By: Sarah Johnson
2021 has had quite a few legislative movements looking to govern transgender people, but it has been especially full of legislation related to transgender youth. Earlier this year, we took a look at the Protection of Women and Girls in Sports Act of 2021, which was the latest attempt at states looking to pass legislation to govern which children can participate in sports. This week, we’ll look at a different legislative movement impacting transgender youth, governing if physicians can administer gender affirming care. The Arkansas Save Adolescents From Experimentation Act aims to legislate whether healthcare professionals can provide transgender minors with gender affirming care while also prohibiting insurance companies from covering care for minors while placing other coverage restrictions on the treatments for those at any age.
What is “Gender Affirming Care”?
Gender affirming care is used to describe procedures that help align one’s body with their gender identity. Gender identity can be defined as “One’s innermost concept of self as male, female, a blend of both or neither – how individuals perceive themselves and what they call themselves. One’s gender identity can be the same or different from their sex assigned at birth.” Often, transgender people experience something called gender dysphoria, which refers to psychological distress resulting from an incongruence between one’s sex assigned at birth and one’s gender identity.
People who experience gender dysphoria may choose to pursue different forms of gender affirmation. Some common forms of gender affirmation include: social affirmation (changing one’s dress, name, and pronouns), legal affirmation (changing one’s gender markers on government-issued documents), medical affirmation (pubertal suppression or gender-affirming hormones), and/or surgical affirmation (vaginoplasty, facial feminization surgery, breast augmentation, masculine chest reconstruction). Not all people who are transgender will seek all forms of gender affirmation. Forms sought by people are very personal decisions unique to their own experience and gender identity.
Medical and surgical affirmation is what we will be speaking about in the context of “gender affirming care” for the Arkansas Save Adolescents From Experimentation Act.
Medical affirming care can include treatments that postpone physical changes as well as treatments that lead to physical changes. These treatments are meant help an individual affirm their gender identity, like delaying the onset of puberty via “puberty blockers”, or, taking a hormone such as testosterone to promote physical changes like growing facial hair. Surgical affirming care, also known as Gender Affirmation Surgery, usually refers “to the whole genital, facial, and body procedures required to create a body phenotype that best represents one’s own identity.” People may choose to get one or many procedures available to them in order to accomplish a physical appearance reflective of their gender identity. Some of these surgeries include, but are not limited to: “bottom” surgeries where a person’s genitalia are altered to match their gender identity (Phalloplasty, Vaginoplasty, Metoidioplasty), “top” surgeries where breast tissue is removed (also known as masculinizing chest surgery), or other cosmetic surgeries to masculinize or feminize facial features or other body features to correspond more to what is “normalized” in society for a gender.
According to the Trevor Project, “Pubertal suppression may be used for youth currently in the early stages of puberty who are experiencing distress over their sex assigned at birth and their gender identity. Delaying puberty can provide youth more time to explore their gender identity without the development of unwanted physiological changes and may also serve as a precursor to gender-affirming hormone therapy (GAHT).” The Trevor Project goes on to say that GAHT has positive effects on overall psychological well-being (including body image) and reduces suicidality in transgender youth. They also cite research stating that pubertal suppression helps reduce behavioral problems in youth experiencing distress over their sex assigned at birth and their gender identity (44% of youth experienced clinically significant behavioral problems; however, after an average of two years of pubertal suppression only 22% experienced them).
What does this Bill Do?
The “Arkansas Save Adolescents From Experimentation Act,” aims to prohibit medical providers in Arkansas from providing gender affirming care to transgender youth. It does this by threatening medical providers with disciplinary action if they recommend puberty blockers, hormones, or gender confirmation surgery to youths struggling with gender dysphoria. On top of the disciplinary action, it also would allow anyone who undergoes any gender affirming care as a minor to sue the prescribing physician for up to 20 years after receiving the treatment. These new policies will likely intimidate doctors into refusing to treat transgender minors. The legislation also bans any referrals stating, “A physician, or other healthcare professional shall not refer any individual under eighteen (18) years of age to any healthcare professional for gender transition procedures.”
The bill then goes on to prohibit different types of funds from being used to pay for transition-related care. It first prohibits public funds, including Medicaid dollars, from being used to cover the costs. It states “Insurance coverage of gender transition procedures for minors prohibited”, thus preventing private insurance from covering procedures or treatments prescribed those under 18. Finally, the bill allows insurance companies to refuse to cover any gender affirming care, no matter the age, stating, “A health benefit plan under an insurance policy or other plan providing healthcare coverage in this state is not required to provide coverage for gender transition procedures.”
With the recent passage of the Medical Ethics and Diversity Act, which gives medical providers discretion to refuse treatment to LGBTQ patients and others based on religious, moral, or ethical objections, last week, the Arkansas Save Adolescents From Experimentation Act is expected to be passed this week.
Cover Photo by Lena Balk on Unsplash
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