Doctors Oppose Tennessee's Trans Healthcare Bill

Doctors and researchers call on politicians to fight a recent proposed bill.

Posted Mar 09, 2020

In Tennessee, state legislators have introduced House Bill 2576 that would criminalize the provision of gender-affirming medical care to transgender youth. The proposed bill would label standard medical care, as outlined by The American Academy of Pediatrics and The Endocrine Society as child abuse.

Physicians and other experts on the mental health of transgender youth have been speaking out against the bill, noting that it contains dangerous medical misinformation. They highlight that the bill would cause serious harm to vulnerable adolescents if passed.

Nearly 100 physicians, researchers, and clinicians who treat transgender youth and youth with gender dysphoria have signed onto a letter to Governor Bill Lee asking that he and politicians in the state fight this dangerous bill.

In the letter, they point to several misleading claims in the bill. They note that the bill states “the majority of pre-pubescent children who claim a gender identity different from their biological sex will ultimately identify with their biological sex by young adulthood or sooner when supported through their natural puberty." This claim is false, as outlined in The Journal of The American Academy of Child & Adolescent Psychiatry.

Furthermore, under current guidelines set forth by The Endocrine Society, medical interventions are not offered until the onset of puberty, making this statement irrelevant to the matter at hand. Once adolescents reach puberty (i.e. the point when medical intervention is considered), it is rare for adolescents with gender dysphoria to stop identifying as a gender different from their sex assigned at birth. 

The bill goes on to state that “[gender-affirming medical treatments] carry elevated risks of mental illness… and may even contribute to suicide.” This is also false. To the contrary, a recent study in the journal Pediatrics found that access to pubertal suppression for transgender adolescents was associated with dramatically lower odds of suicidal ideation. Other studies have similarly shown that gender-affirming medical care for adolescents results in improved mental health outcomes. 

There is no evidence that these medical interventions worsen the mental health of young people. Additionally, these medications have been shown to be medically safe.

Despite being standard medical care for the treatment of gender dysphoria, as has been highlighted by The American Academy of Pediatrics, The Endocrine Society, and The American Academy of Child & Adolescent Psychiatry, the experts point out that it is extremely difficult for young people to access this medical care. In a recent study, fewer than 3% of transgender people who desired pubertal suppression during adolescence were able to receive it. 

The signatories highlight that HB2576 would put in place unnecessary barriers to care that would make access to these treatments even more difficult. They note that this would result in worsening mental health for a vulnerable patient population. They note that this is particularly concerning for transgender individuals, given a 40% suicide attempt rate.

The experts summarize by noting that HB2576 contains inaccurate scientific assertions and misleading claims. They note that if it were to become law, it would create barriers to medical care that would result in significant damage to the mental health of a vulnerable pediatric patient population. Signatories for the letter include doctors from The University of Tennessee, Vanderbilt University School of Medicine, Harvard Medical School, and Yale School of Medicine, among others.

Similar legislation has been introduced in states across the U.S. This week, the Alabama State Senate passed a bill that would put physicians in prison for up to a decade if they provide gender-affirming medical care to adolescents. A similar bill in South Dakota was recently defeated in the State Senate.

References

Olson KR. Prepubescent Transgender Children: What We Do and Do Not Know. Journal of the American Academy of Child and Adolescent Psychiatry 2016;55:155-6.e3.

Hembree WC, Cohen-Kettenis PT, Gooren L, et al. Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology and Metabolism 2017.

Turban JL, Ehrensaft D. Research Review: Gender identity in youth: treatment paradigms and controversies. Journal of Child Psychology and Psychiatry, and Allied Disciplines 2017.

Turban JL, King D, Carswell JM, Keuroghlian AS. Pubertal suppression for transgender youth and risk of suicidal ideation. Pediatrics 2020;145.

Costa R, Dunsford M, Skagerberg E, Holt V, Carmichael P, Colizzi M. Psychological support, puberty suppression, and psychosocial functioning in adolescents with gender dysphoria. The Journal of Sexual Medicine 2015;12:2206-14.

de Vries AL, McGuire JK, Steensma TD, Wagenaar EC, Doreleijers TA, Cohen-Kettenis PT. Young adult psychological outcome after puberty suppression and gender reassignment. Pediatrics 2014;134:696-704.

Klaver M, de Mutsert R, van der Loos MA, et al. Hormonal Treatment and Cardiovascular Risk Profile in Transgender Adolescents. Pediatrics 2020.

Rafferty J et al. Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents. Pediatrics 2018;142:e20182162.

The American Academy of Child & Adolescent Psychiatry. AACAP Statement Responding to Efforts to Ban Evidence-Based Care for Transgender and Gender Diverse Youth. 2019.