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American Medical Assoc. President: Stop the Anti-Trans Bills

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States should expand access to gender-affirming care, not criminalize it.

Lawmakers across dozens of states are attacking the health and well-being of transgender individuals by introducing bills that encourage bias, reinforce stigma, and impose new barriers to health care. These measures -- some under consideration and some enacted -- run counter to longstanding AMA policy that opposes discrimination based on a person's gender or gender identity.

Even as we work to defeat a global pandemic, it is maddening that more states than ever before are considering legislative proposals that would directly harm transgender patients while promoting government intrusion into the patient-physician relationship, jeopardizing patient care, trust, and privacy.

The AMA is fighting dozens of regressive proposals to limit transgender rights that have been introduced or advanced in some 30 states. The most grievous are bills that seek to criminalize the provision of medically necessary gender-transition care to patients who are minors, and in some states, to treat the delivery of such care as child abuse.

This is wrong. Decisions about courses of treatment and other aspects of medical care should always be made within the sanctity of the patient-physician relationship. No state should legislatively prohibit certain transition-related services, nor limit the range of options physicians and families may consider in making decisions for pediatric patients.

A measure enacted in Arkansas this spring bans all "gender transition procedures" including (but not limited to) hormone therapy, puberty-delaying medications and surgeries for transgender youth under age 18; physicians who do so can be stripped of their medical licenses. Meanwhile, lawmakers in 18 states are targeting gender-affirming surgical interventions as well as medications and hormone therapies that should be available to transgender patients based on care decisions made in consultation with their physicians.

Other legislative proposals in multiple states seek to ban transgender women and girls from participating in school athletics consistent with their gender identity, or to prohibit transgender individuals who are minors from participating in any type of youth athletics. Measures pending in some states would require a health care provider to "verify" a student's gender before allowing athletic participation.

Actions like these intensify the discrimination, harassment, and outright violence directed toward the estimated 1.4 million adults and 150,000 teenagers in our nation who identify as transgender or as gender expansive, which means they identify with neither traditional binary gender roles nor a single gender narrative or experience. The challenges confronting these individuals in nearly every facet of everyday life -- education, employment, health care, social services, and more -- can create stress that severely impacts their health.

Because of this marginalization, studies have shown that transgender individuals report or are diagnosed with mental health disorders at a rate up to three times higher than the general population, and that their risk of suicidal thoughts and behavior is markedly higher. At the same time, their physical health is endangered when they are denied insurance coverage for care related to their transgender status. Individuals with additional historically marginalized identities feel this pain in an intersectional way. For example, transgender Black women suffer not only the sting of anti-LGBTQ discrimination and violence, but also the health and social impacts of systemic racism.

Rather than embarking upon discriminatory and damaging legislation, the AMA believes we must instead broaden access to gender-affirming care and the treatment of gender dysphoria. This will improve health outcomes for transgender people, and provide them with the opportunity to live fully and openly in accordance with their true gender identity. We are not alone in advocating for this approach, as every major medical association in the nation recognizes the medical necessity of transition-related care to improve the physical and mental health of transgender people.

We cannot allow any level of government to interpose itself between patients and physicians or force physicians to disregard clinical guidelines. Nor can we tolerate outside interference with the ethical duty physicians follow to always act in the best interest of their patients. Physicians know that trust lies at the heart of the patient-physician relationship, and that any action that places that trust at risk must be rejected.

The AMA believes that everyone deserves quality, evidence-based medical care regardless of gender identity or any other factor. Transgender rights are fundamental human rights, including the right to seek out and receive medical care tailored to an individual's specific needs and circumstances. Lawmakers in every state should focus on improving access to care instead of obstructing or criminalizing the care their constituents need.

Susan R. Bailey, MD is president of the American Medical Association.

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Susan R. Bailey, MD