Suicide rates increase for transgender youth, especially for those with no parental support. (Chart from The Trevor Project)
Suicide rates increase for transgender youth, especially for those with no parental support. (Chart from The Trevor Project)

Republican-held states across the country are pursuing bans regulating access for minors seeking gender-affirming healthcare, including total bans in Arkansas, Alabama and Texas, leading some to wonder if Indiana is next.

The Washington Post reported that 2022 saw the largest number of proposed anti-trans laws in recent history, 155 bills compared to just 19 in 2018. Among those, Indiana’s ban on trans female athletes who want to play with their peers, a bill Gov. Eric Holcomb vetoed in March but the General Assembly voted to override in May. 

That law is currently under a preliminary injunction following the case of a 10-year-old girl who wanted to play softball at an Indianapolis Public School.

Holcomb said he hadn’t yet seen any legislation that would bar gender-affirming healthcare for minors in Indiana. 

“The devil is always in the details,” he said Tuesday. “(No bill) has been shared with me to date so give me an opportunity to look at each and every bill that comes before me — especially when it takes away parents’ rights.”

Conservative groups have urged the legislature to take more action and prohibit care for children even with parental consent. 

“If somebody wants to do this after the age of 18 or 21, that’s a little different,” said Micah Clark, executive director of the American Family Association of Indiana. “These are minor children and they’re not even allowed to give legal consent for sex under the age of 16, I don’t think we should change their sex underage or as minors.”

Numerous conservative legislators did not return messages seeking comment.

And advocates for transgender youth warn of the dire consequences if children are denied this care, which is often life-saving.

“So the idea that we would have youth that are not really able to receive that care until they’re 18 is just not acceptable because it’s asking them to continue to suffer all the way until they turn 18,” said Richard Brandon-Friedman, an assistant professor at the Indiana University School of Social Work at IUPUI. “It’s just asking them to continue to suffer for years and years for, really, no legitimate reason.”

Importance of interventions for youth

Brandon-Friedman was part of a team that helped to develop the initial protocols for the Gender Health Clinic at Riley Hospital for Children in 2016. Though not as actively involved with the program as he once was, he continues to counsel youth considering transitioning as a social worker in private practice and helps children and families understand the transition process. 

LGBTQ+ teens and children report higher rates of depression, anxiety and suicidal ideation than their peers but especially so for transgender youth. According to The Trevor Project, 59% of transgender boys and men reported considering suicide compared to 28% of cisgendered boys and men in 2022. For transgender girls and women, the rate was 48% compared to 37% for cisgenderwomen girls and women.

Oftentimes, Brandon-Friedman said, getting medical treatment was enough to resolve body dysmorphia and relieve accompanying mental health issues. The Trevor Project went on to determine that youth living in affirming households were less likely to consider suicide than those living with unapproving family members.

“They’ll still have social judgment from others that they still have to address but that support from family and from friends is critical to their overall well-being,” he said.

Brandon-Friedman said receiving care earlier would help youth in the long-run. Puberty blockers, generally considered reversible, stop individuals from getting their periods or growing breasts. For others, the care means voices won’t deepen, something difficult to reverse later in life.

Powerful supporters within the Republican Party

Bill filing deadlines in Indiana are still months away in Indiana and no proposals are yet public. Other states that have introduced legislation barring minors from receiving gender-affirming care have their laws held up in court. However, Attorney General Todd Rokita signed onto an amicus brief with 18 other attorneys general indicating his support for Arkansas’ ban. 

The filing directly counters an amicus brief filed by the American Academy of Pediatrics and the American Medical Association against Arkansas, that states the “only effective treatment for individuals at risk of or suffering from gender dysphoria is to provide gender-affirming care.”

The attorneys contend that the science is against the above healthcare providers, insisting that dysphoria is usually resolved over time, an unsupported claim. 

“Lives are at stake! To protect kids from transgender extremists, states have every right to prohibit the use of puberty blockers, cross-sex hormones and surgery to alter minor children’s so-called gender identity,” Rokita said in a tweet with the brief. 

 A screenshot of a tweet from Attorney General Todd Rokita’s office Twitter account.

 

Several lawmakers contacted by the Indiana Capital Chronicle didn’t return requests for comment about whether they believed Indiana should pursue a ban. But last year both Rep. Bruce Borders, R-Jasonville, introduced a bill regulating bathrooms used by transgender people while Sen. Dennis Kruse, R-Auburn, and Sen. Jeff Raatz, R-Richmond, filed a bill barring gender-affirming healthcare procedures for minors.

Neither received a hearing.

Clark said that at a “bare minimum” parents must be involved in any decision regarding their child.

“No matter what happens regarding legislation, I think parents have to get involved in this,” he said. “In no way should a minor child… be allowed to do this without parental consent and parental notification.”

But Clark said he didn’t think it was a good decision even for youth with parental consent, because they’ve been misled about the information out there.

Clark called the medical treatments “risky,” saying physicians didn’t use these practices 20 years ago. He said children shouldn’t be allowed to make “radical changes” to their “gender appearance.” Gender appearance, rather than identity, because he said gender couldn’t be changed.

“But if somebody is going to change their appearance with these new and somewhat unproven techniques – we don’t really know the long-term effects of this,” Clark said. “…I would hate for us to move into this and 20-30 years from now have thousands or hundreds of children who were in Indiana… and will be harmed and regret these surgeries.”

Clark said that most kids will grow out of “gender confusion,” something that some researchers dispute, saying the studies were flawed. 

“It’s the same thing as giving an anorexic who has a body image issue liposuction. We don’t do that to anorexics who think they’re fat,” Clark said. “I don’t think we should do this to girls who think they are boys or boys who think they’re girls. I think this is a psychological problem, not a physical problem that needs to be treated with drugs or surgery.”

He noted that laws made children wait to drive, to vote and to drink alcohol. Thus, decisions shouldn’t be made about their gender.

“We need to be very, very cautious of what we’re doing to young children simply because of what the culture says, rather than what medicine and science has said for centuries,” Clark said.

Youth denied treatment seeking care later in life

Brandon-Friedman noted the proliferation of misinformation in groups opposing transitioning, many inflating the numbers of children seeking treatment or who later change their mind. 

“In my view, restricting care for any youth based on the idea that a few might identify differently in the future just doesn’t make sense,” he said. 

Brandon-Friedman said one popular study had been so thoroughly debunked its publishing journal had redacted it and another only sought out post-transition individuals who regretted their decision and now belonged to a very vocal anti-transition group.

“If you seek out people who are actively in a part of an organization that is trying to limit trans-affirming care, or people who are in a group explicitly for people who regretted their decision, that’s all you’re going to find,” Brandon-Friedman said. 

He observed that some of the bills introduced so far are vague about what constitutes gender-affirming care, meaning that even his work could count. He worries that combined with the shortage of mental healthcare providers in Indiana those seeking treatment for gender dysphoria won’t have any other gender-affirming options.

Part of his work includes screening 18-24 year olds for gender dysphoria before their insurance coverage permits them to access gender-affirming care. Many had unsupportive parents who delayed gender-affirming interventions and now don’t speak. 

“When I’m talking to older youth and do assessments, I’d say probably three-quarters of the adults I see have detached from their family in some way,” he said, emphasizing the number is just based on his own experience. “But there are so many that come and just have no relationship with their family or origin.”

Overall, Brandon-Friedman said he heard more discussion about the supposed risk to children and not recognition of the reward simply because an exceedingly small majority may regret their choice.

“It’s hard to understand why, in this instance… the perceived risks are so high that a youth can’t make those decisions. That a youth and their caregiver and their family and their doctor do not have the capacity to make this decision even though medical providers make these decisions all of the time. Any medication you take, you’re risking something,” Brandon-Friedman said.

“I don’t understand why this type of care is somehow so extreme that a medical team can’t make that decision.”

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