Growing up has always brought challenges. For transgender or non-binary teens, teens and young adults, growing up is especially difficult amid stigma that has recently been exacerbated by a wave of state laws that allow discrimination. For them, the Covid-19 pandemic has further complicated life due to the loss of positive social interactions and connections.
Suicide has been ranked as the second leading cause of death among people aged 10 to 14 and the third leading cause among 15 to 24 year olds, according to data compiled by the Centers for Disease Control and Prevention (CDC). For transgender children, adolescents and young adults, evidence indicates that significantly higher rates of suicidal ideation are linked to complex school and family dynamics, increased bullying and the distressing effects of puberty. and the development of secondary sex characteristics.
Transgender people face a disproportionate burden of mental health issues, including depression, anxiety and suicidal tendencies, which may be linked to gender dysphoria, social stigma and discrimination. The risks are heightened for transgender children, adolescents and young adults. These factors lead to rates of anxiety and depression up to 10 times higher than their cisgender peers and lead to alarming rates of suicidal ideation and behavior. Evidence shows that transgender or non-binary youth who experience discrimination have higher rates of depressed mood, seriously considering suicide, attempted suicide, and multiple suicide attempts.
It is important to note that this higher suicidal risk is not inevitably associated with transgender or non-binary status, but is instead the result of stigma, discrimination and abuse. A large body of medical literature demonstrates that with support at home, school, and in the community—and with access to gender-affirming care—transgender youth perform equally well on mental health measures. than their non-transgender peers.
Gender-affirming care aims to minimize the distress of trans people by providing a supportive, non-judgmental environment that acknowledges the individual’s gender identity or uncertainty about their gender identity. This type of care also offers interventions to reduce the incongruity between gender identity and the individual’s birth-assigned sex, and gives patients struggling with their gender identity the time and support they need. need to resolve this struggle.
Despite widespread support from major medical associations for care that affirms gender as the accepted norm, state legislatures across the country are considering or have already banned physicians and other medical professionals from providing such care to minors. This includes denying access to drugs that delay the onset of natal puberty and hormone therapy for older adolescents. Some of these measures also provide penalties — including criminal prosecution and disciplinary action by state medical boards — for doctors and other health professionals providing gender-affirming care to minors.
To date, two states – Alabama and Arkansas – have enacted laws prohibiting medical professionals from providing evidence-based gender-affirming care to minors. Both laws have been prescribed. Additionally, the Florida Medicaid program recently finalized rules prohibiting coverage of gender-affirming treatments.
Our AMA strongly opposes these types of discriminatory actions as dangerous government intrusions into the practice of medicine. Decisions about gender-affirming care are properly made through shared decision-making between patient, family, and physicians, without politicians intruding into the medical examination room or questioning gender-affirming decisions. health care. AMA policy specifies that clinical interventions for gender dysphoria should not be criminalized or otherwise restricted.
We must reject the efforts of politicians and government to interfere in clinical decision-making, force physicians to ignore standards of clinical care, or prevent us from fulfilling our ethical duty to act in the best interests of our patients. It is dangerous for any state to limit the range of options doctors, patients and families can consider when making decisions together for pediatric patients.
In addition to legislative advocacy, the AMA Litigation Center has advocated for transgender patients through amicus briefs supporting legal challenges to restrictive laws. We will continue to work diligently at the state and federal levels to expand access to medical services, reduce stigma in treating patients with unique care needs, and dismantle discriminatory barriers to care, where and when they are.
All major medical associations recognize the vital role of gender-affirming care in improving the physical health and mental well-being of transgender people. Widely accepted standards of care and clinical guidelines recommend a step-by-step process for transgender minors that allows young people to explore and experience the gender they choose while keeping options open. Studies have consistently shown that providing age-appropriate, evidence-based gender-affirming care leads to better mental health outcomes. Conversely, refusal of such care is linked to a greater incidence of anxiety, depression and self-harm.
For these and other reasons, it is imperative that transgender minors be allowed to explore their gender identity under the safe and supportive care of a physician. Our AMA has partnered with Fenway Institute, Howard Brown Health Center and others to create CME modules covering affirmative care for LGBTQ+ patients. You can find valuable educational resources about LGBTQ+ health care at the AMA Ed Hub™ Health Equity Education Center.
Everyone deserves access to high-quality, evidence-based health care. Transgender children, like all children, have the best chance of thriving when they are supported and can get the health care they need. Our AMA will continue to work diligently at the state and federal levels to ensure that transgender or gender non-conforming people can receive compassionate care that meets their needs, free from discrimination, unconscious bias or stigma. We will continue to fight to protect the rights of patients and the ability of physicians to provide strong, evidence-based medical care.