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Kansas bill barring gender-affirming medical treatments until age 21 draws fire from doctors

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Rose Conlon
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Kansas News Service

Kansas SB12 would make it a felony to provide gender-affirming care to teens and adults under the age of 21. Critics say it would harm transgender youth.

WICHITA, Kansas — Legislation introduced in the Kansas Senate this week would make it a crime for doctors to provide gender-affirming health care to transgender teens and adults under the age of 21.

That’s drawn almost immediate criticism from some health care providers and transgender rights advocates arguing the state should leave difficult medical choices to families and their physicians.

Republican state Sens. Mike Thompson of Shawnee and Mark Steffen of Hutchinson cosponsored the bill that would make it a class 4 felony to prescribe hormone replacement therapy or puberty blockers to people younger than 21. Clinicians would also risk losing their medical licenses.

The bill, labeled the “Kansas Child Mutilation Prevention Act,” would also prohibit providing gender-reassignment surgery to those under 21. In practice, such procedures are rarely offered to anyone younger than 18.

It’s part of a growing wave of legislation across the country that would restrict how transgender people can seek health care related to their gender identity. More than two dozen similar bills face state legislatures this year.

Thompson told reporters he wants to “protect these children from what could be life-altering and irreversible” medical treatments.

That’s despite the fact that the treatment options commonly available to minors are either fully reversible, in the case of puberty blockers that can be started at the onset of puberty, or partially reversible, in the case of hormones offered to older teens.

Some health care providers and transgender rights advocates criticized the bill as a dangerous government intrusion into medical decisions. They said it would further jeopardize the mental health of a population that already faces elevated rates of depression and suicide.

“This bill creates a sense of hopelessness for trans kids and their families,” said Stephanie Byers, a Democratic former state representative and the first openly transgender lawmaker in Kansas.

“Medical care should be left up to the individual, their families and their physicians — not politicians who have an agenda,” she said.

Amanda Mogoi, a nurse practitioner who specializes in treating transgender and nonbinary patients at her Wichita clinic, M-Care, said in a statement that access to gender-affirming medical care is vital for her patients.

“The social, psychological, and medical consequences of withholding treatment are well documented,” she said. “Health care should not be restricted or impeded by individuals or groups who know nothing of a patient’s medical and personal circumstances.”

Mental health

Most major medical groups — including the American Medical Association, the American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry — have opposed bills that would restrict gender-affirming treatment, calling the regulations dangerous and not based in evidence.

They said gender-affirming care is a vital tool for improving the mental health of transgender youth, who have been shown to experience significantly higher rates of depression and suicide than their peers. They’re also more likely to be bullied.

In Kansas, a recent survey by the Trevor Project found that 65% of transgender and nonbinary youth — kids who see themselves as neither clearly boy nor girl — experienced symptoms of depression in the past year. Additionally, 51% seriously considered suicide in the past year and 23% attempted suicide. Nationally, those rates run even higher among transgender youth of color.

Transgender respondents to a November report by the Kansas Department on Health and Environment reported that mental health is the number one issue affecting their health.

“We’re seeing an increase in suicidality among our youth,” said Lauren Lucht, executive director of mental and behavioral health for the University of Kansas Health System, “and we know that our transgender and nonbinary youth are at a high risk.”

A growing body of research indicates gender-affirming care reduces those risks, including a recent study in the Journal of the American Medical Association that found gender-affirming treatment was associated with up to 60% lower odds of depression and up to 72% lower odds of suicidality in transgender and nonbinary youths.

“There are clear mental health benefits of gender-affirming care,” said Alex Keuroghlian, a Harvard psychiatry professor and director of the National LGBTQIA+ Health Education Center at the Fenway Institute. “This is something that we see clinically in our practices, repeatedly.”

Too young?

Neither Thompson nor Steffen responded to questions from the Kansas News Service about the legislation.

But critics of gender-affirming care for young people have raised concerns about potential health implications of the treatment, and questioned whether young people are ready to make profound decisions changing their bodies. Others want doctors to more rigorously evaluate adolescents before they begin treatment.

Unknowns about the long-term consequences of the treatments still exist, and some research has suggested puberty blockers might impact bone density in some patients.

But doctors who treat transgender patients say delaying treatment until adulthood can also have grave implications. Young people who are denied gender-affirming care often experience prolonged gender dysphoria — a sense of unease because of a mismatch between their biological sex and their gender identity — and might face greater stigmatization or abuse by their peers.

“The ability for a transgender person to speak for themselves and affirm their own identity through gender-affirming medical care is life-saving,” said Mogoi, the Wichita nurse practitioner.

And while a small number of people who pursue gender-affirming treatments later decide to “detransition,” or stop or reverse those treatments, it’s rare.

One recent study found that the vast majority of transgender teens who began puberty suppression — often the first step in gender-affirming care, which can afford them more time in which to evaluate their decisions — decided to continue on to hormone replacement therapy. Another found that very few people regret their decision to undergo gender-reassignment surgery.

Critics of gender-affirming treatment have said that growing numbers of adolescents identifying as transgender could be attributed to influence from peers, especially among teens assigned female at birth. The “social contagion” theory emerged from a controversial 2018 study in the journal PLOS One concerning parent observations of “rapid onset gender dysphoria” in their children that sparked heated debate among medical experts.

The theory was rebutted in a 2022 study by Keuroghlian and others published in the journal Pediatrics.

“Unfortunately, this idea has made its way into state-level legislative battles around access to or banning of gender-affirming medical care for adolescents,” Keuroghlian said.

Other experts say the most likely reason why more teens and adults are openly identifying as transgender is because of a safer social environment — despite continued instances of hate crimes directed at transgender people — and growing options for medical care.

“The idea that you could brainwash somebody into having a different gender identity seems unlikely,” said Joshua Safer, executive director of the Mount Sinai Center for Transgender Medicine and Surgery in New York.

“I’m not saying that there isn’t any influence by peers on a temporary basis,” he said, “but certainly long-term and having somebody come in and actually get medication is a completely different situation.”

Lawmaking

Two years ago, House Republicans introduced a similar bill that would have banned gender-affirming medical care for those under 18. Last year, legislation that would have banned transgender girls and women from competing on girls’ and women’s sports teams narrowly failed when House Republicans fell just short of overriding Democratic Gov. Laura Kelly’s veto.

Kelly would likely veto the bill if it made it out of the Statehouse. But LGBTQ advocates worry there could be more political appetite for the restrictions this legislative session — and potential power for Republicans to override Kelly’s veto.

“So many changes have taken place in the Kansas Legislature with this last election,” said Byers, the former Democratic representative. “A lot of the more moderate Republicans are gone.”

Rose Conlon reports on health for KMUW and the Kansas News Service. You can follow her on Twitter at @rosebconlon or email her at conlon@kmuw.org.

The Kansas News Service is a collaboration of KCUR, Kansas Public Radio, KMUW and High Plains Public Radio focused on health, the social determinants of health and their connection to public policy.

Kansas News Service stories and photos may be republished by news media at no cost with proper attribution and a link to ksnewsservice.org.

Rose Conlon is a reporter based at KMUW in Wichita, but serves as part of the Kansas News Service, a partnership of public radio stations across Kansas. She covers health, the social determinants of health and their connection to public policy.