Definitions:
In this article, transgender is used as an umbrella term to describe youth whose gender identity or gender expression does not conform to those typically associated with the gender they were told they were at birth. Oftentimes, the term trans is used interchangeably with the term transgender. The term gender-diverse has emerged as an umbrella term for youth who identify beyond the gender binary, meaning outside of the socially expected “male” and “female” genders; youth who are gender-diverse may identify as “non-male” and/or “non-female.”
In 2023, American conservative political commentator, Michael Knowles, called for the “eradication of transgenderism.” Today, state legislators across the country are constructing an agenda around this argument by introducing a record-breaking number of bills aimed at restricting access to gender-affirming care for transgender youth.
Defined by the “American Medical Association” (AMA) as “medically-necessary, evidence-based care that improves the physical and mental health of transgender and gender-diverse people.” Gender-affirming care encompasses a range of services necessary for the well-being of transgender youth experiencing gender dysphoria. With access to gender-affirming care, transgender youth have lower suicide rates and improved health outcomes. Since the beginning of fiscal year 2023, we have witnessed a rise in state legislation that would prohibit these life-saving services.
The transgender community is at risk in the United States. According to the “National Institutes of Health,” transgender individuals have a 40% suicide rate, one of the highest among the LGBTQ+ community. As reported by the “Trevor Project,” 36% of transgender youths do not believe that they will live past the age of 35. For the transgender community, gender-affirming care holds the power to lower these devastating statistics.
While legalized forms of discrimination against transgender individuals is not new in the United States, bills targeting the healthcare of transgender youths are, commencing only within the last 3 years. Before 2021, no state had laws specifically banning medical care for transgender youth. In 2023, over 125 bills–more than the past six years combined–were introduced by state legislators intending to limit gender-affirming care for youths. Of these 125-plus bans, 12 were passed and signed into law. With these in place, 44% of all transgender youth now live in states where they either cannot access medically necessary care or are at risk of it being banned, according to the “Human Rights Campaign” (HRC).
Jeff Livingston, a well-known drag artist who performs under the name Annie Manildoo, admits that while he’s seen changes in the LGBTQ+ community after these bills, it’s only a newer obstacle in the centuries of challenges that transgender individuals have had to face. “People are definitely becoming more and more disenfranchised and vigilant […] there’s always been anxiety associated with being a person who lives outside the gender norm, so I think that this is just amplifying what has already existed,” said Livingston.
This increase in attacks is not historically unprecedented, as Livingston points out. “Any time that there is a group that is a minority […] any time that group starts to gain traction and power, the majority tends to get nervous,” Livingston said. As the LGBTQ+ community gains more acceptance and power within society, the pushback from opposing sides increases.
While these bills primarily target transgender youth, five states have made it a crime to provide or aid youths in accessing gender-affirming care. Medical practitioners in these states face criminal charges, or the loss of their medical license for providing best-practice medical care for transgender patients under 18. Similarly, parents can face criminal charges for acting in any way that aids or abets their children in receiving gender-affirming care. In light of this, the HRC declared the first national state of emergency for the LGBTQ+ community.
When these bans fail to pass, legislators have created other ways of limiting access. In Texas, State Attorney General Ken Paxton issued a nonbinding legal opinion classifying gender-affirming care as criminal child abuse. This movement ultimately failed but sparked similar legislation across the country.
“When things get mentioned by people with some kind of power, like politicians […] it can help to validate certain opinions that people might have,” Livingston said. “Even if certain laws don’t necessarily get passed, just putting those ideas into the zeitgeist does its own kind of irreparable damage because that’s swaying public opinion and I think that’s just as dangerous as a lack of access,” Livingston continued.
While not all bills are being passed, it is indicative of a shift in public opinion. As Livingston notes, “Once something happens somewhere, who’s to say it’s not just going to keep happening?”
However, as legislation continues, several forces are working to preserve the right to healthcare for transgender youth across the country. The AMA itself has publicly opposed the restrictions on transgender medical care and deems treatment for gender dysphoria to be medically necessary. According to Board Member Michael Suk, “The AMA opposes the dangerous intrusion of government into the practice of medicine and the criminalization of health care decision-making.”
While some states are attacking transgender youth, others are passing laws in defense of the transgender community. In 2023, New York State Governor Kathy Hochul signed a law declaring New York a safe haven state, guaranteeing gender-affirming care for transgender individuals and legal safety for their parents and doctors.
Chanel Lopez, Deputy Director of LGBTQ+ Affairs in Governor Hochul’s office, says that for the gender non-conforming employees in the state, it’s essential to pass legislation that increases protections for all people in the face of oppression. “We take it personal because it’s like attacking us,” Lopez said. “We are constantly creating new bills to protect the trans community,” said Lopez.
Additionally, the Biden administration is pushing for federal laws to protect transgender rights in all states. Having described anti-transgender bills as “close to sinful” and “cruel,” the President of the United States passed an executive order in 2023 promising to safeguard access to gender-affirming care for all transgender Americans, including youths. Within the order, the “Department of Health and Human Services” (HHS) has been tasked with promoting “expanded access” to care across the country. While it is too early to determine the success of this legislation, it is certainly a step in the correct direction.
“The Department of Justice” is working to combat the onslaught of attacks. Recently, Kentucky attempted to pass SB 150, and “The Department of Justice” responded, claiming that “by denying transgender youths–and only transgender youths–access to medically necessary and appropriate care, [the bill] violates the Equal Protection Clause of the Fourteenth Amendment.” Viewing anti-transgender legislation as a violation of federal law signals that the federal government recognizes the inherent right of transgender youth to be protected from discrimination.
At a time in history where, according to a Marist Poll, 54% of Americans say that they oppose bills criminalizing gender-affirming medical care for youths, these anti-transgender bills do not reflect the opinion of the majority population.