By Madeline Budroe, JHBL Staffer
In 2021, a national survey representing over 35,000 LGBTQ youth between 13 and 24 years old showed that 52% of transgender and nonbinary youth considered suicide, and 20% attempted suicide.[1] Another study from 2020 revealed that transgender adolescents who had access to puberty blockers were 70% less likely to consider suicide compared to their transgender peers without access to these kinds of medications.[2]
Health care is meant to enhance our quality of life. Imagine watching your state legislation filled with powerful people attempting to deny access to the few treatments that may help you attain a good quality of life. In 2021 so far, there are 21 bans or restrictions on transgender medical care by 16 state legislatures being considered.[3] In April, Arkansas became the first state in the U.S. to make certain medical treatments for transgender minors illegal. The law prohibits a physician or other healthcare providers from providing, or even referring, any person under the age of 18 for “gender transition procedures.”[4] The bill was purported to “protect” minors from making decisions they are not ready for, according to the bill’s lead sponsor Representative Robin Lundstrum.[5] Despite Governor Hutchinson’s veto, HB 1570 was passed by a majority vote. The American Civil Liberties Union (ACLU) filed suit on behalf of four transgender youth, their families, and two doctors, resulting in a federal judge blocking the law from going into effect at this point. Even so, the proposal of such laws leaves transgender youth at a higher risk.
Gender dysphoria is defined as a feeling of discomfort or distress that may occur in people whose gender identity differs from the sex they were assigned at birth or their sex-related physical characteristics.[6] Gender-affirming healthcare is the standard treatment for those suffering from gender dysphoria in the Unites States and includes both medical and nonmedical treatments. Aside from social transitioning, which plays a large non-medical role in allowing a person to explore and become comfortable with their gender identity and inner-self, several medical treatments have been recently questioned by state legislations. Common types of medical treatment include puberty-suppressing hormones, hormone therapy, and gender affirming surgery.[7]
Children can separate from their gender assigned at birth from as young as two years old, when they begin to understand the concept of gender and can start to express themselves verbally.[8] Brooke, one of the plaintiffs in the lawsuit against Arkansas, has “known exactly who she is since she was two years old,” according to her mother.[9] Children like Brooke are at serious risk. Mental illness among transgender youth is already disproportionate to that of cisgender children. According to one study, 75% of transgender and gender nonbinary children experience symptoms of generalized anxiety and about 50% of transgender youth will contemplate suicide. Access to gender-affirming health care reduces the likelihood of mental illness, and in some cases, death.[10]
Daniel is an example of someone who could have benefitted from earlier utilization of gender-affirming healthcare. Daniel is a nonbinary teen who took gender-affirming hormones after seeing a therapist who specialized in gender identity. They were often misgendered due to their voice, and before staring hormone therapy, they, like so many other transgender and nonbinary adolescents, considered suicide. They state: “Starting testosterone, for me, saved my life.”[11] Puberty sets foot in all our lives at some point, involving both physical and developmental changes that correlate with our sexual maturity. For those with gender dysphoria, this often involves changes incongruous with their gender identity, which is a source of confusion and distress. As a concerned mother points out, laws seeking to restrict or ban gender-affirming healthcare might force children to “go through the bodily changes of puberty for the wrong gender,” and choose death over this process.[12] One indicator of mental health is physical acceptance. Body image is commonly linked to depression and anxiety and largely overlaps with gender dysphoria. Pediatrics journal did a survey asking about body dissatisfaction. Using a scale of 0 to 116, with 0 being no dissatisfaction and 116 being the highest level of dissatisfaction, it examined the correlation between level of satisfaction and whether the adolescent or teen was receiving gender-affirming care. Unsurprisingly, the ratings fell, on average, 20 points from around 71 before receiving treatment to about 51 after treatment.[13]
COVID-19 has not made things any easier for transgender youth. Making social connections is a crucial part of grappling with gender dysphoria, which is why social transitioning is typically the first step in gender-affirming treatment. Losing these opportunities during the COVID-19 pandemic creates more suicidal tendencies. In a 2021 survey, The Trevor Project found that 70% of LGBTQ youth said that their mental health was “poor” most of the time or always during COVID-19.[14] This study indicates that mental health is correlated to being able to express one’s sexual orientation and gender identity. For example, it has been proven that allowing youth to legally change their pronouns is correlated with lower suicide rates.[15] Our name and our pronouns are some of the purest, simplest forms of identity, and it is often a clinician who first addresses pronouns with a transgender or nonbinary adolescent. Losing these relationships with healthcare professionals due to the pandemic, as well as other societal relationships, has a negative impact even without the implementation of laws such as HB 1570.
A major problem with recently proposed legislation, is the rhetoric framing gender-affirming healthcare. It portrays gender-affirming treatment as something dangerous, high-risk, and experimental, even though these health practices have been utilized for years. HB 1570 offers a laundry list of health risks (including death), states that there is no long-term studies on the benefits of puberty-blockers, and also claims that most physiological interventions are “unnecessary.”[16] Jason Klein, a pediatric endocrinologist at NYU Langone Health, expresses concern that these types of bills will make youth question their gender, making them more reluctant to ask for help, and additionally make parents more reluctant to seek help for their kids.[17] He states, “Children will die because of these policies.”[18] In criminalizing healthcare for gender transition purposes, politicians are falsely claiming to save lives that they are in fact threatening. Naturally, there are risks involved in gender-affirming healthcare, as there are in any kind of treatment. But this risk does not outweigh the fact that there is a vastness of children out there who are contemplating suicide or suffering from depression and anxiety related to the battle of self-acceptance and acceptance from society.
We live in an era where people are struggling with their mental health more than ever. Instead of sending transgender children the message that that they need to be saved from experimentation, as HB 1570 does, we need to take steps towards reducing suicide and improving overall mental well-being. Transgender and nonbinary youth depend on a sense of community and acceptance as means of surviving. Statistically, less healthcare utilization during youth leads to worse outcomes as they get older.[19] Those who seek puberty blockers and hormone therapy at a later age are more likely to have mental health issues.[20] Thus, there needs to be earlier access to gender-affirming healthcare, the opposite agenda of which state legislatures like Arkansas seek to impose.
Madeline Budroe is a second-year law student at Suffolk University Law School with an interest in civil rights and public interest law. Her most recent work was with a non-profit called Project Citizenship, assisting immigrants apply for citizenship. She has a Bachelor of Arts in Political Science and English from Providence College.
Sources
[1] See Trevor Project, National Survey on LGBTQ Youth Mental Health 2021, https://www.thetrevorproject.org/survey-2021/?section=Introduction.
[2] See Maria Temming, Gender-affirming care improves mental health for transgender youth, ScienceNews (Aug. 26, 2021), https://www.sciencenews.org/article/transgender-youth-mental-health-gender-affirming-care-laws.
[3] See Chelsey Cox, As Arkansas bans treatments for transgender youth, 15 other states consider similar bills, USA Today (Apr. 8, 2021, 7:41 PM), https://www.usatoday.com/story/news/politics/2021/04/08/states-consider-bills-medical-treatments-transgender-youth/7129101002/.
[4] See H.B. 1570, 93rd. Gen. Assemb., Reg. Sess. (Ark. 2021).
[5] See Cox, supra note 3.
[6] Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/gender-dysphoria/symptoms-causes/syc-20475255 (last visited Sept. 15, 2021).
[7] See The Importance of Gender Affirming Care for Transgender and Gender Expansive Youth, Nursing License Map (May 17, 2021) https://nursinglicensemap.com/blog/the-importance-of-gender-affirming-care-for-transgender-and-gender-expansive-youth/
[8] See Caroline Miller, Transgender Kids and Gender Dysphoria: How can we support kids making transitions, for the healthiest outcome?, Child Mind Institute, https://childmind.org/article/transgender-teens-gender-dysphoria/
[9] See We’re Suing Arkansas Over its Ban on Health Care for Trans Youth, ACLU (May 25, 2021), https://www.aclu.org/news/lgbtq-rights/were-suing-arkansas-over-its-ban-on-health-care-for-trans-youth/
[10] See Tori Rodriguez, Addressing the Mental Health Needs of Transgender Youth, Psychiatry Advisor (July 16, 2021) https://www.psychiatryadvisor.com/home/topics/child-adolescent-psychiatry/methods-for-better-mental-health-support-of-transgender-youth/.
[11] See Temming, supra note 2.
[12] See id.
[13] See id.
[14] See Trevor Project, National Survey on LGBTQ Youth Mental Health 2021, https://www.thetrevorproject.org/survey-2021/?section=Introduction.
[15] See id.
[16] See HB 1570, 93rd. Gen. Assemb., Reg. Sess. (Ark. 2021).
[17] See Temming, supra note 2.
[18] See id.
[19] See Rodriguez, supra note 10.
[20] See Julie Moreau, Early care leads to better mental health for transgender youths, study finds, NBC News (Sept. 29, 2020, 4:34 AM), https://www.nbcnews.com/feature/nbc-out/early-care-leads-better-mental-health-transgender-youths-study-finds-n1241289.
Brandt v. Rutledge, 2021 U.S. Dist. LEXIS 148442, (Ark. E. Dist. Ct. 2021).
https://www.mentalhealth.org.uk/publications/body-image-report/sexuality-gender-identity
https://www.aclu.org/press-releases/federal-court-blocks-arkansas-ban-gender-affirming-care-trans-youth-moving-forward
https://www.thetrevorproject.org/wp-content/uploads/2020/04/Implications-of-COVID-19-for-LGBTQ-Youth-Mental-Health-and-Suicide-Prevention.pdf
https://www.forbes.com/sites/unicefusa/2021/06/25/queer-during-quarantine-a-spotlight-on-lgbtq-youth-mental-health-amidst-covid-19/?sh=61bd17076633
https://www.aclu.org/news/lgbtq-rights/doctors-agree-gender-affirming-care-is-life-saving-care/