their gender identity or to prevent developmental changes that don’t align with this identity. Decisions regarding the appropriate treatment for each individual patient are made by the patient, the parents, and the health care team and are guided by evidence-based standards put forth by organizations such as the Endocrine Society, the World Professional Association for Transgender Health, and the American Academy of Pediatrics. Each person has their own gender journey, and there is no one-size-fits-all approach to this kind of care.
Pediatric gender clinics originated in the 1980s in Amsterdam. Dutch physicians recognized that transgender children tended to face mental health challenges during adolescence, as secondary sex characteristics developed, and that early intervention could be lifesaving. They also appreciated the value of delaying decisions that could have a permanent effect on a child. To resolve these conflicts, they created a protocol under which puberty would be paused using medications at Tanner stage 2 (the period during which signs of central puberty are first detected, most often between 8 and 15 years of age) if gender dysphoria had persisted, thereby forestalling the development of unwanted and potentially permanent secondary sex characteristics with a reversible intervention. Gonadotropin-releasing hormone (GnRH) analogues, or “puberty blockers,” have been used by pediatric endocrinologists for more than 30 years for the treatment of precocious puberty. These agents have well-known efficacy and side-effect profiles, and their effects are reversible. In later adolescence, treatment with gender-affirming hormones could be initiated if gender identity remained incongruent with the sex assigned at birth.
The Dutch-developed treatment model was shown to result in long-term improvements in the well-being of adolescents with gender dysphoria1 and was the basis for current guidelines formalizing the treatment of gender dysphoria. These guidelines recommend using GnRH analogues at Tanner stage 2 and prescribing hormone therapy later in adolescence if the patient, the parents, and the medical team all agree with this approach. Today, prescribing these therapies is coupled with education on the safe use of such medications and with close surveillance for potential risks associated with therapy — for instance, monitoring for changes in bone health in children taking GnRH agonists, for risk factors for blood clotting with estrogen therapy, and for polycythemia with testosterone therapy. With proper monitoring and education, the risks associated with these therapies can be mitigated, and the benefits are substantial: use of hormone therapy is associated with improved quality of life, reduced rates of depression, and decreased anxiety among transgender people.2
A recent survey of U.S. high school students conducted by the Centers for Disease Control and Prevention found that 1.8% of students identify as transgender. More than one third of transgender adolescents surveyed had attempted suicide in the previous 12 months.3 As clinicians caring for this population, we are alarmed by this statistic, but we see it as a call to action. We know that mental health disparities between transgender and cisgender children are not inevitable and that with support from their families and communities and access to evidence-based mental health and medical interventions, transgender children and adolescents can survive and thrive.
A multidisciplinary approach to treating transgender young people has been shown to alleviate gender dysphoria when treatment occurs in a supportive environment that attends to the patient’s mental, social, and physical needs. Young people who receive such gender-affirming care report improvements in their overall well-being, and their level of well-being is generally in line with that of their cisgender peers — and sometimes it’s higher.4 Having access to gender-affirming care in childhood and adolescence can have profoundly important mental health benefits: one study found that transgender adults who had had access to puberty suppression during adolescence had lower odds of suicidal ideation than those who wanted such treatment but hadn’t received it.5
Under the new Arkansas law, known as the Save Adolescents from Experimentation (SAFE) Act, physicians who provide gender-affirming therapy for transgender people younger than 18 will be subject to loss of licensure and could be sued. The law’s name implies that following evidence-based guidelines while working closely with patients and families is a form of experimentation. The law references inaccurate information about the care of gender-diverse young people, stating that genital surgeries are being recommended for people younger than 18. In reality, guidelines indicate that genital surgeries should be delayed until the person reaches the age of legal adulthood in their country, which in the United States is 18 years. The law also states that there are no long-term data on the use of puberty-blocking drugs for the treatment of gender dysphoria, when multiple studies have revealed long-term positive outcomes for transgender people who have undergone puberty suppression.4,5
The content of the Arkansas law, and that of similar bills that have been proposed in other states, is not based on data, medical literature, or correct information about the process of treating transgender adolescents. We believe these bills threaten the health, well-being, and survival of transgender children and young adults. By penalizing physicians for practicing evidence-based medicine, the legislation nullifies their expertise and interferes with therapeutic relationships among physicians, patients, and families. It strips power from patients and families who are already marginalized. And although the stated purpose of the legislation is to protect adolescents, we believe that criminalizing what has been shown to be lifesaving treatment will do the opposite — and that the consequences could well be tragic.
What is gender-affirming health care? Around the country, there’s a Republican campaign to legislate and regulate the lives of trans youth. The most destructive of these efforts would bar trans youth in certain states from accessing gender-affirming treatment. Dr. Izzy Lowell runs Queer Med, a private clinic that specializes in providing accessible health care to trans patients ranging from kids to adults. Her practice covers 10 states across the South – and half of those have anti-trans health care bills on the docket. If they pass, it would become criminal for her to provide this care to many of her patients. Dr. Lowell joins this week to break down what exactly we mean when we talk about gender-affirming care, how the decision is made for kids and teens ready to transition, and the potentially devastating impact this legislation would have on their lives.
Gov. Asa Hutchinson vetoed the bill denying medical care but said there is nothing he can do. This is heartbreaking for the children and families affected as they realize their State Government doesn’t want them there.
Dylan Brandt, 15, is a transgender teen from Arkansas who has been taking testosterone but will no longer be able to receive the hormone once a new state law takes effect this summer that bars gender-affirming medical care for minors.
If the Brandt family is forced to leave they will join a growing exodus of the gender diverse from states controlled by the extreme right.
The Spurriers, a family of three in Central Arkansas took note of legislation introduced and passed by the Arkansas General Assembly that has directly targeted our son’s healthcare, education, and mental well-being. As a result,” the Spurriers wrote on their gofundme, “we are making a serious effort to relocate to a state that is more friendly to the LGBTQIA+ community”. Keeping closeness to family, post-secondary educational opportunities, and our own health in mind, we have determined that New Mexico is the best fit for us.
We’ve lived in Arkansas since 2005. Our child has grown up in that time, learning kindness, humor, and empathy. A year and a half ago, he hesitantly came out to us as transgender. Despite the love and acceptance, we have tried to embody, he was terrified of how we might react. He had heard horror stories of trans youth whose families responded with cruelty. We assured him of our unchanged love and understanding. Following that conversation, we reached out to his existing therapist and the wonderful staff at the Arkansas Children’s Hospital Gender Spectrum Clinic to begin the long journey to help him transition into an identity that felt right for him.
Counselors and clinicians confirmed his conviction that this new course was right. The medical staff at ACH-GSC helped our son take the first step toward easing his dysphoria, by administering common birth control injections to reduce or eliminate the monthly trauma of his periods. In most transgender males, two doses of such drugs achieves the completely reversible cessation of monthly cycles for a period of time. For our son, the duration and frequency of periods increased substantially, which made what was already traumatic an absolute hell for him. After a third Hail Mary dose, which failed to produce the desired effect, the doctor suggested that moving on to testosterone injections would be the best option.
We are a month and a half into weekly T shots, which our needle-shy teenage son has been self-administering (the surest testament to his commitment to this transition). His confidence and comfort have increased by leaps and bounds, and it is clear that he is elated with his progress so far. He has gone from being on the verge of suicide to excitement for his future.
The Arkansas General Assembly has taken action to return him, and his transgender male and female peers, to that brink of self-destruction. House Bill 1570 , explicitly prohibits not only gender reassignment surgeries—which are not performed on minors in Arkansas in the first place—but the puberty-blocking medications and hormone replacement therapies that help ease gender dysphoria in teens until they reach the age of majority and can make their own independent choices regarding surgery. Lacking a “grandfather clause” to exclude active hormone/blocker patients, the bill would cut off these teens…our teen…from their therapies, doing irreparable physical and mental harm.
Arkansas Governor Asa Hutchinson has vetoed HB1570, but members of the General Assembly have already pledged to see that the legislature overrides his veto. Even if the bill dies, it is but one of at least four (SB289, SB354, HB1570, & HB1749 so far) such bills, three of which have already been signed into law.
The Texas legislature is will likely pass a bill today denying transgender healthcare to minors. Not to be outdone by Arkansas the punishment for parents would be a sentence to prison as child abusers.
“I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.”
Years ago, I donned a white coat and uttered these words. I gathered with other young doctors and pledged to provide comprehensive and compassionate care for all my patients.
Now the state of Alabama, where I practice, is on the verge of passing a bill that would make it a felony for medical professionals to provide essential care to transgender youth. This is unconscionable, especially in the middle of a public health crisis that has killed half a million Americans.
When I first took the Hippocratic Oath, I understood the obligation I was assuming. I knew I would become responsible for fellow humans’ lives and be a harbinger of the worst or best possible news a family could hear.
Never though, in all of my training, did I imagine that those in our highest offices of power would work to subvert our solemn oath, using their positions to make determinations about who can and cannot receive care. Yet here we are. If this law is enacted, I could face up to 10 years in prison just for doing my job.
The Alabama bill would be one of the most harmful pieces of anti-trans legislation in our nation’s history. But it’s far from the only attempt to discriminate against trans people and punish those who provide them care. Trans rights, and specifically trans children’s rights, are under brutal attack by state legislatures across the country. State lawmakers have proposed a record number of anti-transgender bills this year — from banning trans kids from playing on sports teams in nearly 20 states to criminalizing doctors who provide trans youth essential healthcare in a dozen.
Compounding these legislative attacks, COVID related clinic closures and travel restrictions have further limited access to medically necessary, gender-affirming care for transgender patients during the pandemic.
Moreover, about two-thirds of LGBTQ adults have pre-existing conditions such as diabetes, asthma, or HIV, conditions that put them at higher risk of severe illness from COVID-19. Access to essential care for trans Americans is more imperative than ever.
Even without this law in place, trans people face rampant discrimination in healthcare settings.
In Alabama, one in four transgender people who visited a healthcare provider had a negative experience related to being transgender, according to a 2015 survey. More than a third did not see a doctor when they needed to because they feared being mistreated as a transgender person. And 17 percent experienced issues with their insurance because of their gender identity.
The barriers to care for trans people are extensive and dangerous.
The evidence is irrefutable. Transgender children who receive gender-affirming care such as puberty-delaying medication and hormones when they are young have better mental health outcomes and report fewer cases of depression and suicidal ideation. As COVID-19 continues to take an enormous toll on the mental health of children, access to this care is critical.
The passage of this bill would make it nearly impossible for trans youth in Alabama to receive the care they need and jail doctors like myself who are committed to treating all people. And it’s not just Alabama. Bills like this are proliferating all across the country, and trans youth are relying on healthcare providers to fight for their rights.
“May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.”
I write today to uphold this oath — to preserve this fine tradition and fight back against hate. So to the lawmakers who insist on legislating intolerance, quit standing in the way of healthcare professionals who only seek to help.
Dr. Izzy Lowell is a family medicine physician whose clinic, QueerMed, specializes in transgender medicine and treats trans patients in Alabama and across the Southeast.
They weren’t “aware” of the situation until they were embarrassed enough to answer a tweet.
Freedom Oklahoma verified that the transgender woman was able to get vaccinated Friday when she returned to the Logan County site.
Three Years To Life in prison for assisting a transgender person
Oklahoma state legislature has five anti-transgender bills in the works from trans healthcare to sports. The worst is SB 676 a bill that would make anyone knowledgeable of a person 21 years of age transitioning a felon. They would be punishable by imprisonment in the custody of the Department of Corrections for a term of not less than three (3) years nor more than life and a fine of not more than Twenty Thousand Dollars.
Tell me that is an isolated event. 21 GOP-controlled states have passed or in the process of enacting bills attacking transgender adolescents’ right to life. This is about the GOP controlling bodies that they hate.