Finding the Motivations Behind Anti Transgender Laws

The Arkansas state legislature recently overrode a veto from conservative governor Asa Hutchinson to pass the Save Adolescents From Experimentation (SAFE) Act. What does it do? It bans gender-affirming treatments for trans youth under 18 years of age. The stated objective sounds reasonable: We shouldn't experiment on kids, and we shouldn't allow drastic changes to their bodies that they might regret. But is that the objective? Several warning signs point to completely different motivations.

First, Hutchinson vetoed it. Why? He's admitted the legislation is related to “the cultural wars that we’re engaged in,” and Republicans were “acting out of fear of what could happen, or what our imagination says might happen, versus something that’s real and tangible.” He considered the issue one of government overreach, interference in the private medical decisions.

Gender-Affirming Treatment Reduces the Risk of Depression
Second, those private medical decisions Hutchinson was thinking about involved physicians skilled in the management of trans youth, and they contacted him and urged him to veto the law. The law's supporters were worried about irreparable harm to young people, and conservative politicians have referred to gender-affirming therapy as genital mutilation, which is not something these doctors, or the kids' own parents, who would have to consent, would want. There is no "experimentation" going on here. Gender-affirming treatment has been around a long time, and it's been established to improve outcomes in trans kids. Specifically, it reduces their risk of depression and suicide. It saves lives. The law's supporters didn't cite evidence for their legislation, because the evidence shows the law forbids treatments that save kids' lives. It's not to protect kids.

Third, supporters of the law have said they want to delay treatment until kids can make an informed decision as adults, meaning to put off a momentous decision. That again sounds like it would protect trans kids. But the truth is the opposite. Doing nothing isn't nothing to a trans kid. A trans boy left untreated to age 18 is going to develop breasts, and feel as harmed by that as a cis boy developing breasts would. A trans girl untreated until age 18 will develop facial hair, a deepened voice, and other changes, and feel as harmed by that as a cis girl developing a beard would.

Importantly, these changes are permanent, requiring correction. The breasts will then need surgical removal. The facial hair will need removal. The deep voice cannot be changed. The harm will be lasting. But there actually is a way to temporize this important decision: puberty blockers. Medicines can delay these changes in a reversible manner, allowing kids to be sure about their identity and transition later, before harmful changes, without taking any permanent treatments.

Gender Affirming Therapy Reduces Suicides
That is temporizing; that is also current medical care of trans kids. What these legislators have done is forced trans kids into life-altering body changes and difficult treatments by forbidding puberty delaying therapy. In short, the law's effect (well known to the authors) is the opposite of the stated objective.

We know, based on the lack of evidence proposed to justify these laws, the existing evidence that gender-affirming therapy is temporizing and **reduces suicide**, while forbidding therapy forces distressing body changes on trans kids, and the lack of concern shown to other children (e.g., how supporters of these laws tend to support conversion therapy for LGBTQ youth, despite the advice of psychiatrists and pediatricians that such treatments are harmful). The welfare of kids really isn't at issue here.

Instead, these kids are, as Governor Hutchinson noted, part of a culture war. They're the pawns. As a gay-bi person myself, as someone who knows many LGBTQ people, as a colleague of child psychiatrists, and as a doctor, my advice: Let the healthcare professionals practice healthcare. Meanwhile, legislatures could promote universal healthcare for children and provide services to hungry and homeless children with all their new free time.