U.S. Republicans target transgender youth health care in legislative push

Republican legislators across the United States have escalated a campaign to ban certain health care for transgender youths, in some cases seeking to charge parents and doctors with child abuse if they provide treatment.

This year’s legislative agenda, unprecedented in the number and scope of bills around transgender issues, also includes measures to block teachers from using pronouns that match a student’s gender identity, ban trans girls from playing on girls’ sports teams and require trans people to use the bathroom corresponding to their sex assigned at birth.

The aggressive legislative push comes as battles over gender and sexuality increasingly are being fought in U.S. classrooms, courtrooms and political campaigns. Republicans including former President Donald Trump have embraced restricting trans rights ahead of the 2024 White House race, a push that trans advocates fear will harm transgender children.

“This issue will be a national debate in the next presidential election,” said Jay Richards, a senior research fellow at the Heritage Foundation, a conservative think tank. “If Republicans in the relevant states handle this properly, it’s actually politically beneficial.”

The think tank supports the proposed legislation in several states, though Richards said some bills, such as those that seek criminal liability for doctors and parents, might be “overly draconian.”

Republicans have introduced more than 300 bills in 33 states aiming to limit transgender and wider lesbian, gay, bisexual, transgender and queer (LGBTQ) rights this year, more than double the number of such bills filed in 2022, according to Erin Reed, Alejandra Caraballo and Allison Chapman, a trio of transgender rights advocates tracking the legislation.

In addition to the familiar legislative efforts targeting sports and bathrooms, the emphasis this year is on banning gender-affirming care, the goal of 97 bills in 27 states.

Gender-affirming care covers a variety of treatments, including puberty blockers, hormone therapy and, in exceedingly rare cases for trans people under 18, surgery. Medical associations, which call the bills transphobic, say such health care can be life-saving.

In many states, transgender children and their parents have testified against the proposed legislation, describing how gender-affirming care changed their lives and fearing the impact of the bills, which have proliferated even as federal courts blocked bans passed in Arkansas in 2021 and Alabama in 2022.

But many opponents of trans rights believe that the sex assigned at birth is immutable and distrust the prevailing opinions of medical associations with specialties in pediatrics, endocrinology and mental health. They contend the government must intervene to prevent parents and doctors from permanently harming children.

Governors in South Dakota and Utah have already signed into law gender-affirming care bans that state legislatures passed this year.

Bills in Idaho, Missouri and Wyoming would criminalize providing such care as felony child abuse, while measures in Tennessee and Texas would categorize it as abuse under family law.

The Tennessee bill, which would bar doctors from providing gender-affirming care to anyone under the age of 18, passed the state’s Republican-led Senate on Monday.

Transgender advocates say such moves are punitive, especially considering the difficulty of getting treatment due to cost, lack of family support or trouble finding a provider.

“The idea that we have a social contagion encouraging people to be trans in a climate that is this hostile to trans people in so unbelievably offensive,” said Chase Strangio, an ACLU lawyer who has litigated against the Arkansas and Alabama laws.

Out of 121,884 minors diagnosed with gender dysphoria from 2017 to 2021, fewer than 15%, or an average of about 3,500 per year, received puberty blockers or hormone therapy, according to a data analysis by health technology company Komodo Health Inc in conjunction with Reuters last year.