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Right now, 13 (mostly GOP-run) states have at least one active bill that targets health care for transgender children, and one state (Arkansas) already passed such a law, becoming the first state in the country to come after vital pediatric trans health care. The bills all function differently: Some introduce punitive measures for physicians who provide gender-affirming care while others (like an active bill in Texas) designate gender-affirming care as child abuse.
“It’s certainly the most aggressive attack I’ve seen,” Chase Strangio, deputy director for Trans Justice at the ACLU, previously told VICE. He’s right; the dozens of bills circulating at the state level represent the most widespread attack on the rights of trans and nonbinary children that the United States has yet to see. While they may operate slightly differently, as VICE reported, the bills employ the common GOP tactic of “copy-and-paste” legislation. Embedded within each bill is an argument that puberty blockers, or hormones that temporarily suppress puberty, are inherently dangerous and suffer from a lack of long-term, longitudinal data. But as pediatric endocrinologists told VICE, nothing could be further from the truth. Puberty blockers have long been used to treat precocious puberty (the medical term for early puberty) in cisgender children—safely, and without any controversy. “Puberty blockers have been used for decades in cisgender kids who either are going through puberty too early, or, in some instances, kids who are going through puberty very quickly,” Jason Klein, a pediatric endocrinologist and Assistant Director of the Transgender Youth Health Program at Hassenfeld Children’s Hospital at NYU Langone, told VICE. “Their use has been FDA approved, well-studied, well-documented, and well-tolerated for a long time now. And it’s the exact same medication that we use in trans or nonbinary children to basically put a pause on pubertal development. Exactly the same medications, at exactly the same doses.”
Shona Rabon, an assistant professor in the Dell Medical School’s Department of Pediatrics, said puberty blockers are an important treatment option because early puberty can cause health issues into adulthood. “The main two things early puberty affects is their final adult height—it can make them much shorter—and it has effects on the bones, as well,” Rabon said. “And then it can make them start a period early. We’re talking about eight year olds having their period, and I don’t know anybody—parent or child—that would be ready for an eight year old to be having a period.” Rabon, who works as a pediatric endocrinologist in Texas, said the bills introduced in her state and throughout the country “make me really nervous, because we’ve been using [puberty blockers] forever.”
To be clear, the bills as written leave exceptions specifically for cis kids. In every case, the laws target puberty blockers only when used as trans care. Physicians could continue providing the medication to cis kids who start puberty too early, but could face punishment or risk child abuse charges if they provide the exact same medication for a kid who’s trans or nonbinary. (Oddly enough, the bills almost never use the words “transgender” or “nonbinary,” instead referring to “gender transitioning or gender reassignment.”)GOP lawmakers stake their false claims that puberty blockers are understudied and unapproved on the fact that the FDA has yet to give approval for puberty blockers specifically as a treatment for transgender and nonbinary care. (It’s significant here that the FDA is historically slow to approve health care for those who aren’t cisgender). Klein referred to this as merely a “veil” behind which lawmakers are hiding blatant discrimination for kids who aren’t cisgender. “There’s a lot of data in the trans and nonbinary population; it’s not like this is just now being studied,” Klein said. “Studies outside of the U.S. have been going on for a while now, and studies in the U.S. have been going on for at least 15 years, maybe longer. My guess—and I don’t know for sure—is that there’s a lot of political background to [approving puberty blockers for trans kids]. There might be some concern or worry about blowback. But as a pediatric endocrinologist who treats kids who are cisgender and is also the assistant director of our Transgender Program, it’s the same outcome.” GOP lawmakers love to claim (even in the writing of these bills) that kids who receive gender-affirming care face psychological distress in the inevitability that they later “change their minds,” a false logic that completely ignores the distress trans and nonbinary kids and teens already have to deal with if their loved ones, teachers, coaches, and peers refuse to affirm their gender. Endocrinologists in the Netherlands were the first to study puberty blockers in trans children, and recently told the Scientific American that, out of about 1,500 teens who were treated, none experienced any major side effects. Those researchers further found, perhaps unsurprisingly, that trans and nonbinary adolescents who receive gender-affirming care have fewer suicide attempts than those who didn’t receive early care.“It’s very clear that this is a growing national conversation about the quote-unquote dangers of treating these kids, and it’s really terrifying,” Klein said. “To me, the side effects of these medications are well-documented and the medications are safe. This legislation is out there in order to try to suppress a population that is already particularly vulnerable from obtaining medical care. And that’s dangerous.” Follow Hannah Smothers on Twitter.