I sit across the exam room from a happy, healthy 16-year old boy. His voice cracks just a little as he tells me about the part-time job he just started. His mom and I laugh at his joke about needing stronger deodorant if he’s going to have to work so hard.
It’s hard to believe that this is the same dejected kid who, when I first met him, wouldn’t make eye contact or speak in sentences of more than three or four words. A few months of gender-affirming hormone therapy have placed this family firmly in the light at the end of the tunnel. And now I sit here, across the exam room, preparing to tell them that Indiana legislators are about to take it all away.
I live and work in Indiana, where our governor, Eric Holcomb, just signed SB 480. This bill bans all gender-affirming care for patients under the age of 18. Indiana’s SB 480, and similar bills in states like Kansas, Kentucky and Tennessee, are based on misconceptions about what this care entails.
For most transgender youth, gender-affirming care starts with therapy and simple changes to things like clothing and hairstyle. Once these children reach adolescence, care might include reversible puberty-blocking medications. These medications, often used in cisgender children who start puberty early, put a pause on puberty. This allows trans youth and their families time to explore gender identity, have conversations with their providers and chart a course for their care. This course may eventually include hormone therapy that would allow the child to enter the puberty of their affirmed gender.
I head home from work, the concerned words of my patient’s mother ringing in my head. Not only will SB 480 take away this child’s potentially lifesaving care, it will prohibit providers like me from referring these patients out of state for care. This bill will hamstring providers in our state. Physicians and advanced practice providers will be forced to ignore evidence-based care. They will be forced to act as if there is no safe and effective option for these patients. The mental health counselors who see these patients will be equally restricted in their care.
Some states face even more chilling effects on transgender youth. In Kansas, an anti-trans bill may allow sports officials to require a child to undergo a genital exam before playing youth sports. For those of us who took oaths of service, this definitely seems like causing harm.
In Indiana, 75% of LGBTQ youth report symptoms of anxiety. More than 80% report being negatively affected by recent politics. These numbers are reflected throughout the U.S. Numerous studies show the benefits of gender-affirming care for transgender youth. Rates of depression and suicidality decrease when youth have access to gender-affirming care. In fact, this care is recommended by every major medical organization in the country, including the American Academy of Pediatrics, the Pediatric Endocrine Society, the American Psychological Association and the American Medical Association. One has to wonder: Why do lawmakers think they have more expertise than these well-established medical institutions?
Arriving home, I find my 19-year-old son making dinner. He tells me about his latest Dungeons & Dragons campaign while chopping onions and garlic, laughing at the antics of his fellow players. He is happy. A wave of relief washes over me, knowing that my son is outside the reach of this bill, that his weekly testosterone injections will not be hijacked by the state. But that relief is tinged with guilt at the knowledge that so many people we know won’t be similarly lucky. How many parents will have to watch their children’s light dim because our state legislators feel emboldened to overstep the provider-patient privilege? How many of my patients will sink back into despondency?
Undoubtedly, there will be those who think the intent of this bill is to protect children. But what are we protecting them from? Evidence-based care? Shared decision-making with medical professionals? Legislators have gone too far. We must let them know that trans kids deserve access to care.
If you live in a state pushing anti-trans legislation, call your legislators and let them know that you cannot accept these gross oversteps. Reach out to your transgender friends and family members and let them know you do not support this type of egregious legislation. Your trans loved ones need you.
Kathy Campbell Feeney is a family nurse practitioner and the mother of a trans son. At the tender age of 22, she was awarded a degree in journalism, which she promptly gifted to her father. She hasn’t seen it since. In the ensuing 20-plus years, she has been a waitress, a bartender, a manager and a nurse. As an NP, she spends her days tending to her patients and her nights watching “Dropout” with her son. She firmly believes that health care decisions are a private matter between patients and their providers. The views expressed are her own and do not reflect the opinions of her employer.
If you or someone you know needs help, dial 988 or call 1-800-273-8255 for the National Suicide Prevention Lifeline. You can also get support via text by visiting suicidepreventionlifeline.org/chat. Additionally, you can find local mental health and crisis resources at dontcallthepolice.com. Outside of the U.S., please visit the International Association for Suicide Prevention.
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