Trans health care is under attack on multiple fronts in the U.S., from direct anti-trans legislation, to cuts to vital resources, to the targeting of gender-affirming care providers.
While dozens of states have proposed bills attacking trans health care in 2022, currently, three U.S. states already have passed laws restricting trans-affirming health care for minors: Alabama, Arizona and Arkansas. Alabama is the only state in which it is now a felony to provide certain care to minors. (Tennessee bans hormone replacement therapy for pre-pubertal children, even though such treatment is not actually practiced anywhere in the country.) Each of these three laws is under intense legal scrutiny. Arkansas’s law has been blocked by a federal judge from taking effect, and Arizona’s law doesn’t come into effect until 2023. The Williams Institute estimates that if all the bills filed against trans-affirming care for youth were passed in 2022, nearly 60,000 of the country’s 150,000 high school-aged trans youth would lose access to the care they need.
While Florida does not currently ban trans-affirming care for anyone in the state, trans Floridians may not access Medicaid funds to cover the costs of their care. Medicaid is a state and federal partnership that covers the health care costs of low-income and disabled people. Transgender people are disproportionately low income, due to housing and employment discrimination, making this ban on coverage for low-income Floridians especially harmful.
Meanwhile in Texas, the Republican governor and attorney general have been hard at work making it painful and dangerous for the families of trans children to live in the state. In February 2022, Texas Attorney General Ken Paxton issued a nonbinding legal opinion holding that some forms of trans-affirming care for minors constitute child abuse, and Texas Gov. Greg Abbott followed the statement with a chilling announcement that the state’s Department of Family and Protective Services would be investigating the families of trans children to determine if they met these new life-threatening standards. Three families sued the state with the help of Lambda Legal and the ACLU of Texas. A Texas judge agreed with the parents’ assertion that the law could cause irreparable harm to their children and ordered an injunction of the directive, pausing investigations while the case proceeds.
However, in the brief months during which the Texas governor’s directive was permitted to stand, children, parents and families were subjected to invasive and humiliating investigations and interrogations. By May, at least nine families were under active investigation by the Texas Department of Family and Protective Services, according to the Texas Tribune.
Moreover, the injunction has not meant the end of interrogations. In a recent addition to the suit against the state, one mother revealed that her 13-year-old son was removed from his classroom in late August and interrogated by department officials, while his responses were recorded. The eighth grader had been distressed by his state’s attacks on trans-affirming care at the beginning of the year but had calmed down for the start of the new school year, according to his mother, who is identified using the pseudonym Carol Koe in her signed declaration. Then the interrogation happened. The Washington Post reported: “He had a ‘meltdown’ after the meeting and asked his mother to pick him up, his mom said. He’s missed more classes and has frequent anxiety attacks, Carol Koe wrote. School for him is no longer the safe space it used to be, she claims.”
The Koes’ story is just one of many in this larger landscape of attacks on trans-affirming care and thus trans lives themselves. Like Koe’s eighth-grade son, many other children and teens across the United States are suffering acute mental health impacts and diminished capacity to feel safe and well at school due to these laws and bills. Some youth are being denied affirming care, and those who do access care are enduring increased fears of persecution that severely impact mental health.
In additional to legislative measures, attacks on providers of gender-affirming care are also ramping up. Throughout the summer, Twitter account LibsofTikTok focused the ire of the anti-trans internet toward a number of children’s hospitals providing gender-affirming care, such as support for the parents of trans kids and guidance for families and schools supporting youth through social transition. Under the guise of concern for the children receiving this care, LibsofTikTok (the online face of former real estate agent Chaya Raichik) posted dozens of tweets to its million-plus followers, spreading dangerous lies about “pedophiles” and “groomers.” Raichik’s influence was thrown into clear view when Boston Children’s Hospital in Massachusetts began receiving bomb threats and death threats for providing trans-affirming care. And Raichik’s disregard for children’s actual health became all the more apparent when she refused to end her campaigns, even as the Boston Children’s Hospital had to briefly close its doors to visitors due to bomb threats.
The impacts of campaigns like Raichik’s cannot be understated. Boston Children’s Hospital, like every children’s hospital, focuses on providing specialized care for children with health needs that are serious, rare and difficult to treat. The attacks on these hospitals make it very clear these anti-trans activists are comfortable sacrificing the health of thousands of children with serious illnesses, even terminal illnesses, in order to reduce the care available to trans children.
The reality of trans-affirming care for youth in the United States is that it is difficult to access, and the vast majority of trans youth never do access it. In fact, research shows that there is a huge disconnect between trans youth and their providers: gate-keeping, wait lists and insurance refusals mean that many trans youth are not accessing the care they need. Meanwhile, each attack on health care makes it more difficult for youth and their families to access the lifesaving support they need.
For trans youth, this lack of health care is often accompanied by a lack of other essential resources. According to the Trevor Project, a national LGBT suicide prevention organization, over one-third of transgender youth report having experienced homelessness or housing instability. Transgender youth comprise a precarious population of young people who rely on one another for resilience and survival, who live on the street and crash on one another’s couches, who don’t have access to routine medical and dental care, much less trans-affirming care, and who face violence and discrimination at many turns in their lives.
The attack on trans health services in the United States will only exacerbate this lack of care, support and resources. And the disinformation campaigns appear to be at least partly working: Public opinion on trans health care is slipping, with 46 percent of American adults now agreeing that it should be illegal for health care professionals to offer trans-affirming care to minors. Just one year ago, a PBS NewsHour/NPR/Marist poll found that only 28 percent of Americans supported laws that “prohibited gender transition related medical care for minors.”
Advocacy against trans-affirming care persists despite overwhelming medical consensus that trans-affirming care is evidence-based and lifesaving. The American Medical Association, the American Psychological Association and the American Academy of Pediatrics strongly endorse trans-affirming care for youth. Within the trans community itself, many underfunded organizations are spending their scarce resources on supporting trans lives on the ground and beating back negative laws and policies rather than pushing for expanded health care access.
We have a crisis here in the United States that is endangering trans children’s lives. These consistent persistent attacks on trans health care will not stop with attacks on youth. Gov. DeSantis’s revocation of Medicaid coverage for trans adults makes that very clear. Unless and until we have strong leadership in support of trans-affirming care for everyone, more states will pass laws making it impossible for families to access care for their children, and the anti-trans lobby will move to banning trans-affirming care for adults, too.