Republican-led state legislatures are considering a new round of bills restricting medical care for transgender youths — and in some cases, adults — returning to the issue the year after a wave of high-profile bills became law and sparked lawsuits.
As legislatures begin their work for the year, lawmakers in several states have proposed enacting or strengthening restrictions on puberty-blocking drugs and hormone treatments for minors. Bills to govern the pronouns kids can use at school, which sports teams students can play on, and the bathrooms they can use are back, as well, along with efforts to restrict drag performances and some books and school curriculums.
LGBTQ+ advocates say that most of the states inclined to pass bans on gender-affirming care have done so, and that they now expect them to build on those restrictions and expand them to include adults. With legislatures in most states up for election this year, transgender youths and their families worry about again being targeted by conservatives using them as a wedge issue.
In Ohio, House Republicans voted Wednesday to override Republican Gov. Mike DeWine’s veto of legislation banning all forms of gender-affirming care for minors. The Senate is expected to follow suit this month. Despite his veto, DeWine signed an order banning the rare occurrence of gender-transition surgeries before adulthood. He also proposed rules mandating a care team for children and adults that critics say could severely restrict access for all patients.
In South Carolina, one of the few Southern states without a ban on gender-affirming care for minors, a House committee voted Wednesday to send a ban to the House floor. The bill, sponsored by the state’s Republican House speaker, would also prevent Medicaid from covering such treatments for anyone under age 26. And last week in New Hampshire, the House voted to ban gender-transition surgeries for minors.
At least 22 states have enacted bans on gender-affirming care for children, with most of them approved in the past year. Those who support the bans say they want to protect children and have concerns about the treatments themselves. Major medical groups, including the American Medical Association and the American Academy of Pediatrics, oppose the bans and have endorsed such care, saying it’s safe when administered properly.
Last year’s limits included a Florida law that has made it nearly impossible for many transgender adults in the state to receive gender-affirming care. Florida Gov. Ron DeSantis has promoted that ban as one of his accomplishments as he seeks the Republican presidential nomination.
Bills filed in Missouri include efforts to remove two provisions that were key in overcoming a Democratic filibuster to that state’s ban on gender-affirming care for youths. The new Missouri Freedom Caucus is prioritizing a bill that would make the ban on gender-affirming care for minors permanent, removing a provision that allows it to expire in 2027. Legislation would also remove a clause that allows minors who began the care before the law went into effect to continue with it.
Republican state Sen. Mike Moon, who is sponsoring bills both to repeal the expiration date on the medical restrictions and to require schools to tell parents if a student wants to go by a name or pronoun other than the one the parent used to register the child for school, compared transgender medical restrictions for minors to age thresholds in laws for smoking, drinking and driving.
LGBTQ+ activists call laws that require schools to tell parents about a student’s desire to change names or pronouns “forced outing,” saying schools might be the only safe place for a transgender or nonbinary student to express their gender identify.
In Oklahoma, at least two bills remain active from last year that target gender-affirming care for adults. One proposal would prohibit insurance coverage for the procedures for adults, while another would prohibit public funds from going to any entity that provides such care.
Both measures stalled in the Republican-controlled Legislature last year but could be reconsidered during the legislative session starting in February.
The rules proposed in Ohio by DeWine last week place new limits on adults that advocates say would make treatment difficult, if not impossible, for some people.
Several bills have been filed in Florida, including a measure to require employees at state agencies or at any entity that receives state funding to use the pronouns consistent with their assigned sex at birth.
Legislation introduced Wednesday in West Virginia would ban gender-affirming care up to age 21 and prohibit mental health professionals from supporting what lawmakers call a transgender patient’s “delusion” about their gender identity.
In California, which has offered refuge to transgender youths and their families from states with medical bans, conservatives are mounting a longshot effort to put a measure on next year’s ballot targeting the rights of transgender minors.
Nationwide, challenges to laws already in place are moving closer to the U.S. Supreme Court. The American Civil Liberties Union has asked the court to block restrictions on care for youths in Kentucky and Tennessee.
The full 8th U.S. Circuit Court of Appeals is also considering Arkansas’ request to reverse a ruling that struck down the state’s first-in-the-nation ban on gender-affirming care for youths.
Federal rulings against the bans so far have come from judges appointed by both Democratic and Republican presidents.
6 stats you need to know about LGBTQ+ youth mental health
Of the more than 520 anti-LGBTQ+ bills that have been introduced within state legislatures since the beginning of the year, more than 145 have passed in at least one legislative chamber, according to the LGBTQ+ civil rights organization Human Rights Campaign. At least 70 statutes were passed into law—15 of which specifically ban gender-affirming medical care for transgender youth.
The Centers for Disease Control and Prevention’s 2011-2021 Youth Risk Behavior Survey found that LGBTQ+ high school students were “significantly more likely to experience all forms of violence” than their peers. Almost 70% reported having “persistent feelings of sadness or hopelessness,” and the systemic targeting of their greater community in the form of legislative action has been one of the primary factors contributing to an increase in psychological and psychiatric illnesses among LGBTQ+ children, adolescents, and young adults.
The CDC’s statistics coincide with a recent survey conducted by The Trevor Project, a nonprofit organization that provides professional counseling for LGBTQ+ youth who are at risk of self-harm or suicide. For the fifth consecutive year, this survey gathered vital information about the mental state of more than 28,000 people ages 13 to 24 who identify as LGBTQ+. The findings were alarming: “Sixty percent of LGBTQ young people reported that they have felt discriminated against in the past year due to their sexual orientation or gender identity,” while 27% of trans and non-binary respondents said they had been physically threatened or harmed in that same time frame.
To look more closely at the current state of youth mental health in this besieged community, Northwell Health partnered with Stacker to compile a list of statistics related to LGBTQ+ youth mental health using data from The Trevor Project’s 2022 National Survey on LGBTQ Youth Mental Health.
The organization’s CEO and executive director, Amit Paley, affirms the national survey “is one of the most diverse” ever conducted on LGBTQ+ youth—45% of respondents are “of color,” and 48% identify as transgender or nonbinary. [Editor’s note: The Trevor Project employs the term “LGBTQ” to encompass the surveyed community; for the purposes of this report, the commonly used “+” was added in order to recognize the “totality of possibilities” as experienced by individuals within this group.]
Nearly half of LGBTQ+ youth seriously considered suicide in the last year
Those subjected to conversion therapy often report seriously considering suicide. The Trevor Project, therefore, directs its advocacy work to youth subjected to these treatments that human rights organizations and medical and mental therapists and organizations diametrically oppose.
From 2020 to 2022, rates of LGBTQ+ youth considering suicide and experiencing symptoms of anxiety, depression rose
Mental distress in LGBTQ+ youth can be mitigated by implementing affirming, accepting, and empathetic approaches in homes, schools, colleges, and other social settings. The CDC recommends educating the community at large—especially adults who act as role models—about the needs of LGBTQ+ kids and young adults, in order to provide a safe and understanding environment. This is particularly important when facing psychologically demanding times.
60% of LGBTQ+ youth desiring mental health care couldn’t obtain it
The World Health Organization warns that undiagnosed and untreated mental illnesses will worsen without professional aid. The WHO also points to the fact that continuous symptoms lead people to self-medicate, which can lead to abusing drugs or alcohol. The younger people start consuming drugs, the higher their risk of developing addiction and other related mental disorders.
Though not a replacement for continued, personalized care from a mental health professional, several organizations connect LGBTQ+ youth to free counseling, mental health support, and suicide prevention help, including the LGBT National Youth Talkline (1-800-246-7743), TrevorText (text “start” to 678-678), and Trans Lifeline (877-565-8860).
93% of LGBTQ+ youth said they were worried about being denied access to gender-affirming care and 91% said they were worried about being denied access to bathrooms
The Human Rights Campaign condemned the North Dakota House of Representatives after it passed seven different bills in January and February 2023 prohibiting transgender children and teenagers from identifying as such in public and legal documents. This “Slate of Hate” also restricts the use of an array of facilities, such as gym showers and restrooms, compatible with a trans person’s gender identity. Initiatives like The Human Rights Campaign focus on LGBTQ+ equality and inclusion through policy advocacy and tracking anti-trans legislation.
Suicide rates among LGBTQ+ youth are lower when they feel that their home and school are gender-affirming spaces and receive support from friends and family
Parental acceptance is vital to the mental health of any child or young adult, particularly to LGBTQ+ youth. The rest of the family and community also play decisive roles in their development and inclusion. Suicide, depression, and anxiety are drastically reduced when they are met with visibility, support, and inclusion from the people around them. That’s also the mission behind the It Gets Better Project, which helps LGBTQ+ youth feel that they’re not alone through a global community that shares stories of their own struggles and experiences.
Story editing by Brian Budzynski. Copy editing by Nicole Caldwell.
This story originally appeared on Northwell Health and was produced and distributed in partnership with Stacker Studio.
