In the face of unjust bans, California can expand lifesaving, gender-affirming care | Opinion

This spring, a family contacted me from Texas. Their teenage son has been on testosterone for a year, but Texas’ recently passed ban on transgender care means their child can no longer be prescribed hormones. As multiple studies show, without access to hormones and gender-affirming health care, this child is now at a higher risk of poor health outcomes, including depression and suicide. In fact, their son is increasingly exhibiting these symptoms and does not want to go to school.

Transgender care is evidenced-based, lifesaving and, as such, a public health imperative. Laws criminalizing care are cruel and dangerous for transgender people of all ages. As a doctor licensed in California, I am ready and willing to provide care for this patient via telemedicine. But current California law does not protect me from efforts by Texas to criminalize providers for acting in our patients’ best interest.

Opinion

A bill authored by California Sen. Nancy Skinner, D-Berkeley, would change that, opening opportunities to address the concurrent public health, human rights and medical crises unfolding across Texas and the country. Known as a shield law, Senate Bill 345 passed through the Senate and is now making its way through the Assembly. It proposes substantial protection — from arrest, loss of license, or other forms of retribution — to medical providers licensed in California who use telemedicine to provide gender-affirming care and abortion care regardless of a patient’s location.

As with abortion, unjust bans have decimated access to gender-affirming care across the country. Eighteen states now restrict gender-affirming care for youth, and some have made it a felony for health care professionals and parents of trans youth to provide or facilitate such care. Florida Gov. Ron DeSantis and Texas Gov. Greg Abbott have both signed laws banning transgender care for youth, though Florida’s has since been temporarily enjoined by a federal judge.

Trans kids are already much more vulnerable to abuse and neglect than cisgender kids, and, with these laws, their prospects are worsening. A Kaiser Family Foundation summary of public health data notes that transgender youth who cannot access puberty suppressors and hormone therapy face worse mental health outcomes, including higher rates of suicidal thoughts and suicide. On top of this, transgender youth in some states now face the trauma of losing their parents, who can be arrested for getting their children the very care they need.

Bans on gender-affirming care are deeply intertwined with abortion bans, all of which disproportionately affect communities of color, low-income communities and trans and gender-diverse communities. As clinics close and doctors leave states where they are unable to practice evidence-based medicine, the costs to access essential care with travel to another state — loss of work, child care, flights, gas, hotels and food — are out of reach for many.

At a time when stigma and stochastic violence against vulnerable communities is on the rise, trans folks are especially vulnerable to both discrimination in health-care settings and to being reported to police by the very health care medical professionals from whom they seek help, especially if they have to travel for care.

As a physician, I am skilled in both transgender health and abortion care. I have a choice between following the Hippocratic Oath that I took upon finishing medical school and breaking a law that is inherently misguided and wrong. I choose to follow my conscience. Expanding telemedicine to serve patients regardless of their location enables me to provide lifesaving care that’s critical to meeting patients’ needs and reducing harm. Through secure video-conferencing, I can provide hormone therapy, medication abortion and other essential care.

By expanding shield laws, we can mitigate harms and increase access to vital health care in all 50 states, including in rural and low-income areas of California. Colorado, Massachusetts, New York, Washington and Vermont all now have strong shield laws protecting providers using telemedicine.

SB 345 will save lives. With the protections it offers, more providers in California will use telemedicine to stem the growing national public health crisis.

Jen Hastings, MD, is genderqueer and an assistant clinical professor at the UCSF Department of Family and Community Medicine with more than 25 years of experience in transgender health care and reproductive care in California.