THE BAD SCIENCE BEHIND TRANS HEALTHCARE BANS

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Special interest groups and conservative legislators are using scientific studies to try to restrict children's access gender-affirming healthcare. Arkansas is the site of one of the most important battlegrounds.

Arkansas state senator Alan Clark stated, on March 29, that "we can't act as though these studies don't matter." He was speaking in support of HB1570, which bans Arkansas minors from receiving gender-affirming healthcare. Clark was referring specifically to cherry-picked research which depicted various treatments being dangerous, experimental, or unsafe for children.

Arkansas was the first state that passed such a bill after a vote.

In May, the ACLU sued Arkansas challenging the constitutionality and validity of the law. The ban was temporarily stopped by a judge on July 21st. This happened just days before the law was due to take effect. "We were able show that these laws were irrational," stated Chase Strangio, an ACLU attorney at a press conference. "We're going to continue arguing that through the court system."

Arkansas was one of twenty states that tried to ban gender-affirming medical care for young adults in the past year. All the bills attempt to weaponize science against trans children and parents, in the form questionable, outdated or misinterpreted research. They willfully ignore both the experiences of trans persons and the expert opinions of many scientists, scholars and doctors.

Florence Ashley, a transfeminine bioethicist and jurist, says that while they claim they are doing science, they ignore what all the scientific associations have to say. She is a transfeminine lawyer and bioethicist, who studies how science and legal systems impact trans youth. The bills have been opposed by the American Medical Association, American Psychological Association and the American Academy of Pediatrics, as well as the American Academy of Child and Adolescent Psychiatry and the American Academy of Pediatrics.

HB 1570 has almost identical language to trans healthcare bans currently being passed through state legislatures. They're simply copy-paste bills that are based on "model legislation" from an alliance backed by antiLGBTQ hate organizations. This is a breakdown of the reasons these arguments don't stand up to scrutiny.

HB 1570: "For those children who are not gender-conforming or have difficulty identifying with their biological sexuality, research consistently shows that most of them identify with it in adulthood or adolescence, rendering all physiological interventions unnecessary."

Research refers to the idea that many trans children will grow out it as desistance. This term is derived from criminology and describes the act of quitting criminal behavior. Desistance is used often to take children's agency out of discussions about their identities. It can be used to portray them as confused or going through phases. It is also used to advocate "reparative" therapy, which, unlike Gender affirming Care, are dangerous and unethical.

One of the most cited statistics on desistance is that approximately 80 percent of children who suffer from gender dysphoria will become cisgender adults. The four studies that examined young children in gender identity clinics in Canada, the Netherlands and Canada from 2008 to 2013 are responsible for this percentage. The way these studies were conducted and the interpretation of their results are problematic.

All the children in all studies were not diagnosed with gender dysphoria but had been considered gender-nonconforming parents. The percentage of children who are desistant is dramatically increased by labeling them as such. Three studies showed that participants didn't keep in touch with researchers during adolescence and adulthood, which inaccurately raised the desistance percentage. Researchers discuss the methodological issues in an article and Julia Serano, a trans writer and biologist, discusses them in more detail.

It is also irrelevant because the desistance myth refers to children younger that those who are eligible for the physiological treatments listed in the bills. Ashley says, "It's not relevant." This is a prepubescent population. It is not the group being offered puberty blocking drugs. Puberty blockers will only be offered to those who have not yet desisted.

HB 1570: "Even inpatient gender reassignment procedures, suicide and psychiatric morbidities as well as mortality rates are markedly higher than the background population."

This is most likely to refer to a 2011 Swedish study, which the bill's sponsors have specifically mentioned in their arguments. The study found that adult trans people had higher rates than cisgender individuals of the same age of suicide attempts and mental illness.

Senators did not mention that the researchers acknowledged that gender affirming surgery alleviated gender dysphoria and that their findings should inspire improved care for transgender people following surgery. Researchers explicitly state that they don't believe that gender affirming surgery increases mortality. It is also very limited in many ways. The focus of the study was trans patients who were treated between 1970 and 1980. Since then, significant improvements have been made in both mental health care and surgical techniques.

Avery Everhart is a trans legal and medical geographer who studies access to trans healthcare. He points out that it's not easy to compare mental health between trans and cis kids due to so many variables. It's not ideal for you to compare to cisgender mentally healthy, well-adjusted youth of the same ages. Instead, you should be comparing with other youth who experience comorbidities.

Everhart states that trans youth are not more likely to develop mental illness or other problems because they are trans. Living in a transphobic environment, where children don't have support from their families and legislators try to limit their rights, can have negative consequences for mental health.

Everhart says that biomedical research generally assumes that it's better to diagnose the individual than to diagnose the society that gave them suicidality. This may have caused them to become depressed and led to substance abuse problems.

HB 1570: "The prescribing and use of puberty-blocking medications is done despite the absence of long-term longitudinal studies that evaluate the risks and benefits of these drugs in the treatment of gender transition or distress."

Jules Gill-Peterson is a trans historian and author of Histories of the Transgender Child. There is ample evidence to show that they delay puberty. The FDA has approved their use for cis-born children, who are particularly likely to enter puberty young. They have been prescribed for many decades. They are temporary and not reversible.

Long-term studies are not required to determine if puberty blockers have any risks or benefits for trans kids. WPATH Standards of Care, and guidelines of the Endocrine Society recommend the use of puberty blocksers for trans kids. A 2017 review of all evidence found that puberty suppression is safe and associated with better psychological health. A longitudinal study done in the US suggests that trans youth who have been treated with hormones, including puberty blocking drugs, show lower levels of depression and suicidal thoughts.

HB 1570: "Healthcare providers also prescribe cross-sex hormonal treatments for children who are experiencing distress in identifying with their biological sexual sex. Despite the fact that there have not been any randomized clinical trials on the safety or efficacy of using cross-sex hormones in children or adults for such distress or gender transition,

This is not a conclusive sign that there aren't randomized clinical trials. It would be unethical for hormone-related studies to be conducted in which some hormones are given to certain people while others are withheld. Hormone therapies for cisgender individuals are often prescribed, similar to puberty blockers. Anti-estrogen drugs can be recommended for teenage cisgender boys suffering from psychological distress. They are not approved for use by the FDA. These treatments are not available in randomized clinical trials. Hormone therapies for trans children are not permitted to be used by lawmakers.

After careful discussion and consideration between parents, healthcare providers, and children, hormones are prescribed to minors. Researchers argue that many barriers and gatekeeping exist to providing gender affirming care. Young teens often have the ability to make their own decisions regarding when and how to start hormones. WPATH, Endocrine Society and other medical associations consider hormone treatment safe and beneficial for trans teens.

HB 1570: "It concerns the General Assembly that individuals who are experiencing distress in identifying with their biological sexual sex will be subject to irreversible, drastic nongenital gender surgery and irreversible permanent sterilizing genital reassignment surgical despite the fact that there have not been any studies to show the benefits outweigh the dangers."

Minors are very rare to undergo gender affirming surgery, particularly genital surgery. Most minors who undergo gender affirming surgery are at least 16 years of age and have been medically and socially transitioning for some period under the supervision of healthcare professionals. WPATH Standards of Care recommend that you wait until you are majority to start hormones. Also, it's worth noting that trans children can avoid many more surgeries by using puberty-blockers.

Although the vast majority of trans youth don't have any surgery until they are 18 years old, there is increasing evidence that certain procedures can be beneficial to those who are younger. A study found that transfeminine patients were more likely than those who had vaginoplasty at college to continue with aftercare at home. A second study on transmasculine patients who had chest surgery in their early years of life showed significantly lower regret rates and dysphoria.

Opponents of trans healthcare use fear-mongering language to oppose gender affirming surgery, using words such as "irreversible", "sterilizing" or making comparisons with mutilation. However, bodies experience irreversible changes throughout their lives. These include puberty and aging as well as appendectomies (tonyllectomies) and tonsillectomies (appenctomies).

Gill-Peterson says, "It's a fantasy the cis body, some kind of organic, naturally evolving body that just perfectly unfolds following nature's plan and never undergoes any kinds of significant changes." "The human body is fundamentally biologically flexible."

Everhart says that irreversibility is based on two assumptions. One, it's a zero sum indicating that something is either reversible or not. Two, it's not a spectrum. "Some things will return to their former state but not completely, while others will reverse."

HB 1570: "Gender Transition Procedures" does not include: (i. Services to persons who are born with a medically verified disorder of sex, including someone with irresolvable biological sex characteristics [.Services provided by a doctor when the physician has diagnosed a disorder in sexual development through genetic or biochemical tests.

Although the bill prohibits surgery for trans youths, it specifies that it does not apply to intersex procedures. This exception allows healthcare providers to continue operating on intersex youth of any age without consent or knowledge. Gill-Peterson says, "They're going force intersex persons to endure the things they withhold from trans people."

Contrary to the medical treatment that trans youth seek to affirm their identities, intersex procedures on children can cause irreversible psychological and physical harm. Intersex activists continue to call for hospitals to cease performing intersex surgery despite the fact that medical opinion no longer supports them as necessary.

"That's what the tell. Gill-Peterson says that this is how you can tell these bills don't have any science or are ideological. It's all the same medicine for intersex, trans and cis people. It's just that they're treated completely differently under the law now, and I find that really, really troubling."