Protecting Trans Kids: Why you should be opposed to House Bill 321

Tammy Berlin

What is HB 321, and why are we talking about it?

Kentucky is one of several states that are currently considering legislation that would affect how transgender people will be able to receive healthcare.  These bills are based on wide-spread public misconceptions about what it means to be trans and what is appropriate healthcare for transgender people. Kentucky’s HB 321 is a bill that denies doctors the ability to provide gender affirmation treatment to transgender children under penalty of law.  If passed, this bill would put Kentucky’s transgender children at risk. Read on to understand why.  

What is transgender?  

There’s a biological basis for being transgender.  Gender in humans is determined by a complex set of factors, including genetics, brain development, and our endocrine systems.  Scientists are only now beginning to understand how these factors work together in determining our gender, however, it is clear that the scientific community no longer considers human gender to be a binary, but rather a continuum that encompasses a number of variations.  There’s so much more to our gender identity than our external genitalia or even our chromosomal composition.  

People who are trans have a strong sense that their personal identity and gender do not correspond with the gender they were assigned at birth.  Children as young as three can know that who they are on the inside does not match what their bodies look like on the outside. The World Health Organization classifies this condition as gender incongruence.   For some children, especially those approaching puberty and beyond, this incongruence between the child’s gender identity and their assigned gender may cause them significant discomfort and distress, known as gender dysphoria.  Gender dysphoria is a condition recognized by both the American Medical Association and the American Psychological Association. It is the condition for which trans people might seek a medical diagnosis and treatment.  

What are the health implications of gender dysphoria in children?  

Gender dysphoria poses serious health risks.  Children and adolescents who experience gender dysphoria are at increased risk for anxiety and depression, and are at high risk for self-injury and suicide.  Almost 84% of these children experience bullying related to their gender identity at school, resulting in social isolation, low self-esteem, and aversion to school.  Children with gender dysphoria are five times more likely to talk about or attempt suicide than other children.  As many as 45% of trans children engage in self-harm before the age of 20, with many of these individuals often targeting their genitals or breasts as physical reminders of the gender to which they feel they don’t belong.  

What is gender affirmation?  

Gender affirmation is the process through which a person receives support for their gender identity and expression.  The World Professional Association for Transgender Health has published standards of care to guide doctors and mental healthcare providers in reducing gender dysphoria in children.  These recommendations include allowing children to socially transition by living in their affirmed gender (changing their hairstyle, how they dress, using different pronouns, and perhaps using a different name).  Children approaching puberty may decide along with their parents and doctors to receive hormone blockers that will temporarily halt the development of physical characteristics that may be distressing for gender dysphoric youth.  The effects of these drugs are reversible, and puberty will resume when they are discontinued. Around age 16, older transgendered children may be eligible to receive hormone therapy, either estrogen or testosterone, that will help their bodies develop the characteristics that match their gender identity.  Children are not eligible for surgical transition. Gender reassignment surgery is only available to adults over the age of 18, and who have passed an intensive screening process.  

Why should we continue to allow doctors to provide gender-affirmation treatments to Kentucky’s trans children?  

Allowing trans children to affirm their gender is life-saving.  Receiving gender affirmation treatment significantly reduces the rate of suicidal ideations and self-harm in transgender children.  Gender affirmation is the course of treatment recommended by the American Academy of Pediatrics for gender incongruence.  Medical treatments like hormones and puberty blockers can only be administered after a thorough discussion of the risks and benefits.  The decision for when and how to assist a transgender child to transition to their affirmed gender is a decision that is made carefully and thoughtfully by the patient, the parents, and the physician together.  Children who are at risk for suicide and self-harm deserve supportive healthcare that is mutually agreed upon by the patient, their parents, and their physician. Legislation such as HB 321 that would put decisions about children’s healthcare in the hands of the government is dangerous and should not be enacted.  Protect trans kids; Oppose HB 321.  

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