Alabama Outlaws Healthcare for Trans Youth: What to Know

  • An Alabama law makes it a felony that criminalizes gender-affirming healthcare for transgender and nonbinary youth.
  • Only one other state — Arkansas — has enacted a law restricting access to gender-affirming healthcare for minors.
  • The law will go into effect on May 8.

Alabama Gov. Kay Ivey signed into law a bill this month that criminalizes gender-affirming healthcare for transgender and nonbinary youth.

The law makes it a felony — punishable by up to 10 years in prison and a fine of up to $15,000 — for doctors to provide or recommend interventions such as puberty blockers and hormone therapies to people under 19 years old.

It also includes bans on gender-affirming surgery — which is extremely rare among youth — and compels school personnel to disclose to a child’s parent or legal guardian that a “minor’s perception [of] his or her gender or sex is inconsistent with his or her sex.”

The law will go into effect on May 8.

“I believe very strongly that if the Good Lord made you a boy, you are a boy, and if he made you a girl, you are a girl,” said Ivey in a statement Friday, according to The Hill.

“We should especially protect our children from these radical, life-altering drugs and surgeries when they are at such a vulnerable stage in life,” she added.

A group of physicians and patients filed a lawsuit Monday challenging the law.

The law “denies necessary and appropriate medical treatment to transgender minors and imposes criminal penalties on parents and healthcare providers who obtain or provide such care,” according to legal documents.

Only one other state — Arkansas — has enacted a law restricting access to gender-affirming healthcare for minors. A federal judge blocked this from going into effect pending the outcome of a lawsuit by the ACLU.

Dr. Joshua Safer, a professor of medicine at the Mount Sinai Center for Transgender Medicine and Surgery and the Icahn School of Medicine at Mount Sinai in New York City, said, “medical care options offered to youth are reversible.”

For younger children, gender-affirming care may be as simple as a new haircut or clothing, he said. These children may also receive mental health support to help them explore their gender identity.

Once a child enters adolescence, puberty-delaying medication — also known as puberty blockers — may be given. This “gives teenagers and their families more time to explore their options,” said Safer, a co-author of the Endocrine Society’s transgender medicine position statement.

This type of medication is also used to treat precocious or early-onset puberty.

“Older adolescents, who demonstrate persistent gender incongruence, may start gender-affirming hormone therapy to help them experience puberty in a way that matches their gender identity,” added Safer.

Medical and mental health professionals say gender-affirming care can save lives by reducing the risk of depression and suicide among transgender and nonbinary youth.

“Denying access to healthcare for anyone carries predictable harm, especially when targeting vulnerable young people like transgender and gender diverse teens,” said Safer.

“It raises the risk of suicidal ideation and self-harm, along with increasing the risk of more invasive medical intervention later,” he added.

In January, the American Academy of Pediatrics (AAP) said that healthcare for transgender youth is vital. They are working with the ACLU to counter the push to outlaw healthcare for transgender youth.

“It is critically important for every child to have access to quality, comprehensive and evidence-based care — transgender and gender-diverse youth are no exception,” AAP Immediate Past President Lee Savio Beers, MD, said in a statement on the AAP website . “As pediatricians, we will continue to speak up and advocate for our patients. We also want transgender and gender-diverse youth to know that not only do we care for them, we care about them, we value them and we will do all we can to ensure they have access to the care they need and deserve.”

Jonah DeChants, PhD, a research scientist at The Trevor Project, pointed to a 2021 survey by the nonprofit, which found that more than half of transgender and nonbinary youth seriously considered suicide in the past year, and one in five attempted suicide.

Access to appropriate medical care can reduce those risks.

A recent study in the Journal of Adolescent Health found that for transgender and nonbinary youth under the age of 18, the use of gender-affirming hormone therapy was related to lower rates of depression and suicide attempts.

DeChants is concerned about the rise in anti-transgender healthcare legislation throughout the United States, especially the impact it may have on the mental health of this “group of marginalized young people.”

Another survey by The Trevor Project, in conjunction with Morning Consult, found that 85 percent of transgender and nonbinary youth reported that debates around anti-trans bills have negatively impacted their mental health.

“These legislative attacks … may exacerbate the poor mental health of youth who already experience disproportionate levels of suicide risk,” said DeChants.

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