Transgender youth health care bans have a new target: adults

Lawmakers in at least three states this year have filed legislation meant to restrict access to gender-affirming health care for individuals as old as 26, an escalation of a battle waged nationwide last year over whether children should be able to access certain prescription medications and procedures.

Bills filed this year in Oklahoma, South Carolina and Virginia aim to bar state health care providers from recommending or administering treatments like puberty blockers, hormones and gender-affirming surgeries to patients younger than 21, signaling an aggravation in the fight over transgender health care.

Another Oklahoma bill filed this month would prohibit adults up to 25 from receiving gender-affirming care in one of the most extreme and restrictive bans introduced to date. The state’s proposed “Millstone Act,” which gets its name from a Bible verse about punishing adults who harm children, would also block Oklahoma’s Medicaid program from providing coverage for “gender transition procedures” to individuals younger than 26.

“I don’t think it was ever about children,” Erin Reed, an independent legislative researcher, told The Hill this week, referring to state and federal attempts to ban gender-affirming care over the past two years.

GOP legislators’ arguments against transgender health care have in the past centered around a need to protect children from alleged predatory doctors and “woke” gender ideology. Bills filed across the country last year used inflammatory and misleading rhetoric to disparage gender-affirming care for youth with titles like the “Save Adolescents from Experimentation Act” and the “Protect Children’s Innocence Act.”

“These adult bans show that that’s not what it was about,” Reed said. “It’s about banning care entirely. It’s about forcing transgender people back in the closet.”

State legislators haven’t moved away from youth health care bans entirely, and dozens of bills seeking to ban gender-affirming care exclusively for minors have already been introduced in more than 10 states this year.

Reed added that she’s skeptical whether legislators sponsoring adult health care bans this year expect those measures to pass as written. It’s likely, she said, that lawmakers are targeting older individuals to make youth health care bans appear less extreme and more palatable.

“This is, in part, a way that they’re trying to make it easier to pass gender-affirming care bans for smaller groups in the population,” she said.

Efforts to restrict transgender adults’ access to health care lean heavily on claims from so-called “gender-critical” organizations that young people should not be recognized as adults before they turn 25, when the human brain is believed to reach full maturity.

State GOP lawmakers in Missouri last year weighed extending a proposed youth health care ban to adults under 25, arguing that individuals even into their early 20s are unable to fully consent to gender-affirming interventions.

That and similar claims have been disputed by medical experts and physicians with experience treating transgender youth, and multiple inquiries have found that affirming a child or adolescent’s gender identity can improve their mental health outcomes into adulthood.

Passing laws to delay health care deemed medically necessary by most major medical associations is also dangerous, according to Dr. Meredithe McNamara, an assistant professor of pediatrics at Yale University, and runs the risk of worsening rates of anxiety, depression and suicidality among transgender youth and young adults struggling with gender dysphoria.

Nearly 20 percent of transgender and nonbinary 13- to 24-year-olds surveyed last year by The Trevor Project, a leading LGBTQ youth suicide prevention organization, said they had attempted suicide in the past year. Fewer than a third said their gender identity was affirmed at home.

For McNamara, who treats transgender youth aged 11-25, the primary concern with adult health care bans lies with individuals under 21 — or 26, in Oklahoma’s case — who are already receiving gender-affirming medical care.

“There are people currently on treatment, living as their authentic selves and experiencing relief from gender dysphoria who face forcible detransition,” she said.

None of the proposed measures include language or provisions that explicitly address transgender youth and young adults already receiving medications like hormones or puberty blockers.

Efforts to restrict gender-affirming health care for adults also risk backfiring by limiting the freedoms of individuals who can legally vote, drink a beer and go to war. They also discriminate based on sex and transgender status, according to Chase Strangio, deputy director for transgender justice at the American Civil Liberties Union LGBTQ & HIV Project, making them unconstitutional.

“It’s not about protecting anyone,” Strangio said of recent legislative efforts to restrict gender-affirming care. “It’s about an opposition to trans identity.”