Protesters of Kentucky Senate bill SB150, known as the Transgender Health Bill, cheer on speakers during a rally on the lawn of the Kentucky State Capitol in Frankfort, Ky., Wednesday, March 29, 2023. (AP Photo/Timothy D. Easley)

Voices & Opinion

POV: Gender-Affirming Care is Under Siege

Laws prohibiting care will harm, not help, trans and gender-diverse youth

A tsunami of anti-LGBTQIA+ legislative efforts is currently sweeping across the United States. Under the misguided notion that restricting gender-affirming care “protects children,” 12 states have enacted laws restricting or banning access to gender-affirming care for minors, including Alabama, Arkansas, Arizona, Florida, Georgia, Idaho, Iowa, Kentucky, Mississippi, Tennessee, Utah, South Dakota, and West Virginia.

As these laws proliferate, dangerous and cavalier language has taken hold in public forums, with insufficient care paid to what it might incite. In March, , Daily Wire host Michael Knowles, speaking at the Conservative Political Action Conference, advised the audience, “For the good of society… transgenderism must be eradicated from public life entirely—the whole preposterous ideology, at every level.” These callous calls to ban the very existence of transgender people have the potential to drive an increase in violence against an already marginalized community.

Recently in Kentucky, the Republican-dominated legislature voted overwhelmingly in favor of overturning Democratic Governor Andy Beshear’s veto of the most severe anti-trans bill to date (Kentucky SB 150). The resulting law, which will go into effect in June, will have chilling effects for all Trans & Gender Diverse (TGD) citizens in Kentucky. The bill creates multiple restrictions and regulations designed to ensure that Transgender and Gender Diverse youth cannot access gender-affirming healthcare. It requires medical providers to detransition minors who have already been accessing affirming care, requires school districts to forbid students from using the bathroom associated with their gender identities, forbids school districts from requiring or even recommending the use of a youth’s preferred name/pronouns, and limits what can be discussed in schools, specifically banning lessons at all grade levels related to gender identity or sexual orientation.

The rapid rise in laws, book bans, and education reform targeting youth members of the TGD community is fueled by fear mongering that erroneously equates the TGD community’s modest increases in visibility with a social contagion that threatens to engulf the nation’s youth. While the social contagion theory has been disproven, the inherent bias underlying this anti-trans rhetoric—that TGD identities are not valid and are something to be contained and controlled to prevent contamination of cisgender youth —still has a societal hold. Increasing public discourse might have brought more attention to TGD communities, but it did not create them. TGD people have been recorded throughout history and modern-day erasure is not proof of non-existence.

Many proponents of anti-trans legislation claim fear of regret as a pressing concern when pursuing gender-affirming care; however, data clearly state that the rates of regret amongst TGD communities are minor (1 percent) when compared with plastic surgery or other commonly accepted procedures. In fact, evidence clearly shows that gender-affirming care is life-saving care. Extensive research shows that those who are able to access gender-affirming care experience reduced symptoms of depression and anxiety, decreased substance use, improved self-esteem, and an overall reduction in suicidality. Limiting access is dangerous. Laws prohibiting gender-affirming care will harm, not help, youth.

In Massachusetts, we are already seeing the impacts of these horrific legislative efforts as out-of-state youth and families in need of care seek refuge from states where they are increasingly more vulnerable and less welcome. We have had families reach out to our clinic expressing feelings of persecution and fear while noting hastily developed plans to move from their home states to Massachusetts in order to ensure their TGD children can access the care they so clearly need. In essence, the aforementioned laws are creating “trans refugees.”

We already know what happens when TGD people cannot access care: rates of depression, anxiety, substance use disorder, and suicidality higher than those of their cisgender peers.

In today’s rapidly changing landscape, medical providers who strive to uphold their oath to “do no harm” must navigate a legal minefield to provide the care they know is necessary. As a behavioral health provider for the TGD community, I spend most of my day affirming my clients’ identities and reminding them that the poor mental health outcomes experienced by the community are the result of society’s marginalization, not their own flawed design. Trans and gender-diverse people experience abuse, oppression, and discrimination far too often. Each piece of anti-trans legislation legally codifies the harm.

It is important that this care be readily accessible and driven by the trans and gender-diverse community, those who care about them, and their providers, NOT by politicians.

Meghan McGrath is a clinical social worker and the behavioral health lead at Boston Medical Center’s GenderCare Center.

“POV” is an opinion page that provides timely commentaries from students, faculty, and staff on a variety of issues: on-campus, local, state, national, or international. Anyone interested in submitting a piece, which should be about 700 words long, should contact John O’Rourke at orourkej@bu.edu. BU Today reserves the right to reject or edit submissions. The views expressed are solely those of the author and are not intended to represent the views of Boston University.