In a letter to the National Governor's Association, the American Medical Association urged opposition to state legislation barring physicians from providing transgender minors with care related to their transition.
"We believe it is harmful for any state to legislatively dictate that certain transition related services are never appropriate," wrote AMA CEO and Executive Vice President Dr. James Madara.
On April 6, the Arkansas Legislature passed the Save Adolescents From Experimentation Act, or the SAFE Act, which would bar access to hormones and puberty blockers that provide gender-affirming treatment to transgender youth. Other states such as Alabama, New Hampshire, and Arizona have introduced similar legislation with penalties for physicians providing this treatment.
In his statement, Madara says these laws are a "dangerous intrusion" into the physician-patient relationship, since many of these services are offered based on an individual client's need. Research referenced in Madara's letter shows stalling this care can contribute to an increase in stress and poor mental health, which is dangerous considering trans youth are already at a heightened risk of suicide.
Bills being debated in Texas would allow these gender affirming treatments to be listed under the statutorial definition of child abuse and prevent liability insurers from covering transition-related care. In Arizona, a Senate bill would make providing this treatment to patients punishable for up to 12 years in prison.
While these bills are still pending in state legislatures, Alabama's Senate passed a law that would restrict transition related care to trans youth up to 19-years-old, impose felony charges on physicians offering this treatment, and prevent Medicaid from covering care as of March 2. Most recently, Arkansas's SAFE Act, which goes into effect 90 days following the end of the legislative session on April 30, will revoke a physicians license if they offer hormone or puberty blocking treatment to trans patients under the age of 18.
Stakeholders, such as insurer Aetna which has covered this service, recommend at least a year of hormone treatments before undergoing any gender reassignment surgery to "provide ample opportunity for patients to experience and socially adjust in their desired gender role." These treatments are not permanent.
Studies in AMA's letter show these treatments have reduced sucide attempts as well as rates of depression and anxiety in trans youth. A community report mentioned by AMA explains that gender affirming treatment under the supervision of a physician prevent youth from resorting to "harmful self-prescribed hormones" or "construction-grade silicone injections" that can cause serious damage to health. Other organizations, such as the Association of American Medical Colleges, have spoken out against these laws saying it will make patients vulnerable to "already significant" inequities in quality of care.
According to the Trevor Project, an organization providing crisis intervention to LGBTQ teens, a 2020 national survey of trans and non binary youth show 60% have engaged in self harm and over half considered suicide. AMA said increased risk of suicide in trans kids is likely due to coping with the stigma and discrimination surrounding their gender identity.
The National Governor's Association was unavailable for comment.