As a mother of two transgender children living in Tennessee, Kristin Marquardt Itnyre is terrified. On March 26, the governor, Bill Lee, signed a discriminatory bill that would require middle school and high school athletes to show proof of their assigned sex at birth, effectively banning trans youth from taking part in sports. Unfortunately, this piece of legislation is only the beginning. At least six states, including Tennessee, moved to criminalize providing gender-affirming care — which encompasses temporary puberty blockers or hormone therapy — to children who identify as transgender in 2020 alone.
Although he was past the age of exploring puberty blockers, a form of gender-affirming care, Kristin's oldest child, Griffin, came out as transgender at age 15. However, Kristin's 9-year-old daughter, May, was eager to get treatment. "She wanted to [explore the options]," Kristin told POPSUGAR. "And we're set to start them soon. My fears are that this legislation is going to pass this bill and my child is not going to be able to get those blockers. She'll be forced to go through male puberty, which for her mental health is not beneficial. I'm hoping that if the bill passes in Tennessee, it will go to the Supreme Court and get shot down."
A sense of deep-rooted fear has developed among parents of transgender children, Kristin shared. "As far as the LGBTQ+ community goes, parents are very scared," she said. "We're talking about the mental health of our kids, and the suicide rate for these transgender kids is so high. We feel powerless at times, but we are really trying to fight this legislation. Living in the bible belt, there's a big consensus that being transgender is wrong and God doesn't make mistakes."
"These kids just want to be who they are. And it's not fair."
But Kristin — who had a feeling May might identify as transgender ever since she was a preschooler — disagrees with this notion. "From about three years old, we knew," she said. "And then finally, about a year ago she was able to come out and said, 'Why couldn't I have been born a girl? I'm supposed to be a girl. I want to be a girl.' We had her name legally changed, and now she's just May. That's all anybody knows her as. I don't even remember the kid that she was before."
Since recently moving and enrolling May in another school where she is free to express herself as a girl, Kristin's family has been met with unwavering support from the school system. Although May has been encouraged by her peers and teachers to embrace her identity — and even has access to gender-neutral bathrooms — the mounting discrimination from lawmakers and right-wing organisations is still unbearable for Kristin.
"These kids just want to be who they are. And it's not fair," she said. "I had to explain to my daughter who plays football on a co-ed team right now that Tennessee passed the anti-trans athlete bill. And her response was so innocent at 9 years old. She said, 'It feels like people don't want transgender people to do anything.'"
"From about three years old, we knew," she said. "And then finally, about a year ago she was able to come out and said, 'Why couldn't I have been born a girl? I'm supposed to be a girl. I want to be a girl.'"
Over the last two years specifically, the discrimination the LGBTQ+ community has faced at a national level has been overwhelming. According to the Human Rights Campaign, 240 anti-trans bills — including initiatives that ban transgender youth from playing sports, prevent them from using school bathrooms that coincide with their gender identity, and deny them access to proper medical care — are currently under consideration across the US. In the first four months of 2021 alone, 82 anti-trans bills have been introduced throughout the country. The previous record was set last year, with 79 discriminatory bills being introduced. Coupled with the fact that 26 anti-transgender laws were proposed in 2018 and 19 bills were proposed in 2019, the overwhelming concern in the LGBTQ+ community is justified.
Texas is the latest state to pass anti-trans legislation with a new law that bans transgender kids from playing sports. Moreover, some Texas politicians have proposed a bill that will not only make it illegal for health providers to provide gender-affirming care to individuals younger than 18 but will also charge any parent who consents to these treatments with felony child abuse.
What Is Gender-Affirming Care and Why Is It So Important?
According to Dr. Scott Leibowitz, a pediatric psychiatrist and the medical director of behavioural health for the THRIVE program at Nationwide Children's Hospital, gender-affirming care is an umbrella term for several different potential treatment options "that speak more to the acknowledgment, appreciation, and respect of all genders as it relates to one's body."
"Within gender-affirming care, there are several treatments that are medical in nature. The treatments that are recommended are based on an individualized, case-by-case understanding and assessment. This is not a one-size-fits-all issue," he told POPSUGAR, underscoring that it takes years of therapy and doctor's appointments to even arrive at this conversation. "There is a very important, thoughtful process that goes into decision-making between physicians, parents, patients, a social work team, and a mental health provider."
"There is a very important, thoughtful process that goes into decision-making between physicians, parents, patients, a social work team, and a mental health provider."
For many transgender patients, gender-affirming care is absolutely necessary for both their physical health and mental well-being. In particular, puberty blockers — which suppress the body's release of sex hormones, including testosterone and estrogen, during puberty — can be beneficial for kids around the ages of 10 or 11. "Period-blocking medicine, or what we call menstrual suppression medication, is one treatment that can help alleviate distress," said Dr. Leibowitz. "For other kids — particularly those who are in the earlier stages of puberty — puberty blockers are another form of gender-affirming treatment."
Although puberty-blocking medication can also be administered after a teen has begun undergoing puberty, it can be especially effective in younger patients, who will not be forced to have two separate puberty experiences, which can be incredibly traumatic.
"These medicines are designed to buy time for that young person to be able to appreciate what the meaning of their gender is for them while avoiding going through the puberty associated with their assigned sex at birth," he explained. "If a young person starts puberty suppression, and then ultimately gets older and becomes more mature, they can make a decision about something more irreversible — such as gender-affirming hormones like testosterone or estrogen. What puberty blockers will have done is allowed that person to only go through one puberty, rather than two. Any parent who has watched their teenager go through puberty will tell you that the notion of having their child have to go through a second puberty is very undesired for all involved."
Dr. Terrance D. Weeden, a Pediatrician & Adolescent Medicine Fellow at Lurie Children's Hospital of Chicago, who grew up in Alabama and recently penned a moving op-ed for AL.com in support of the LGBTQ+ community, agreed that providing this treatment for transgender youth is crucial.
"It's so important because this population is at such a high risk of mental health disparities. So there's an increased risk of depression, an increased risk of suicide, and an increased risk of anxiety," said Dr. Weeden, noting that conversion therapy — or "any attempt to change a person's sexual orientation, gender identity, or gender expression" — is also detrimental to LGBTQ+ youth. "Conversion therapy is obviously a big issue, and it's been proven to be harmful. Many people don't realise that this population is at risk for so many disparities and they're not just related to mental health. Transgender people are also at a higher risk of experiencing poverty and homelessness."
Overall, 48 percent of LGBTQ+ youth said that they engaged in self-harm within the last 12 months. That figure jumped to 60 percent for kids who identified as transgender or non-binary.
An alarming survey The Trevor Project published in 2020 put the risk of suicide within the LGBTQ+ community into perspective. Overall, 48 percent of LGBTQ+ youth said that they engaged in self-harm within the last 12 months. That figure jumped to 60 percent for kids who identified as transgender or non-binary. Even more concerning, 50 percent of trans or non-binary young adults stated that they have seriously considered suicide within the last year, which is 10 percent more than the greater LGBTQ+ community.
Dr. Weeden doubled down on these terrifying statistics, sharing that anti-trans legislation is discriminatory at best and potentially life-threatening at worst. "This population is more likely to be bullied in high school," he said. "Now more than ever, young adults are identifying as part of the LGBTQ+ community — more than any other generation before. Trans youth and gender non-conforming youth need to be loved. They need to be heard. They need to be supported and validated, and they deserve access to healthcare."
Why Is Criminalizing Gender-Affirming Care Problematic For Healthcare Providers?
For healthcare providers, the concept of criminalizing gender-confirming care goes against the very oath that they took upon graduating from medical school, which requires medical professionals to treat the sick to the best of their ability and preserve patient privacy. "These legislators are forcing providers and doctors specifically to have to choose between upholding the Hippocratic Oath and breaking the law, which is never a choice that any physician should have to make," explained Dr. Leibowitz. "At the end of the day, the most important thing for our patients is their safety and their well-being."
Dr. Weeden agreed, emphasising that providing transgender youth with gender-affirming care is imperative. "These are life-saving treatments," he said. "A lot of the patients who I've seen are labeled with anxiety, depression, or bipolar disorder. They've had suicide attempts. Sometimes they actually don't have anxiety. They don't have depression. They don't have bipolar disorder. Sometimes they do, but it's often the [gender] dysphoria, the expression of the dysphoria, and how it manifests."
He continued, underscoring that these treatment options have existed for decades. "We're not doing anything that would cause harm," he explained. "This is nothing new, either. [Medical professionals] have been doing this for at least a few decades now, and we're guided by professional organisations like the World Professional Association of Transgender Health and the American Endocrine Society, who have put forth recommendations regarding how to manage and treat transgender youth."
What Type of Message Is This Legislation Sending to Trans Youth?
Although the Governor of Arkansas, Asa Hutchinson, vetoed an anti-transgender bill on April 5, it was overruled by the state's largely Republican legislature, making Arkansas the first state to ban gender-affirming care for trans youth. State leaders are continuing to make this a top priority, but this push seems to have little to do with their constituents. Most Americans do not feel strongly about passing anti-trans legislation. In fact, they generally support giving transgender individuals the right to proper healthcare.
"At least 87 percent of respondents across each of the 10 swing states say transgender people should have equal access to medical care, with many states breaking 90 percent support," reads a report from the Human Rights Campaign. "When respondents were asked about how they prioritised the importance of banning transgender people from participating in sports as compared to other policy issues, the issue came in dead last, with between 1 percent and 3 percent prioritising the issue."
Ultimately, many of these bills stem from far-right political organisations — like the Heritage Foundation, a conservative think tank geared towards public policy, and the Alliance Defending Freedom, a Christian non-profit organisation — and do not consider constituents' perspectives.
"The damage was done the moment a law like this was even introduced as an idea or concept."
Even if these bills don't pass, experts agree that their mere existence will take a toll on LGTBQ+ youth. "The damage has been done. The damage was done the moment a law like this was even introduced as an idea or concept. For young people who are afraid to come out or young people who know that they feel differently and yet see some glimmer of hope in the medical community, [it matters]," explained Dr. Leibowitz. "If they perceive that the medical community cannot appropriately address their needs, then in some ways, young people will feel more isolated, more distressed, and less supported and could very much turn to suicide purely as a result of these ideas being thrown out there to the world. It is extremely sad that some of the most marginalized kids in society are being used as political pawns."
For parents like Kristin, this could mean uprooting their families to move to a more progressive state in the northern US. "I told my husband that if this legislation passes and if it continues, we have to move," she said. "We have to. There's supposed to be the separation of church and state and we're just not seeing it in the United States."
How Can Parents Fight Against Anti-Trans Legislation?
At press time, 28 states across the US have proposed one or more anti-trans bills. According to a map provided by the Transgender Law Centre, 15 states — including Texas, South Carolina, Louisana, Alabama, Arkansas, Mississippi, Georiga, Arizona, Idaho, South Dakota, Oklahoma, Wyoming, Tennessee, Nebraska, and Missouri — "have a negative gender identity policy tally." In short, this means that these states do not have laws in place that "explicitly mention gender identity and/or expression," and effectively negatively target members of the transgender community.
Families who are looking to speak out against the introduction of anti-trans bills in their respective states should first reach out to their local legislators. To learn more about the specific nuances of each piece of legislation, head to Freedom For All Americans' website, which has a running list of each bill's sponsors and latest status. Parents can follow organisations like The Human Rights Campaign, the American Civil Liberties Union, and The National Centre For Trans Equality on social media to learn how to take action. The following organisations are also taking donations in an effort to battle anti-trans legislation in the courtroom and beyond:
- The Trevor Project
- The Gay-Straight Alliance Network
- Human Rights Campaign
- Transgender Law Centre
- Trans Women of Colour Collective
- National Centre for Transgender Equality
- Transgender Legal Defence and Education Fund
- The Okra Project
- Gender Spectrum
- Trans Lifeline
- Trans Student Educational Resources
- Sylvia Rivera Law Project