Tuesday, April 13, 2021
By Kelly Folkers (April 13, 2021)
On April 6, the Arkansas state legislature overrode a gubernatorial veto and enacted a bill (H.B. 1570) that will ban access to gender-affirming care (GAC) for people under the age of 18, the first law of its kind in the United States.
H.B. 1570 is one of 80 bills regulating transgender and gender expansive (TGE) people’s access to societal resources that were introduced in state legislatures during the first three months of 2021. Considering the already hostile landscape for reproductive rights in Arkansas, the new law further threatens reproductive rights by legalizing discrimination in healthcare.
The Arkansas law creates a blanket ban on GAC for minors, carving out exceptions only for persons with disorders of sex development, people who are injured by or later regret GAC (an extremely rare occurrence), and people who require surgeries similar to gender-affirming operations for reasons unrelated to gender transition. Notably, the law states that medical care under these circumstances is not gender-affirming care, although patients meeting the criteria for the exceptions receive the same or similar prescription medications and surgeries. This disparate treatment among patients receiving the same or similar care raises an important question: Why is the Arkansas legislature so concerned with TGE youth specifically?
Across the board, professional medical associations consider GAC to be a safe, ethical, and a sometimes life-saving form of healthcare for minors and adults. GAC includes a wide array of psychosocial, medical, and surgical care options aimed at helping TGE people achieve a physical appearance consistent with their gender identity. (It is important to note that not all TGE people choose some or any of these options; having a TGE identity is not a medical or psychological condition that, in and of itself, requires treatment.)
For minors who want treatment, they can start with the administration of puberty suppressing hormones, which prevent potentially distressing bodily changes like breast growth, voice deepening, or facial hair development. Medical experts say that puberty suppression is fully reversible although there is ongoing study of its long-term effects.
For those who want more treatment, gender-affirming hormone therapy involves the administration of estrogen or testosterone aimed at enabling the development of secondary sex characteristics that more closely align with an individual’s gender identity. As gender-affirming hormone treatment can affect adolescents’ fertility, professional medical guidelines state that clinicians should counsel youth on possible options for fertility preservation, which involves harvesting and storing gametes. Though fertility preservation is expensive and often not covered by insurance, the standard practice is to ensure that TGE youth and their families receive fertility counseling before starting any treatment that may affect future reproductive choices.
Even in states with liberal GAC policies for minors, gender-affirming surgical procedures are typically only accessible to individuals who have reached the age of majority, with some limited exceptions.
The Arkansas legislature claims it has a compelling government interest in “protecting the health and safety of its citizens, especially vulnerable children.” The bill’s title is the “Save Adolescents from Experimentation Act,” implying that GAC is a form of medical experimentation on unwilling youth. Bioethicists have long held that there is a distinction between clinical care and medical research, each of which requires different ethical standards and responsibilities toward patients and research participants. It is uncontroversial within the medical field that GAC is a valid form of healthcare.
Additionally, the bill perpetuates the “desistance” myth, or the erroneous notion that the majority of youth who begin puberty suppression or gender-affirming hormone therapy eventually stop treatment and identify with the gender they were assigned at birth. The conservative right wields these and other claims to justify policies that serve to exclude TGE people from accessing healthcare and other public accommodations, thinly veiling their transphobia as a “compelling government interest” to protect youth.
Combined with another recently passed Arkansas law (S.B. 289) that allows doctors to refuse to treat patients because of religious or moral objections (even though clinicians already have federal protections for conscientious objection to abortion and sterilization procedures), TGE people’s right to medical care is rapidly being eroded in the state. S.B. 289’s opponents, including the Human Rights Campaign and the American Civil Liberties Union, predict that it could allow doctors to refuse care to LGBTQ+ patients altogether in addition to further justifying limits on access to abortion, contraception, and other forms of reproductive healthcare.
This recent legislative action in Arkansas is part of an alarming nationwide policy trend of discrimination against TGE people. Anti-trans policies are continuing to diffuse throughout the United States, including state legislation restricting transgender girls from participating in sports and requiring TGE people to use bathrooms that correspond to their gender assigned at birth. This wave of new legislation is not random: the sheer volume of bills that have been introduced this year suggests a highly organized attack on the rights of transgender people that will require an equally coordinated response.
Author’s note: The author of this article, a cisgender white woman, wishes to note that her perspective does not fully capture the variety and nuance of perspectives among TGE people.