Student Opinion: Defining ‘Care’ for Trans Youth

By Milo Feldman

On March 29, 2023, the Kentucky Senate voted to override the veto of Senate Bill 150 which will ban all gender-affirming care for transgender minors in Kentucky. This means banning the use of hormone therapy and puberty blockers by medical professionals on minors, and also seeking to control the treatment of transgender and gender non-conforming students in public schools by strengthening parental rights.


The bill and its amendments attempt to foreground parents’ rights in their children’s “wellbeing,” proposing the following: 


“Establish a parental right of not having a child indoctrinated into any political position or being involved in advocacy in a controversial subject matter; establish limitations on school personnel related to instruction and discussion on sexual orientation, sexual preference, or gender expression, advocacy in the scope of employment, and actions based on the immutable characteristics of students” (House Amendment 3)


Senate Bill 150 is not the first or last of its kind. Bills restricting LGBTQ rights have been widespread this legislative season. As demonstrated by this map of anti-LGBTQ bills in the United States, many have focused on limiting gender-affirming care for minors. In fact, only 4 states (New York, Delaware, Wisconsin, and Illinois, as well as Puerto Rico and Washington DC) have not introduced bills that restrict LGBTQ rights. The widespread panic about minors receiving gender-affirming care raises the question: how are these bills attempting to define “care” for gender non-conforming youth?


The idea is that minors are too young to understand their gender, so parents and lawmakers, acting paternalistically, intend to prevent them from making decisions they will regret — protecting their (cis) bodies and (cis) minds from being altered. But “evidence-based gender-affirmative care” for minors is well-backed by all major medical associations such as The American Academy of Pediatrics, The World Health Organization, and the Endocrine Society. 


The Journal of the American Medical Association published research that found that puberty blockers and gender-affirming care were associated with 60% lower odds of moderate or severe depression and 73% lower odds of “suicidality” over twelve months. 


The Trevor Project’s 2022 national survey on LGBTQ youth found that 45% of LGBTQ youth “seriously considered” suicide in the last year, and 14% had attempted suicide in the last year. Additionally, “LGBTQ youth who felt high social support from their family reported attempting suicide less than half the rate of those who felt low or moderate social support.” And further, “LGBTQ youth who found their school to be LGBTQ-affirming reported lower rates of attempting suicide.” 


These statistics and many other studies and personal testimony from doctors caring for trans youth, overwhelmingly support that gender-affirming care is indeed protecting trans youth, and living in a home or going to a school that does not recognize or actively rejects one’s trans identity has a negative impact on mental health — a potentially fatal one. 


So if it has been repeatedly studied and medically advised not to ban gender-affirmative care for trans youth, how can bills that ban gender-affirmative care be deemed as protectionary? How can they even be entertained as ideas? Is this legislation really caring for our kids or is care only attributed to sustaining kids’ cisgender bodies and minds? Because all the evidence shows that not affirming a minor’s gender identity actively harms them, but legislators seem to be defining harm as being queer or trans. 


What these bills do, under the guise of “protection,” is use the medicalization of transness as a scapegoat for all gender-affirming treatment. Firstly, gender-affirming care is not all medical: a lot of it is social. Senate Bill 150 and other similar bills in Iowa, Mississippi, Utah, South Dakota, and Tennessee prohibit school personnel from being able to address children with their preferred names or pronouns that do not align with their biological sex (see Amendment 6), and require parents to be notified if their child is exhibiting gender-nonconforming actions (see California’s AB-1314).  


Kentucky SB 150 continues on to “forbid student access to material, events, or programs that are obscene, harmful to minors, or contain obscene imagery representing minors; establish a parental right to expect that a child not be exposed to or given access to material, events, or programs that are not educationally suitable” and “allow a parent to require a school to limit their child’s access to material, programs, or events that the parent believes are not educationally suitable.” These sections demonstrate the misplaced fear of parents that it is external indoctrination through “non-educational” materials that is causing their kids to become queer or trans, or to adopt beliefs different to that of their parents.


The idea that barring education on sexual orientation and gender expression and any use of a gender-affirming address is for their children’s protection is completely misguided and not supported. Certainly, they are not wrong that being cis is easier and safer than being trans, but that is not because it is inherently wrong but rather because of anti-trans rhetoric and policy like this one, stemming from deeply entrenched cis-heteronormative Western values. 


Attacking gender-affirmative care, medical or not, as if teens do not have enough insight about their own bodies and minds, as if their self-conception can be swayed from accessing queer and trans media, is completely misplaced. At a glance, ensuring that minors are aware of the decision they’re making to change their bodies and chemistry sounds like a sane and caring one. However, banning gender-affirming care altogether is not scientifically-based, but ideology-based. 


This all goes without mentioning that gender-affirming care does not just apply to transgender minors. It happens all the time to affirm cisgender teens’ genders––particularly when boys take testosterone supplements. It just happens that doctors and loved ones are more sympathetic to a boy who is short and hasn’t gone through puberty when he takes hormones, rather than a trans boy who wants to meet with a doctor to start on testosterone.


The danger of this bill is that it is supposedly not explicitly “anti-trans,” existing under the guise of “protecting kids.” But deeming trans-ness as a matter only for adults implies there is something dangerous, inappropriate, or wrong about it. Pathologizing gender nonconformity has a long history and known disastrous effects on the well-being of trans youth and the adults they become. 


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