The following article appeared September 28, 2022, in The Oklahomanopens in new window.
On Thursday, Oklahoma lawmakers will vote on legislationopens in new window that could remove one of the only providers of medically necessary, best-practice care for transgender youths in the entire state. The bill threatens to functionally ban gender-affirming care at OU Health Facilities as a requirement to receive critical American Rescue Plan Act (ARPA) funds.
This is deeply concerning and another prime example of government overreach into decisions best left to medical and scientific experts. Fearmongering around gender-affirming care has led to a coordinated political campaignopens in new window against transgender youth and has been directly linked to egregious violence and bomb threatsopens in new window against those who support them, especially children’s hospitals and doctors.
Gender-affirming careopens in new window—which encompasses a range of social, psychological, behavioral and medical interventions designed to support and affirm an individual as they explore their gender identity—has been placed at the heart of some of the most contentious legislative debates and most restrictive bans in a record yearopens in new window of state laws impacting LGBTQ communities.
As a direct result of these bills, it is becoming more common to hear storiesopens in new window of families with trans children—like that of Jessie, a young trans girl in Texas — who decided to uproot their lives and move to another state where gender-affirming care is not outlawed. Military parents are being forced to leaveopens in new window their careers rather than serve in states where their children’s care is under threat.
We must cut through this clamor with objective understanding and evidence. As leaders of The Trevor Projectopens in new window—the world’s largest suicide prevention organization for LGBTQ young people—and the American Psychological Associationopens in new window (APA)—the U.S.’ largest scientific and professional organization of psychologists—we trust what the growing body of evidence tells us: that we must support and affirm trans young people for who they are, and that gender-affirming care is medically and psychologically necessary.
This year, Alabama became the first state to enact a lawopens in new window making it a felony to provide gender-affirming care to transgender and nonbinary youth. There is an ongoing legal battleopens in new window in Texas following guidance issued by Gov. Greg Abbott and the attorney general to direct the state’s Department of Family and Protective Services to open child abuse investigations against parents and physicians who provide gender-affirming care. Other states, such as Ohio, are looking to enact similar statewide bansopens in new window.
These laws are part of a larger effort to regulate trans youth’s lives, restricting their ability to play on sports teamsopens in new window, to access bathrooms and spaces that align with their gender identityopens in new window and to be represented in classroom discussions and curriculaopens in new window.
In December, a large-scale study examining hormone therapy among trans and nonbinary youth was published by The Trevor Project inopens in new window the Journal of Adolescent Health. The peer-reviewed articleopens in new window examined gender-affirming hormone therapy (GAHT) among a sample of 11,914 transgender and nonbinary youth ages 13-24. It found that receiving GAHT was associated with lower rates of depression, suicidal thoughts and suicide attempts— in some cases, nearly 40% lower odds of a past-year suicide attempt.
Further, a studyopens in new window in January by a research team from Harvard Medical School and the Fenway Institute had similar findings: Transgender people who accessed gender-affirming hormones during adolescence were significantly less likely to experience psychological distress or suicidal ideation.
Our country’s leading medical and mental health associations support evidence-based clinical care for young transgender people, including the American Medical Associationopens in new window, American Academy of Child and Adolescent Psychiatryopens in new window, American Academy of Pediatricsopens in new window, American Counseling Associationopens in new window, American Public Health Associationopens in new window and APAopens in new window. Experts say it is imperative that young transgender people have the opportunity to be under the safe and supportive care of a physician. Further, the World Professional Association for Transgender Health, a leading global transgender health association, reaffirmed its supportopens in new window for access to gender-affirming care for young transgender people, and just last month lowered its recommended minimum age for gender transition treatment in teens: 14 for hormones (previously 16) and some surgeries at 15 or 17, about a year earlier than prior guidance.
This consensus goes beyond the medical and behavioral experts. Polling dataopens in new window from The Trevor Project shows that a majority of U.S. adults agree that young transgender people should have access to gender-affirming hormone therapy and puberty blockers if recommended by their doctor and supported by their parents. In fact, most voters in Florida and one-third of voters in Texas—two states embroiled in these debates—said they would be less likelyopens in new window to vote for a candidate who tries to outlaw the provision of gender-affirming care.
The bottom line is that any effort to restrict access to gender-affirming care is dangerous legislative overreach that could lead to negative mental health outcomes and increased suicide risk for transgender young people. Psychological researchopens in new window also illustrates how discriminatory laws and policies targeting sexual and gender minorities contribute to concealment, social isolation and internalized shame. This, in turn, can contribute to depression, anxiety and suicidality. And given that The Trevor Project’s 2022 National Survey on LGBTQ Youth Mental Healthopens in new window found that nearly 1 in 5 trans and nonbinary youth attempted suicide in the past year, lawmakers must reconsider these types of legislation and instead introduce bills that support these young people.
What we don’t know often scares us—feweropens in new window than 1 in 3 adults in the U.S. know someone who is transgender, and fewer than 1 in 5 know someone who is nonbinary. But with what we do know, it is time to rise above fear and follow the science. We urge everyone—especially those who have the power to impact policy—to make decisions based on the growing scientific evidence, which is clear: Gender-affirming care is medically necessary care that young trans people should have access to, and their parents and physicians should not be criminalized for providing it.
Carrie Davis is the chief community officer of The Trevor Project.
Mitchell J. Prinstein, PhD, is chief science officer of the American Psychological Association.