Restricting trans health care could increase suicide rates
This article contains references to suicide and self harm. If you or someone you know is in crisis, call the National Suicide Prevention Lifeline at 988. Or text HELLO to 741741 to reach a trained listener with the CrisisText Line. It is free, available 24/7, and confidential.
In many ways, Maddie is a typical high schooler. She watches movies, plays video games, and hangs out with her friends. She has a keychain with various mementos that remind her of important events or people in her life.
In other ways, Maddie has had different experiences than her peers. She's transgender, and was outed by a local television news station while in the carpool line in the first grade. WUNC is not using her last name because she's a minor. Maddie and her family have been forced into advocacy more than they might have liked, but she's not about to back down.
"I do just want to be a kid. I do just want to be at home watching movies and stuff like that. But also I have to fight," she says. "I have to fight because people are trying to take stuff away from me that doesn't even involve them. Like, you are like a 70-year-old man. You do not need to be taking rights away from somebody who's 15-16 years old."
Yet that's exactly what is happening around the United States and in North Carolina. According to the Trans Legislation Tracker, the number of trans-related bills introduced nationally in 2023 is nearly four times the amount from 2021. In North Carolina, there have been a dozen bills introduced this year that activists say target transgender people. Earlier this month, one of those bills passed a House health committee at the state legislature with no discussion, leaving some in the audience aghast.
Critics of House Bill 808 protest in the committee room after House Health approves the Youth Health Protection Act without hearing from any members of the public, due to the committee running out of time. The bill was taken up last with about 15 minutes left. #ncga #ncpol pic.twitter.com/OJWdaw8aAk— Avi Bajpai (@avibajpai_) May 2, 2023
Maddie wasn't at the legislature that day, but says she feels the impacts.
"It hurts to be taken down by people who don't even get it," she says.
Some pieces of legislation would restrict health care available to transgender kids. They could even penalize health care providers for certain kinds of care. Any kind of limits on care — like access to hormone therapy or puberty blockers, or limits on insurance coverage for gender-affirming care — would impact Maddie and others in her position.
"I've said it a million times, I don't know if I would be here if I wasn't like this," she says. "It's life-saving stuff. People are so much happier when they realize who they really are."
Health experts echo Maddie. Studies show that two-thirds of all transgender people thought about suicide before transitioning.
"We have a lot of patients who self-harm. Cutting and burning and things like that," says Dr. Deanna Adkins, a pediatric endocrinologist who works with transgender youth.
She says there's a misunderstanding over what gender-affirming health care even is. For example, proposed legislation in North Carolina would ban gender transition surgery for anyone under 18. But Adkins says surgeries on minors happen only in the rarest of cases.
"Someone who is already trying to cut their breasts off, or cut their penis off," she says. "We would much rather have a surgeon, who knows what they're doing in a safe environment, do that, and keep that patient alive."
Adkins says most gender-affirming care includes a lot of talk therapy, or simply working with parents to help them navigate what their child is going through.
"Even just using [preferred] name and pronouns can reduce suicidality by half," she says.
In some cases, and only after months or years of talk therapy, doctors will prescribe puberty blockers. That's prescription medication to temporarily suppress puberty. Adkins says only later do teens start with hormone therapy, where they receive either testosterone or estrogen.
"We're not putting them in a — as has been indicated — a pathway the minute they come in and say, 'This is what's going on with me,'" she says. "Everyone's pathway is totally different. Some get puberty blockers, some don't. Some stay on, some go off."
Supporters of stricter rules around gender-affirming care say they want to protect children and keep them from doing something drastic they will regret later in life. As transgender rights have received more political attention lately, there has been an increase in claims that people regret a gender transition and then choose to stop treatment or detransition.
Health experts say it's important to understand any case where a patient is unhappy with their care, but say that focusing too much on detransitioners misunderstands how care is delivered. It's not like getting a tattoo on spring break. Anything that dramatically changes a person's body happens only after years of therapy and with multiple medical providers signing off on treatment.
Maddie's mom, Katie Jenifer, says she thinks the latest rounds of legislation are simply aimed at "othering" people.
"Maddie said something as a joke to me the other day, but it really struck me. She said, 'How am I supposed to live, love, laugh under these conditions?'" she says. "How is she supposed to? When she constantly has to worry about what rights they're going to take away next. How are they going to target her next? And for what reason? She's not doing anything or hurting anybody. She's just trying to be a kid."
The legislature has moved fast on some of these bills, meaning they will likely pass some versions this year. Governor Roy Cooper has signaled he will veto some of these bills, but with strong majorities in both chambers, Republicans have a good chance of overriding those vetoes.