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The American Medical Association has warned governors to oppose legislation that seeks to prevent transgender minors from accessing gender-affirming care, calling such measures “a dangerous intrusion into the practice of medicine.”
In a letter addressed to Bill McBride, the executive director of the National Governors Association, the AMA, the country’s most respected medical association, cited evidence that transgender and nonbinary gender identities are “normal variations of human identity and expression,” and warned that limiting access to gender-affirming care, in the form of puberty blockers, hormones, or surgery, can have mental and physical health consequences.
“For gender diverse individuals, standards of care and accepted medically necessary services that affirm gender or treat gender dysphoria may include mental health counseling, non-medical social transition, gender-affirming hormone therapy, and/or gender-affirming surgeries,” James Madara, the CEO and executive vice president of the AMA, wrote in the letter.
“Clinical guidelines established by professional medical organizations for the care of minors promote these supportive interventions based on the current evidence and that enable young people to explore and live the gender that they choose. Every major medical association in the United States recognizes the medical necessity of transition-related care for improving the physical and mental health of transgender people.”
The AMA also condemned the recent spate of bills in close to 30 different state legislatures seeking to block transgender youth from accessing certain treatments for gender dysphoria, criminalize doctors who prescribe such treatments, or — in the case of a bill passed by the Texas Senate — declare parents who affirm their child’s gender identity, even without surgical or hormonal intervention, to be guilty of “child abuse.”
Earlier this month, Arkansas lawmakers overrode a veto by Gov. Asa Hutchinson (R) of a bill that criminalizes doctors prescribing puberty blockers or hormones for minors, threatening them with disciplinary action and the loss of their license to practice, and even goes so far as to allow private insurance to deny coverage for medically necessary transition-related care for adults.
The American Civil Liberties Union has already threatened legal action over the Arkansas bill, and says it will also pursue a lawsuit should the Texas bill pass. Its Texas affiliate has already dubbed the bill “cruel and unconstitutional,” citing the AMA’s opposition as evidence of the bill’s extremist agenda.
“Decisions about medical care belong within the sanctity of the patient-physician relationship,” the AMA’s letter to the National Governors Association reads. “As with all medical interventions, physicians are guided by their ethical duty to act in the best interest of their patients and must tailor recommendations about specific interventions and the timing of those interventions to each patient’s unique circumstances. Such decisions must be sensitive to the child’s clinical situation, nurture the child’s short and long-term development, and balance the need to preserve the child’s opportunity to make important life choices autonomously in the future.
“We believe it is inappropriate and harmful for any state to legislatively dictate that certain transition-related services are never appropriate and limit the range of options physicians and families may consider when making decisions for pediatric patients,” the letter continues.
The AMA also noted in its letter that transgender individuals are up to three times more likely than the general population to report or be diagnosed with mental health or substance use disorders, due in part to stress, societal stigma, loneliness and isolation, and discrimination. That stress also poses a risk to transgender youth, prompting many of them to consider suicide.
Furthermore, the AMA notes, multiple studies show that access to gender-affirming care reduces the rates of depression, anxiety, suicidal ideation among patients, leading to overall improvements in mental health — as well as physical health, because trans individuals will not seek out “gray market” or “black market” hormones, silicone injections, or other potentially unsafe medical interventions.
“Transgender children, like all children, have the best chance to thrive when they are supported and can obtain the health care they need,” the letter concludes. “It is imperative that transgender minors be given the opportunity to explore their gender identity under the safe and supportive care of a physician. Arkansas’s law and others like it would forestall that opportunity. This is a dangerous intrusion into the practice of medicine and we strongly urge the NGA and its member governors to oppose these troubling bills.”
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