Ban on gender-affirming care for Kansas kids misrepresents evidence, likely to cause harm

On March 27, the Kansas Legislature passed Senate Bill 233, which would prohibit the provision of gender-affirming health care to transgender and nonbinary youths across the state. Gov. Laura Kelly vetoed this bill April 12. A vote to override the veto is expected to occur when Kansas lawmakers return from their adjournment for the final weeks of the session. If SB 233 is signed into law, Kansas will join 24 other U.S. states that have passed similar legislation.

I have been researching the social aspects of transgender medicine in the United States and globally as a sociologist for seven years. Specifically, I study how knowledge in gender-affirming health care is produced and put into practice. Over the past four years, I’ve watched the flurry of proposed and enacted bans on this care across the U.S. with increasing concern. My dismay stems from the misrepresentation of scientific evidence supporting gender-affirming health care, as well as the harms that I anticipate restrictions on care will cause.

Proponents of bans on gender-affirming health care for people under the age of 18 often argue that there is inadequate scientific evidence for this care. Many of the criticisms center on the lack of randomized control trials (RCTs), which are considered to be the “gold standard” of evidence in medicine. However, these criticisms overlook that RCTs are not ethically feasible in many areas of medicine (not just gender-affirming health care), and that other forms of evidence can and should be evaluated to assess the risks and benefits of various interventions.

Puberty blockers offer a poignant example of this issue. Many transgender and nonbinary youths seek these medications, typically provided as a gonadotropin-releasing hormone analogue (GnHRa), because they pause the onset of puberty. These effects are reversible: Youths may choose to stop and go through endogenous puberty. Alternatively, youths may choose to begin gender-affirming hormone therapy once they have reached the recommended age.

Because there are no RCTs of puberty blockers for transgender youths, proponents of bills such as SB 233 have portrayed them as “experimental” treatments. This depiction of puberty blockers falsely implies that there is no scientific evidence available to evaluate the benefits and risks of these medications. Contrary to this picture, the prescription of GnHRa has been an accepted treatment for cisgender youths diagnosed with central precocious puberty for several decades. Absent RCTs, rigorous medical and social scientific research has shown the benefits of delaying puberty for transgender youths, including alleviation of gender dysphoria and decreased suicidal ideation or attempts.

Supporters of restrictions on gender-affirming health care for youths have also expressed concerns that clinicians may be pressuring youths into medical transition. This fear was stoked when an ex-employee of a St. Louis clinic providing care to transgender youths claimed that clinicians had been making inappropriate referrals. Many of the testimonies submitted in favor of SB 233 referenced news media accounts of this story.

These testimonies neglect to mention two important points. First, youths who were patients at the clinic and their families directly contradicted these claims. Second, an internal investigation completed by Washington University found no substantiation for those allegations.

In the years I have spent interviewing clinicians and patients, observing transgender health conferences, and analyzing medical publications, I have seen no justification for the concern that clinicians are pressuring youths to transition medically. On the contrary, the clinicians I spoke with tended to emphasize that decisions to begin medical transition at any age require careful and individualized consideration by patients and their providers. The trans adults I interviewed who had sought care before the age of 18 generally recounted a widespread reluctance to prescribe puberty blockers among clinicians they had visited, let alone hormone therapy or gender-affirming surgeries.

Social science and medical research has consistently shown that transgender and nonbinary people face high rates of stigma and discrimination in health care compared with the general population. Transgender and nonbinary youths experienced significant difficulties accessing care even before U.S. states began restricting its provision, and bans on gender-affirming health care are expected to worsen health outcomes in this community.

My expertise in this field leads me to conclude that similar policies could cause irreparable harm to Kansas’s transgender and nonbinary youths. Kansas lawmakers need to recognize the scientific evidence demonstrating the benefits of gender-affirming health care.

Alyssa Lynne-Joseph is an assistant professor of sociology at Wichita State University. Through its opinion section, Kansas Reflector works to amplify the voices of people who are affected by public policies or excluded from public debate. Find information, including how to submit your own commentary, here.