SAHM Statement in Opposition of State Legislation Barring Evidence-Based Treatment

 
There are an increasing number of bills introduced in state legislatures within the U.S. that would bar medically necessary and evidence-based treatments for patients and interfere with the doctor-patient relationship. These bills would make providing pubertal blockers or cross-sex hormones for transgender and gender-diverse patients younger than 18 years-old a felony or misdemeanor for physicians and other health care providers. These bills are harmful for the health and well-being of transgender and gender diverse youth, a vulnerable population.
 
As an organization that advocates for the health and well-being of all teenagers and young adults, the Society for Adolescent Health and Medicine (SAHM) affirms that transgender and gender diverse youth should have access to all available treatments that will affirm their gender identity, whether it be social support, mental health therapy, pubertal blockers, or cross-sex hormones. Any legislation that would make it a felony or misdemeanor to provide any of these treatments lacks empirical justification and will harm patients.
 
Transgender and gender diverse youth experience distress from their bodies not matching their gender identity as well as from stigma and discrimination from society. As a result, transgender youth are six times more likely to have anxiety, four times more likely to have depression (i Bercerra-Culqui et al., 2018), and four times more likely to engage in substance use (ii Day et al., 2017) compared to their non-transgender peers. Because of family rejection, forty percent of transgender youth are homeless (iii Hafeez et al., 2017). About half of transgender and gender diverse youth have considered or attempted suicide (iv Haas et al, 2014). Additionally, they have limited access to health care due to anti-trans stigma and discrimination, with a fifth of transgender people reporting that their healthcare providers have refused to treat them or have kicked them out of their practice because of their gender identity and/or expression (v Grant et al., 2011); therefore, such laws would make healthcare for transgender youth even more difficult to access.
 
A growing number of medical organizations, including the American Academy of Pediatrics, the World Professional Association for Transgender Health, and the Endocrine Society have stated that the best way to provide care for transgender and gender diverse youth is to support and affirm their gender identity, whether it be by social support, mental health therapy, pubertal blockers, or cross sex hormones. Furthermore, there is growing robust evidence that these treatments are associated with better health outcomes for transgender and gender diverse youth. Transgender youth who receive cross-sex hormones have a 75% decrease in suicidality and a 14% increase in general well-being (vi Allen et al., 2019), and transgender youth who receive pubertal blockers, when needed, experience a 70% decrease in lifetime suicidality (vii Turban et al., 2020) and a 25% decrease in psychological problems (viii de Vries et al., 2014).
 
SAHM We urges all state legislators where these bills are being introduced to vote against such proposals and instead spend the time to know and work with their transgender and gender diverse constituents to propose laws that would expand health care access to these historically disenfranchised citizens. We also ask SAHM Chapters who represent states where this type of legislation is being introduced, to contact Executive Director Ryan Norton for assistance with statements of opposition to the legislation being proposed. 
 
 
References
 
  1. Tracy A. Becerra-Culqui, Yuan Liu, Rebecca Nash, Lee Cromwell, W. Dana Flanders, Darios Getahun, Shawn V. Giammattei, Enid M. Hunkeler, Timothy L. Lash, Andrea Millman, Virginia P. Quinn, Brandi Robinson, Douglas Roblin, David E. Sandberg, Michael J. Silverberg, Vin Tangpricha, Michael Goodman. Mental Health of Transgender and Gender Nonconforming Youth Compared With Their Peers. Pediatrics May 2018, 141 (5) e20173845; DOI: 10.1542/peds.2017-3845
     
  2. Day J.K., Fish J.N., Perez-Brumer A., Hatzenbuehler M.L., Russell S.T. Transgender youth substance use disparities: results from a population-based sample. J Adolescent Health. 2017;61(6):729–735
  3. Hafeez H, Zeshan M, Tahir MA, Jahan N, Naveed S. Health Care Disparities Among Lesbian, Gay, Bisexual, and Transgender Youth: A Literature Review. Cureus. 2017;9(4):e1184. Published 2017 Apr 20. doi:10.7759/cureus.1184
  4. Haas, A.P., Rodgers, P.L., and Herman, J.L. (2014). Suicide Attempts among Transgender and Gender Non-Conforming Adults: Findings of the National Transgender Discrimination Survey. The Williams Institute. Accessed January 30, 2020. URL: https://williamsinstitute.law.ucla.edu/wp-content/uploads/AFSP-Williams-Suicide-Report-Final.pdf  
  5. Grant JM, Mottet, Lisa A., Tanis, Justin, Herman, Jody L., and Keisling, Mara. Injustice at Every Turn: A Report of the National Transgender Discrimination Survey. Washington: National Center for Transgender Equality and National Gay and Lesbian Task Force; 2011.
  6. Allen, L. R., Watson, L. B., Egan, A. M., & Moser, C. N. (2019). Well-being and suicidality among transgender youth after gender-affirming hormones. Clinical Practice in Pediatric Psychology, 7(3), 302–311. https://doi.org/10.1037/cpp0000288 
  7. Turban, J.L., King, D., Carswell, J.M., Keuroghlian, A.S., 2020. Pubertal Suppression for Transgender Youth and Risk of Suicidal Ideation Pediatrics January 2020, e20191725; DOI: https://doi.org/10.1542/peds.2019-1725  
  8. Annelou L.C. de Vries, Jenifer K. McGuire, Thomas D. Steensma, Eva C.F. Wagenaar, Theo A.H. Doreleijers, Peggy T. Cohen-Kettenis. Young Adult Psychological Outcome After Puberty Suppression and Gender Reassignment Pediatrics Oct 2014, 134 (4) 696-704; DOI: 10.1542/peds.2013-2958

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