Anti-transgender health care laws are sweeping US states

For about a week in May, Alabama had the harshest anti-transgender law in the U.S. Any doctor who prescribed puberty blockers or hormone therapy to people under the age of 18 could face felony charges, spend up to 10 years in prison and pay a $15,000 fine. Physicians scrambled to refill their patients’ prescriptions before the law kicked in; parents started contemplating plans to relocate their families out of state.

A federal judge has since issued an injunction on the medication ban. But it was a brief preview of what conservative lawmakers are increasingly pushing for across the country. A Bloomberg News analysis found at least 40 similar bills proposed in around two-dozen Republican-controlled states that would sharply limit or outright ban gender-affirming and transition-related health care, often specifically for minors.

One draft law in Georgia would punish any doctor that prescribes puberty blockers to a minor with up to 10 years in prison; another in North Carolina would fine physicians $1,000 per occurrence for doing the same. In Mississippi, a bill would limit health insurance coverage for transgender health care services.

“We’re seeing a tsunami of these laws,” said Michael Bronski, a professor at Harvard University who researches LGBTQ history and culture.

Anti-LGBTQ legislation has been on the rise in recent years, with a raft of bills seeking to limit what bathrooms transgender people can use and what sports teams they can play on. But in the past year anti-trans health care regulations really started to gain steam. In the 2022 state legislative year, about 60% of all proposed LGBTQ-health related bills aimed to ban or limit transgender-related health care. It’s a reversal from the past decade when pro-LGBTQ legislators were passing progressive laws like banning conversion therapy, the discredited practice of trying to change someone’s sexual orientation or gender identity.

“They’re throwing anything at the wall to see what sticks,” Bronski said.

“Part of the goal is to get rid of the care, but it’s just one of the stops along the way to getting rid of trans people,” said Chase Strangio, a lawyer at the American Civil Liberties Union who has sued multiple states for anti-trans laws arguing they violate the equal protection clause of the 14th Amendment.

Strangio has had some success in convincing judges these laws don’t hold legal water, at least for now. In Arkansas, he got an injunction on a medication ban similar to the Alabama one and in Texas he got another injunction on an order from the governor directing state agencies to investigate parents or doctors who offer gender-affirming care for minors.

The judge that ultimately blocked the Alabama law said “parents – not the states or federal courts – play the primary role in nurturing and caring for their children.” He also said the state had not produced credible evidence that the treatments were “experimental,” and therefore dangerous, as Alabama politicians had argued. The American Academy of Pediatrics and almost two dozen other major medical associations endorse the treatments that clinics are providing for transgender youth.

Conservative groups think that both the public and health care community will come around to their position. “We’re not there yet, but I do think we’ll reach a point in which this will be seen as an absolutely inappropriate way to intervene,” said Jay Richards, a research fellow at the Heritage Foundation, a conservative think tank that’s working to provide model legislation for lawmakers on the issue.

Advocates say that the extremism is part of the strategy. “Each one of these bills is a test,” said Nikita Shepard, a researcher at Columbia University, who studies gender and sexuality. “How far can it go? How far can the rhetoric go?”

They liken it to the anti-abortion crusade that ultimately led to the overturning of Roe v. Wade earlier this year. For more than a decade, state legislators passed hundreds of laws restricting or banning abortion. Many never went into effect, until a more conservative Supreme Court took one up and this year voted to dismantle federal abortion protections. Now physicians in a dozen states face felony charges if they offer any abortion services.

Doctors who see transgender patients fear that’s where their future is headed, said Kellen Baker, the executive director of the Whitman-Walker Institute, an LGBTQ health research and advocacy group. “We’re seeing a lot of confusion, a lot of fear and a lot of anxiety,” he said.

Clinics are also reporting a rise in violence and harassment. Last month, clinicians at Boston Children’s Hospital, home to the nation’s first pediatric and adolescent transgender health program, were the targets of a harassment campaign; the hospital also received a bomb threat a few weeks later.

Despite the legal hurdles they’ve so far faced, the laws aren’t expected to let up.

Promise to America’s Children, an anti-LGBTQ advocacy group, is asking lawmakers to sign a pledge supporting policies that ban “physical interventions on the bodies of children” such as puberty blockers and hormone therapy. The coalition is backed by the Heritage Foundation, the Family Policy Alliance and the Alliance Defending Freedom, conservative groups that have been instrumental in the anti-abortion fight, too. The group will be providing model legislation and education campaigns, Richards said.

“We’re dealing with a fundamental disagreement: Can kids be born in the wrong bodies and so should their bodies be transformed to conform to some presumed internal state or should we be trying to help kids be comfortable in their bodies?” the Heritage Foundation’s Richards said. “There’s a chasm between those two different views of reality and we think one is right and one is wrong.”