Republicans seek to criminalize and outlaw gender-affirming care for trans kids
Dana has known she's a girl since she could talk, but Republican senators want to force her to grow up as a man and put her doctors in jail for providing medical treatments aimed at combating gender dysphoria.
A proposal from Sen. Wendy Rogers — who has a history of introducing anti-trans legislation — would send doctors who provide gender-affirming care to children under the age of 15 to prison for at least 17 years. Providing those treatments to older teenagers and vulnerable adults would earn the doctor at least 5 years in prison.
The only exemption in the Flagstaff Republican's Senate Bill 1130 would be care to resolve sexual development disorders.
The Arizona chapter of the American Civil Liberties Union opposes SB1130. In an email to the Arizona Mirror, the chapter's policy director Darrell Hill said parents, patients and doctors — not politicians — should decide what treatment is best.
"This extreme bill is out-of-step with the views of the medical community, intrudes upon the rights of parents to direct the medical care of their children, violates the rights of transgender youth and criminalizes doctors who are providing medically recommended care to their patients," Hill said.
And another bill from Sen. Warren Petersen, R-Gilbert, would ban gender transition procedures for minors, including puberty blockers, hormone therapy and surgeries — but wouldn't criminalize doing so.
Rogers' bill has twice been scheduled for a hearing in the Senate Judiciary Committee, but each time it has been skipped without a reason given. Bills are often skipped if they don't have the support to pass or if an amendment is being drafted to ease passage. Petersen's bill hasn't yet been assigned to a committee.
In 2019, the American Academy of Child & Adolescent Psychiatry issued a statement in support of the care provided to transgender youth and strongly opposed any legislation that would restrict its access — like both of these bills would do.
"Blocking access to timely care has been shown to increase youths' risk for suicidal ideation and other negative mental health outcomes," AACAP said in a written statement.
Rogers refused to speak with the Arizona Mirror about her bill and Petersen didn't respond to multiple requests for comment on his bill.
All kids deserve to have access to health care that allows them to grow into the young adults they were meant to be. – Tami Staas, Arizona Trans Youth and Parent Organization
The Center for Arizona Policy, a conservative Christian lobbying organization that has backed numerous anti-LGBTQ measures, praised Petersen's bill. It had no comment on Rogers' bill, which it does not support.
"SB 1138 helps children struggling to embrace their biological sex by protecting them from irreversible and harmful drugs and surgery. They deserve treatment held to the same ethical and evidence-based standards as any other medical care," spokeswoman Cindy Dahlgren told the Arizona Mirror in an email.
She went on to say that studies show between 80% and 95% of children dealing with gender conflict grow out of it, citing a statement from Michelle Cretella, president of the American College of Pediatricians, a conservative advocacy group.
That statistic is misleading, however. It is sourced from a 2008 study in the Journal of Sexual Medicine, which examined the research of an Amsterdam clinic. Years later, in 2015, that clinic became notorious for being shut down due to allegations of outdated and unscientific methods. At least 42% of youth admitted to the clinic didn't meet the criteria for gender dysphoria at all – meaning the statistic that supposedly showed kids growing out of their gender conflicts is likely incorrect.
For trans kids, getting ahead of puberty is key
The debate around gender transition medication usually involves puberty blockers, which are either a year-long implant or monthly shots. They stop testosterone and estrogen from causing breast tissue growth, voice-deepening, facial hair growth, and the development of the Adam's apple, among other things. Cross-hormone therapy is estrogen medication for those born male and testosterone medication for those born female. Puberty blockers are started once early signs of physical puberty begin, and cross-hormone therapy generally starts at 16, after blockers, or in cases where youths are too old for blockers.
Getting ahead of puberty is key.
"It stops the need for expensive, painful surgery," said Tami Staas, the executive director of Arizona Trans Youth and Parent Organization.
The average cost of top surgery, the most common type of surgical procedure which either augments or removes breast tissue, ranges from $3,000 to as much as $10,000.
Arizona ranked 12th in a 2016 report of transgender populations from UCLA's law school, and more than 3,600 youths aged 13 to 17 in the state identify as transgender, according to a 2020 fact sheet from the same school.
If Petersen's Senate Bill 1138 becomes law, a large share of those kids would have no access to medication when they most need it, or be forced to go off it and be catapulted into a delayed natal puberty – a puberty consistent only with their biological sex, with all the developmental trappings of a gender they don't identify with.
Obtaining gender transition medication isn't an easy task either, contrary to what many might believe, Staas, who works with more than 300 families valleywide, added. No one is walking into a doctor's office and leaving with a prescription within the hour. Children are assessed by a provider to determine which medication is right for them.
"There's pretty much one guy in town that offers gender-affirming care to individuals under 18, and he has about an eight-month wait," she said, using a description which moves away from viewing the transgender experience as solely defined by medical procedures.
Under Petersen's law, any doctors providing gender-affirming services to minors in Arizona would be subject to lawsuits from anyone, not just patients or their parents. The attorney general is also allowed to bring lawsuits against doctors and clinics. Insurance and health benefits plans operating in the state would also be prohibited from reimbursing gender-affirming care for minors, and health care coverage of any kind for all Arizonans would not be required to include it at all.
Concerns about the safety of puberty blockers ignore their long-standing use and approval by the medical community, said Staas. Puberty blockers have been used in the past and continue to be used for precocious puberty in young children to prevent faster than normal bone growth and sexual characteristic development. In statements, both the American Medical Association and the American Psychiatric Association have voiced their support for gender-affirming care, including medical treatments like puberty blockers.
Forced by politicians to suffer
The most vital reason for gender-affirming care is that it drastically reduces the likelihood of suicide. Suicide rates are disproportionately high among transgender youths. A 2018 University of Arizona study found that 50.8% of transmasculine youth — who are born male but identify as female — between the ages of 11 and 19 have attempted suicide at least once. The introduction of gender-affirming hormone therapy, however, reduced the likelihood of a suicide attempt by nearly 40%.
Staas dealt with this troubling reality before her son came out as trans.
"He had been hiding in his clothes — wearing clothes that were too big — and hiding in his room. I was getting up in the middle of the night and checking on him because I was scared," she said.
Today, her son is 23 and happier than ever before. Access to gender-affirming care made that possible.
The legislation won't impact Staas' son, but would have a profound effect on children just beginning their gender journeys. Kids like Dana are at risk of having their lives interrupted by legislation that ignores and effectively erases their identities – forced by politicians to suffer inauthentic and painful lives.
For Dana, it's never been a question of if she's a girl, but when the rest of the world will start getting with the program. The 10-year-old was firm about her gender identity when she was just two. In fact, most children show a basic understanding of gender at 18 to 24 months old and are secure in their own gender identity by 3 years old.
Claims that children eventually reconcile with their biological sex and regret transitioning are largely false and have more to do with social factors than personal ones. A 2021 study in the Journal of LGBT Health found that only 13% of participants had a history of detransition and 82.5% cited external reasons — the top ones being family pressure and social stigma.
Dana has expressed an interest in taking puberty blockers when she enters puberty, and mom Vanessa wants to keep that option open for her. She doubts that, after eight very outspoken and determined years, Dana will change her mind.
"That's a decision for her and her doctor to make. It should be on the table, but this bill would take it off," she said.
Staas fears the passage of this bill will lead to increased suicide rates among transgender youth who no longer have access to necessary health care, especially those whose families can't afford to travel out of state for it.
"We talk about trans kids and gender-expansive kids, but, really, it's about all kids. It's about the care that all kids deserve," she said. "All kids deserve to have access to health care that allows them to grow into the young adults they were meant to be."
This report was first published by the Arizona Mirror.
Gloria Gomez is a senior at the University of Arizona and the 2022 UA School of Journalism’s Don Bolles Fellow. The university started the fellowship in 1977 to honor Don Bolles, an Arizona Republic reporter killed in a 1976 car bombing.