Transgender Health Care in the USA: Then and Now

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Gender identity is one of the most important aspects of every humans life. A persons gender is usually determined at birth and becomes a social and legal fact from this moment. However, a moderate number of people have problems with the gender assigned to them at birth transgender people. Multiple ongoing debates within feminist studies and theories resulted in the development of a queer theory that legitimized the identities of transgender people.¹ The change of physical appearance or function through clothing, medical, surgical, or other means often becomes part of the personal gender experience of a transgender person.

In the April of 2021, the state of Arkansas became the first state in the United States that banned the use of medical treatments by individuals younger than 18 years old that identified themselves as transgender. The concerns of healthcare providers centered around the age, development, and mental health of youth. Besides, the healthcare providers questioned the youths maturity, as well as their insight.² The Republican bill is purposed to limit the prescription of hormone therapy for gender confirming as well as the surgeries for it and the prescriptions for puberty-blocking medications. The bill also prevents the doctors ability to refer transgender patients to other healthcare providers.

Following Arkansas steps, fourteen other states introduced another 22 bills with restrictions for transgender youth. Some even criminalized transgender surgical procedures claiming them as unlawful and abusive as well as the medical treatments for transgender minors. The bills sponsors and lawmakers defend their cases with the claim that the law protects youth from untimely decisions, as they are not mature enough for those. However, many healthcare providers felt the majority of youth who presented for care were well informed and had the insight necessary to consent to hormone therapy.³ The experts sound the alarm: the transgender community already has exceedingly high risks for both mental and physical health; with these laws in action, the danger rate will skyrocket.

The issue of transgender rights in the USA was always a difficult one. Despite the slow but steady expansion of the LGBTQ+ protection rights, transgender people still face all kinds of discrimination in almost every part of their lives. Transgender individuals comprise a part of society that is deeply vulnerable and constantly faces refusal to access equitable healthcare.⁴ The issues continue and keep reappearing despite the new societal nonverbal policy of protection surrounding an individuals gender identification. The problems in the health department are plenty: HIV/AIDS and health inequalities, bureaucratic and economic barriers to gender transition that involve ridiculously high costs of the surgical treatments, and a copious amount of documents needed.

The political debates around the case of transgender people never seem to cease. The major concerns center around the gender-affirming health care and medical personnel involved in care for transgender patients.⁵ During Trumps presidency, a variety of anti-discrimination laws was canceled; now, with Biden at the helm, the legal protection is slowly coming back. However, with such wildly varying laws, there is no confidence in the future for trans people.

Historically, the transgender community was always the least protected from the outrages of the government. In the late sixties, even the famous Stonewall-Inn, a refuge for all queer folk of New York City, was not that safe for trans people. The burden of medical pathology separated transgender people from the support of other LGB folks.⁶ Moreover, for a long time, due to disagreements within the LGBTQ+ community, no one recalled that Sylvia Rivera originally started the riot.

Despite all hardships, the transgender people did not want to hide anymore. Transgender people kept moving against the stream to the desired transgender visibility, and on the way, they have formed a strong community. The community formed activist organizations designed to promote transgender visibility in order to encourage further research into medical procedures required for gender confirmation.⁷ At the same time, trans-exclusive radical feminists try so hard to erase the experience of gender non-conforming people. Trans people remain the most vulnerable and harassed social group even now.

The question that raises the most discussions about trans rights is this: are transgender minors mature enough to consent to hormonal therapy? The scientific reasoning and empirical evidence state that it is justified to grant the youth a chance to decide whether they need gender affirming therapy.⁸ However, the bills promoted by the Republicans claim that their main concern is the wellbeing of the children the minors are not adults, and that is why they cannot decide for themselves.

With all the evidence of transgender minors being able to decide for themselves the necessity of hormonal therapy and surgical treatment, one might have thought that there is no point in further discussion. However, the reports point to the need for the affirming climate for the trans youth, as that the absence of validation from family and school outcomes in further mental health problems.⁹ Without governmental help, it is difficult enough to create a healthy environment for gender non-conforming youth, but if the laws are against it, too, it becomes nearly impossible.

The continuous back-and-forth play of the governments policies and agendas exhausts the community. The insecurity about the nearest future only adds to the general anxiety that transgender people experience on a daily basis. The potential barriers to care for health disparities could be excluded by the simple understanding of multiple peoples intersection of minority identities.¹⁰ It is obvious that transgender people do not fully benefit from their basic rights, both at the level of legal guarantees and in everyday life. Therefore, it is necessary to study this situation more closely.

References

Call, David C., Mamatha Challa, and Cynthia J. Telingator. Providing Affirmative Care to Transgender and Gender Diverse Youth: Disparities, Interventions, and Outcomes. Current Psychiatry Reports 23, no. 6 (2021). Web.

Clark, Beth A., and Alice Virani. This Wasnt a Split-Second Decision: An Empirical Ethical Analysis of Transgender Youth Capacity, Rights, and Authority to Consent to Hormone Therapy. Journal of Bioethical Inquiry 18, no. 1 (2021): 15164.

Martos, Alexander J., Patrick A. Wilson, and Ilan H. Meyer. Lesbian, Gay, Bisexual, and Transgender (LGBT) Health Services in the United States: Origins, Evolution, and Contemporary Landscape. PLOS ONE 12, no. 7 (2017).

Walch, Abby, Caroline Davidge-Pitts, Joshua D Safer, Ximena Lopez, Vin Tangpricha, and Sean J Iwamoto. Proper Care of Transgender and Gender Diverse Persons in the Setting of Proposed Discrimination: A Policy Perspective*. The Journal of Clinical Endocrinology & Metabolism 106, no. 2 (2020): 3058.

Footnotes

Alexander J. Martos, Patrick A. Wilson, and Ilan H. Meyer, Lesbian, Gay, Bisexual, and Transgender (LGBT) Health Services in the United States: Origins, Evolution, and Contemporary Landscape, PLOS ONE 12, no. 7 (2017). Web.
Beth A. Clark and Alice Virani, This Wasnt a Split-Second Decision: An Empirical Ethical Analysis of Transgender Youth Capacity, Rights, and Authority to Consent to Hormone Therapy, Journal of Bioethical Inquiry 18, no. 1 (2021): pp. 151-164. Web.
Clark and Virani, Analysis of Transgender Youth, 155.
Abby Walch et al., Proper Care of Transgender and Gender Diverse Persons in the Setting of Proposed Discrimination: A Policy Perspective*, The Journal of Clinical Endocrinology & Metabolism 106, no. 2 (2020): pp. 305-308. Web.
Abby Walch et al., Transgender and Gender Diverse Persons, 305.
Martos, Wilson, and Meyer, LGBT Health Services, 4.
Martos, Wilson, and Meyer, 4.
Clark and Virani, Analysis of Transgender Youth, 162.
David C. Call, Mamatha Challa, and Cynthia J. Telingator, Providing Affirmative Care to Transgender and Gender Diverse Youth: Disparities, Interventions, and Outcomes, Current Psychiatry Reports 23, no. 6 (2021). Web.
Call, Challa, and Telingator, Care to Transgender and Gender Diverse Youth.

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Transgender Health Care in the USA: Then and Now

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