GOP bill ignores data on dangers of not providing gender-affirming care to trans youth
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As the mental health of trans and gender diverse youth continues to alarm specialists across Wisconsin, Republican lawmakers have introduced a bill that medical experts warn will have disastrous outcomes for adolescents and families across the state.
The bill, "Help Not Harm," would bar health care providers from conducting or making referrals for certain medical practices for youth under 18 "if done for the purpose of changing the minor's body to correspond to a sex that is discordant with the minor's biological sex," according to a summary from the nonpartisan Legislative Reference Bureau.
RELATED: Republican bill bans gender-transition treatment for minors
On Oct. 4, it generated heated public testimonies at the state Capitol. Democratic Gov. Tony Evers is expected to veto the Republican bill if it passes committee and reaches the floor, but the bill's introduction, perhaps ironically, does harm in and of itself, said Stephanie Budge, an associate professor in counseling psychology at the University of Wisconsin-Madison.
"Research shows there's a psychological impact of these anti-LGBTQ+ bills. Even before we consider if it passes, there's so much harm, because it's dehumanizing," Budge said.
Gender-affirming care encompasses a range of social, psychological, behavioral and medical interventions, according to the Association of American Medical Colleges. Contrary to many popular assumptions, gender-affirming care is not defined solely by medical interventions like surgery.
Medical experts across the state and nation have resoundingly supported gender-affirming care for young people. The American Academy of Pediatrics, representing about 67,000 pediatricians, reaffirmed its support for gender-affirming care in August, maintaining that a comprehensive affirmative care model results in fewer mental health concerns for young people. It also noted the harm of "reparative" approaches, which serve to prevent children and adolescents from identifying as transgender or exhibiting gender-diverse expressions, and have publicly denounced bills like "Help Not Harm."
Additionally, the Wisconsin Medical Society identified transgender individuals as being among the highest risk groups for suicide in the state. According to its policy compendium, the society opposes legislative restrictions on gender-affirming care and supports increased access to gender-affirming care for transgender and gender-diverse youth.
Research overwhelmingly supports gender-affirming care for young people experiencing gender dysphoria, said Budge.
The American Academy of Pediatrics defines gender dysphoria as a clinical symptom characterized by "a sense of alienation to some or all of the physical characteristics or social roles of one’s assigned gender." It's also recognized in the Diagnostic and Statistical Manual of Mental Disorders, the guide used by mental health professionals in the United States.
"When I have worked with clients who are trans or nonbinary and they have experienced medical gender-affirming care, it has been life-saving and life-changing for youth. There's no other way for me to say that," Budge said. "And if I was seeing something different, it wouldn't be ethical for me to continue to do this work."
Gender-affirming care is proven to improve the mental health
More than any other group, LGBTQ+ Wisconsinites are struggling with the highest levels of anxiety, depression and self-harm, according to the 2021 state Youth Risk Behavior Survey. They're also more than twice as likely to be bullied than heterosexual students, no matter if the location is on school property or online.
LGBTQ+ Wisconsinites also struggle much more with suicidal ideation than heterosexual students in the state. Nearly half of all LGBTQ+ youth in Wisconsin have considered suicide, nearly 40% made a plan and nearly a quarter of all LGBTQ+ youth have attempted suicide over the course of 12 months.
According to the Wisconsin Transgender Youth Community Needs Assessment, which partnered with the Department of Pediatrics at the University of Wisconsin-Madison, the Transgender Youth Resource Network and the Wisconsin Transgender Health Coalition, a little more than 80% of transgender and gender-diverse youth don't have a health care provider who is competent and knowledgeable about their health needs.
One in four youths have traveled outside their communities in an attempt to find appropriate medical support, according to the study. Of those who travel within Wisconsin, they spent an average of about an hour en route to a clinic. For those traveling beyond state lines, the average was closer to 175 minutes.
In contrast, data from more than a dozen studies on more than 30,000 transgender and gender diverse adolescents consistently show that gender-affirming medical care "results in favorable mental health outcomes," according to a Psychology Today article by Dr. Jack Turban, a child and adolescent psychiatrist at Standford University who specifically studies the mental health of transgender and gender diverse youth.
"Gender-affirming care is suicide prevention. And it goes beyond the health care provider’s office," said Mel Freitag, an educator and advocate of LGBTQ+ health. "You're validating someone's identity, which encompasses everything from how they see their pronouns to their anatomy. That improves trust in the patient-provider relationship and, in the end, prevents harm."
Adolescents, usually in the age range of 14 to 16, who receive hormone replacement therapy report having less depression, anxiety, suicidality, self-harm, and engagement with substance use, said Budge.
"One of the things we, as clinical researchers, talk about is: Does the person's gender dysphoria decrease after engaging in gender-affirming care? And the answer from the research is yes, that is an outcome of gender-affirming care," Budge said.
Here's what to know about gender-affirming care for adolescents
Most clinicians rely on guidance from the World Professional Association for Transgender Health (WPATH), which breaks gender-affirming medical care into three categories:
Fully reversible puberty-delaying blockers as soon as puberty has started;
Partially reversible hormone therapy for adolescents aged 16 and older;
Irreversible surgeries at age 18 or older, with the exception of chest masculinizing mastectomies or top surgeries, which carry an age minimum of 16.
WPATH recommends that health care professionals assess whether a patient has had a persistent childhood history of gender dysphoria, especially emerging at the onset of puberty, to determine whether gender-affirming care is appropriate.
Any course of action, according to WPATH, must include a team of health care professionals, mental health and medical professionals, to reach the best decision.
Health care providers require parental consent before gender-affirming care can proceed for children under the age of 18, and gender-affirming surgery for minors, especially genital surgery, is rare, Budge said. When she has made referrals for mastectomies, they were in alignment with WPATH's standards of care guidelines, and the patients she referred for that procedure were at least 17 years old.
"If you look at the experts who work with the children who identify as trans and nonbinary, they might just have therapy for a couple of years before they even think about hormones, if at all," Freitag said, adding that hormones would come far before any conversation about surgeries. "There's no such thing as an immediate medical intervention. That's such a linear mindset."
Health care providers such as the Pediatric and Adolescent Transgender Health, or PATH, in Madison, don't perform genital surgeries, and only do top surgeries for patients under 18 following multidisciplinary evaluation, a letter of support from their mental health provider and with informed consent from all legal guardians.
“UW Health is committed to providing gender-affirming care that is evidence-based, patient-centered, and that focuses on the health and well-being of patients seeking the bright future they deserve," said UW Health CEO Dr. Alan Kaplan.
On average, more than 200 adolescents per year between the ages of 13 and 17 receive mastectomies in the United States, according to a special report on gender transitions by Reuters.
More common treatments are pubertal suppression, also known as puberty blockers, and hormone replacement therapy.
Studies also demonstrate that an overwhelming majority of trans youth, at 98%, who started gender-affirming medical treatment continued to use hormone replacement therapy when they reached adulthood.
Medical providers also take seriously the possibility of regret associated with gender-affirming medical care. The rates of reported regret, however, are low, according to WPATH. And detransitioning, a term often applied to transgender youth who reverse their gender identification, is rare. Even among the small pool of patients who do end up detransitioning, research suggests that youth don't regret initiating treatment, as it helped them better understand their gender-related care needs.
"Our job is to support a youth through understanding their identity, and adolescence is a time of identity exploration. A lot of adolescents are exploring identity and what that looks like for them," Budge said. "In my experience, the adolescents who are in more of the exploratory phases are the ones who are not undergoing any type of medical care."
Fundamentalist Christian ministries are behind bills like 'Help Not Harm'
The 2020 Republican platform emphasizes that the patient-physician relationship must be built on "mutual trust, informed consent and confidentiality." It also supports "the right of parents to determine the proper medical treatment and therapy for their minor children.” And yet, as it approaches the 2024 presidential election, the party in state after state has attempted to enact legislation that is absolute in determining their is no gray area in gender.
In Wisconsin, the Help Not Harm bill would ban gender-affirming care for minors and would target health care providers for "engaging in, causing the engagement in, or making certain referrals for these medical interventions."
The bill sets up a dangerous precedent for the right to medical privacy, said Freitag, and it misses that gender-affirming care is a years-long process, not a single major decision made in a vacuum. Someone else's religious beliefs, Freitag said, shouldn't impact another individual's right to medical decisions.
Help Not Harm is one of many efforts drafted and lobbied for by Family Policy Alliance and Family Policy Alliance Foundation, fundamentalist Christian ministries that mobilize Republican lawmakers to propose laws informed by their understanding of the Bible and version of Christianity. Family Policy Alliance opposes efforts to raise LGBTQ+ citizens to protected-class citizens, create non-discrimination laws for LGBTQ+ citizens, and allow transgender individuals to serve in the military, among other efforts to galvanize constituents against LGBTQ+ and specifically trans people.
So far, 20 states have passed Help Not Harm bills, including Florida and Texas. In four states, including Louisiana, Arkansas, South Carolina and Kentucky, the governors' vetoes' were overridden, although a federal judge blocked Arkansas' law banning gender-affirming care for minors in June. That's relevant in Wisconsin, since Evers has already vowed to veto any bills targeting LGBTQ+ youth.
This is not the first time Republican lawmakers have attempted to ban elements of gender-affirming care. In July, Evers vetoed a provision in the state budget that would have blocked Wisconsinites from getting Medicaid coverage for certain gender-affirming services. A federal judge had struck down a state policy excluding adults from getting gender-affirming services through Medicaid coverage in 2019.
"If the bill (banning gender-affirming medical care) passes, it will be harmful. Trans youth won't be able to access medically necessary care," Budge said. "And we know that that will increase suicide attempts and suicide completions in trans youth."
Natalie Eilbert covers mental health issues for USA TODAY NETWORK-Wisconsin. She welcomes story tips and feedback. You can reach her at neilbert@gannett.com or view her Twitter profile at @natalie_eilbert. If you or someone you know is dealing with suicidal thoughts, call the National Suicide Prevention Lifeline at 988 or text "Hopeline" to the National Crisis Text Line at 741-741.
This article originally appeared on Green Bay Press-Gazette: Republican bill in Wisconsin ignores medical community recommendations
