番茄社区

A flurry of bills related to healthcare for transgender patients are popping up in state legislatures across the country, with proponents claiming these measures will improve patient care while critics assert that the changes would deprive these patients of vital healthcare services.

In Arkansas, the state legislature passed a law barring physicians and other clinicians from providing gender-transition-related services to minors.

The " states that "a physician or other healthcare professional shall not provide gender transition procedures to any individual under 18 years of age" and also shall not refer anyone under 18 for such services.

Violating the law "is unprofessional conduct and is subject to discipline by the appropriate licensing entity or disciplinary review board," the law states. It also bars insurers from offering coverage for transition-related procedures for anyone under 18, and says that insurers are not required to offer any transition-related coverage.

The measure defines "gender transition procedures" as "any medical or surgical service ... or prescribed drugs related to gender transition that seeks to alter or remove physical or anatomical characteristics or features that are typical for the individual's biological sex; or instill or create physiological or anatomical characteristics that resemble a sex different from the individual's biological sex, including without limitation medical services that provide puberty-blocking drugs, cross-sex hormones, or other mechanisms to promote the development of feminizing or masculinizing features in the opposite biological sex, or genital or nongenital gender reassignment surgery performed for the purpose of assisting an individual with a gender transition."

Opposition from AAP

The legislature sent the bill to Arkansas Gov. Asa Hutchinson (R) for his signature on Tuesday; he has 5 days to decide what to do. He can either sign it, veto it, or let it become law without his signature.

Hutchinson a bill that allows clinicians to decline to prescribe treatments or perform procedures that they have a moral objection to; opponents of the measure say this could include refusing to dispense contraception or declining to maintain needed hormone treatments for a transgender hospital inpatient.

The American Academy of Pediatrics (AAP) opposes the SAFE bill. Gary Wheeler, MD, a retired Arkansas pediatrician and president of the board of directors at the AAP's Arkansas chapter, says the chapter has several concerns about the measure.

First, "there's generic concerns that involve decisions about patient care which are typically -- historically and in every other way -- given over to the parent, the child, and the physician," Wheeler said in a phone interview. "We've not had direct interference in a specific category of youth care in the past -- it's been so intrusive. We're very concerned about that."

"The second issue is conflicts we would all have were we to follow guidelines, practices, and principles that we are bound to as physicians," he continued. "As pediatricians, we believe we should take care of all children and provide them the best evidence-based care there is ... This bill prohibits us from following our guidelines and values as pediatricians."

In addition, "many people who voted to support this bill have been misled into thinking this is something that will actually help children," said Wheeler. "Unfortunately, it doesn't reflect what will really happen. We know that when bills are passed targeting transgender people, there is ultimately harm. They feel systematically bullied, and that just worsens their mental health and leads to significant psychiatric issues like suicide."

How often are pediatricians seeing children with this issue? "There are estimates of anywhere around 0.5% to 2% of the population of children who entertain some concerns or dysphoria around transgenderness," Wheeler said.

"Very few of those kids go on to become transgender, but these are real issues faced by pediatricians in practice ... All of us in the medical profession are trying to make sure we're not inadvertently doing things that in any indirect way harm these children, and we're actively supportive of new science and evidence that shows gender affirming care is the most important thing we can do for children who are transgender," he continued.

Some Pediatrician Support

Not all pediatricians see it that way, according to Quentin Van Meter, MD, president of the American College of Pediatricians, which describes itself as a "socially conservative advocacy group of pediatricians."

"Our worldview is based on the history of transgenderism," said Van Meter, whose group has about 600 members. For most pediatric patients with questions about gender identity, "if you ... delve into the depths of the family, the family structure, interactions, and adverse childhood events, when you pay attention to those and unravel all of the undercurrent problems and let the patient come to reality and work them through ... 90%-plus of these patients, by the time they're through adolescence, will have resolved their gender incongruence and be comfortable with their biological sex and gender identity matching each other. That's what the literature has proven."

Van Meter said he sees the bill, rather than as undue interference in the doctor-patient relationship, as a "prevention of harm" and something that is rightfully being addressed by state legislators.

"Kids can't own a gun, kids can't technically buy alcohol until they're 21," he said. "Those are all regulatory things put in place by regulatory agencies."

Roger Severino, former director of the Department of Health and Human Services (HHS) Office for Civil Rights under President Trump, agreed. "Children as young as 13 have been subjected to double mastectomies, and Arkansas has moved to protect kids from such radical, dangerous, and ideologically driven experiments when they can barely consent to get a tattoo," he told 番茄社区 in an email.

Part of a Larger Trend

Other states are also passing measures affecting transgender children. In Tennessee, governor Bill Lee (R) that requires middle and high school students who want to play on school sports teams to produce documentation of their biological sex at birth; they will only be allowed to play on teams that correspond with their biological sex.

That law "is just so harmful for people who just want to play sports," said Preston Mitchum, JD, LLM, policy director of Unite for Reproductive & Gender Equity (URGE), a group describing itself as one that "sustains a young people's movement for reproductive justice in the South and Midwest." "Sports are one of the first ways people understand coping skills, how to interact with people, and how to be a healthy competitor," he said.

Van Meter, on the other hand, sees this as a fairness issue. "There's a physical advantage inherent in the biological male body compared to the female body that makes competition totally advantageous to the biological male," he said, adding that allowing transgender girls on sports teams infringes on women's rights for that reason.

Bills like those in Arkansas and Tennessee are part of a larger trend, according to Mitchum, who is also an adjunct professor of law at Georgetown University School of Law, in Washington.

"Just a few months after the Biden-Harris administration repealed the transgender military ban ... we saw more than 50 bills attacking trans people that were introduced in statehouses across the country," he said. "These are coordinated attempts, and they're intentional ... The reason we saw that is because we also saw upticks in violence against Black folks and the AAPI [Asian-American/Pacific Islander] community. It's not a novel concept in the U.S., unfortunately."

Severino, who is currently senior fellow at the Ethics & Public Policy Center and director of the HHS Accountability Project, agreed that these bills are part of something bigger.

"As Biden's HHS appointees seek to dismantle federal conscience enforcement initiatives I helped establish, states are quickly moving to fill the gap," he said. "Americans realize our children's health and futures are being sacrificed to a grand ideological experiment and they are saying enough is enough."

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