Restricting Access to Gender-Affirming Care: Has the Arizona Legislature Gone Too Far?

By Kennedy Shulman. 

Restricting Access to Gender-Affirming Care until 18

In March of 2022, Arizona Governor Doug Ducey signed legislation restricting access to gender-affirming health care for minors. The health care ban, SB 1138, states that “[a] physician or other health care professional may not provide gender transition procedures to any individual who is under eighteen years of age.” Simply put, the bill outlaws gender-affirming surgery until the age of adulthood. 

Ducey rationalized his signoff stating, “The reason is simple, and common sense—this is a decision that will dramatically affect the rest of an individual’s life, including the ability of that individual to become a biological parent later in life.” With his signature coming on the eve of the International Transgender Day of Visibility, however, Ducey and other conservative lawmakers faced harsh backlash from LGBTQ advocates. 

Despite this criticism, SB 1138 went into effect on April 1st of this year, and its impact on trans youth in Arizona is still developing. What message does this bill send to our children? How will this restriction impact the collective psyche of trans youth? Nate Rhoton, CEO of 1-n-10, an LGBTQ youth organization, makes some predictions: “It sends a message to them that they’re not accepted that it’s not okay for them to be who they are [sic]. And it also targets them with various groups that maybe disagree with how they are, quote, unquote, living their lives.” 

Is SB 1138 an Overreach? 

Transgender children and parents around Arizona contend that this law is an overreach—that Arizona lawmakers shouldn’t be legislating their health care. Proponents of the bill argue children shouldn’t be making these decisions. But how do we determine where legislators should draw the line? 

On the one hand, SB 1138 does not ban puberty blockers or other gender-affirming hormone therapy. Its limited scope, as explained by proponents of the legislation, is to prevent irreversible and life-changing decisions from being made by minors, who cannot fully appreciate the permanence of their choices. The Center for Arizona Policy (“CAP”) explains: “Adolescence is a profound time of physical, mental, and emotional change. Children need guidance from adults, including protection from undertaking life-altering and irreversible decisions, before they can fully contemplate the implications.” As the number of minors seeking gender transition procedures continues to rise, the risk that these same adolescents may later change their minds increases along with it. In fact, the CAP points to a study that shows 80 to 95 percent of these children wind up accepting their biological gender as they enter adulthood. 

Michelle Cretella, MD, even goes so far as to say that ethics demands the termination of gender transition procedures in children and adolescents. Cretella argues that, “There is a serious ethical problem with allowing irreversible, life-changing procedures to be performed on minors who are too young to give valid consent themselves; adolescents cannot understand the magnitude of such decisions.” 

On the flip side of the debate, LGBTQ advocates cite the mental health consequences trans youth experience due to ongoing discrimination. The American Academy of Pediatrics explains the heightened risk for mental illness, which stems from “an internal conflict between one’s appearance and identity, limited availability of mental health services, low access to health care providers with expertise in caring for youth who identify as [transgender and gender diverse], discrimination, stigma, and social rejection.” 

This argument centers on the notion that “anti-trans” bills, such as SB 1138, contribute to a decline in the mental health of our trans youth. SB 1138 could worsen the isolation and rejection felt by children who identify as transgender and gender diverse, which can in turn put their lives at risk. Rhoton expresses concern that this legislation will result in “heightened cases of depression, anxiety, self-harm, suicidal ideations and even suicide attempts.” These concerns align with results from a new Trevor Project survey, which shows 85% of trans youth claim their mental health has declined as a result of these legislative attacks. 

So where do we go from here?

The Real Cause of Declining Mental Health for Trans Youth 

Currently, we know too little to pinpoint the exact cause of declining mental health in our trans youth. Proponents of the “anti-trans” legislation point to studies that show gender-affirming surgeries do not combat the referenced decline in mental health. A study out of Sweden “revealed that 10 to 15 years out, the suicide rate of those who had undergone sex reassignment surgery was 20 times that of comparable peers.” Put another way, proponents believe that the mental health crisis in trans youth stems from inadequate treatment of gender dysphoria, not from bills such as SB 1138. This is in contrast to LGBTQ advocates who claim these mental health problems are a consequence of transphobic legislation, stigma, rejection, bullying, and discrimination. 

Regardless of which side of the debate you land on, it is abundantly clear that there is disagreement over the root cause of this deteriorating mental health crisis. Presumably, further research may help us clarify the answer. 

The Future of SB 1138 and “Anti-Trans” Bills Alike 

The future of SB 1138 and similar “anti-trans” bills is largely unknown. Is SB 1138 a one-size-fits-all solution? Do we need more individualized health care to determine what is best for each child on a case-by-case basis? Is this even the legislature’s business? These are just a few of the many questions we need answered in order to alleviate the rift. As studies continue to roll out, perhaps we will find some clarity and minimize the divide between proponents of this legislation and LGBTQ advocates. In the meantime, there is one thing we can agree on: additional research is necessary to determine whether the benefits of gender-affirming care outweigh the costs.