Endocrine Society Condemns Efforts to Block Access to Medical Care for Transgender Youth

The treatment of transgender and gender diverse youth should be governed by the best available medical evidence, not politics.

With Joshua Safer MD, FACP, FACE

On April 6, Arkansas passed the Save Adolescents From Experimentation (SAFE) Act, otherwise known HB 1570.

With the passing of the bill, Arkansas became the first state to ban gender-affirming care for transgender and gender diverse youth. HB 1570 prevents clinicians from prescribing identity-affirming puberty blockers, hormone replacement therapy, and surgeries to trans youth under the age of 18.

Additionally, the bill prohibits doctors from providing already-prescribed therapies to youth, which would mean trans and gender diverse youth who are already being treated will no longer be able to gain access to medication previously prescribed by their doctors.

Transgender Medical Care Guidelines

Dr. Gary Wheeler, who is a pediatric infectious disease physician and the president of the American Academy of Pediatrics Arkansas Chapter, says, “HB1570 limits physician care and referral for transgender patients and is a dramatic invasion of the legislature into patient and physician privileged care. The bill is in conflict with standards of practice and is strongly opposed by multiple national medical organizations.”

The passing of HB 1570 came after Arkansas governor Asa Hutchinson vetoed it. Now, 19 other states are considering or are introducing legislation like the SAFE Act. The Human Rights Campaign (HRC) counted nearly 80+ anti-trans bills in legislation in 2021, making it a record-breaking year.

Examples include two bills introduced in Texas. HB 1646 stipulates that it is considered child abuse to provide medical intervention to trans youth under the age of 18, while HB 1311 aims to prevent liability insurance coverage for gender-affirming surgeries and treatments for some children.

Transgender People Denied Medical Care

Parents, advocates, and youth alike are concerned about what this bill — and others like it — could mean for patients who are receiving these therapies or who hope to in the future.

Puberty blockers, hormone therapies and surgery are treatments that fall under the Gender-Affirmative Care Model (GACM), which is geared toward understanding and appreciating youth gender experience, according to a recent policy statement from the American Academy of Pediatrics in support of the practice.

Is Transgender a Medical Condition?

The GACM states that trans and gender diverse expressions are not a mental disorder, that variations in identity are natural and that gender is a combination of biology, development, culture and socialization.

The Endocrine Society and other medical organizations who oppose the bill argue that stripping medical practitioners of their licenses or suing them for prescribing gender-affirming care to youth is a dangerous rejection of science, and that bills like HB 1570 are further adding to anti-trans prejudice.

Research has repeatedly shown that when trans and gender diverse youth are denied proper medical care and treatment by qualified health and mental health professionals, the risk for suicide, suicidal ideation and self-harm sharply increases.

According to the Trevor Project, which issued a statement condemning HB 1570, “More than half of transgender and nonbinary youth seriously considered suicide in the past year, compared to 40 percent of all LGBTQ youth.”

How to Support Transgender Youth

Studies increasingly show that young people who are able to access gender-affirming care such as puberty suppression medication, hormone therapy and surgery experience significantly improved mental health. Unfortunately, 80% of endocrinologists are not trained in transgender medicine in medical school, according to the Endocrine Society. 

According to Endocrine Web Editorial Board Member Joshua Safer MD, FACP, FACE, co-author of the Endocrine Society’s Position Statement on Transgender Medicine, “The treatment of transgender and gender diverse youth should be governed by the best available medical evidence, not politics. As our patients’ physicians, we are always working to deliver the best care possible based on medical evidence."

Gender-affirming care shouldn’t be up for debate. It is a medical practice like any other. Safer continues, “When caring for transgender and gender diverse youth, physicians and mental health professionals must be able to freely practice and choose the best available treatment options in consultation with the patients and their parents, as they would when treating any other condition.”

According to trans advocate Cody Miller Pyke JD, who identifies as transgender and non-binary, there isn't a valid reason for legislators to be introducing these bills.

Pyke says, “Legislators are only offering these bills for one of two reasons. One, they are tokenizing and scapegoating children for political gain, or two, they have no genuine understanding of trans health issues and are reacting out of fear. The former is abhorrent, and the latter is ignorant.” To make matters worse, "Legislators aren't talking to trans folks or their advocates. They aren't coming to the table in good faith. They are not trying to learn or understand the trans experience, or the mountain of science that supports gender-affirming care."

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