Opinion: Senate Bill 514 and the Attack on Transgender Youth

On April 5th, a bill referred to as the “Youth Health Protection Act” was introduced in the North Carolina Senate. The bill proposed legislation that if enacted, would bar doctors from providing gender-affirming care, including puberty blockers, hormone treatment, and surgery to anyone under the age of 21. This bill was the latest in a string of attacks targeted at transgender youth across the country. Here are my thoughts.

Senate Bill 514, to put it plainly, cannot be logically justified. The arguments made in favor of this legislation are not based in fact. The bill has been framed by supporters as an effort to protect children from receiving medical treatment that may be harmful to them. Pediatricians, however, have voiced opposition to legislation that restricts access to gender affirming care. When it comes to matters relating to health care, I feel very strongly that it is best to heed the judgment of medical professionals, not politicians.

I also take issue with the language often used by critics of gender-affirming care. One word that comes up frequently is “mutilation.” This points to another problem with opposition to gender-affirming care: misinformation regarding the transition process. For many, the first image that comes to mind when they hear the phrase “medical transition” is that of children and teenagers undergoing irreversible surgical procedures to alter their biological sex. In the vast majority of cases, it simply doesn’t happen that way.

To unpack false perceptions of medical transition, one must first examine the transition process as a whole, particularly as it applies to minors. While each case is unique, the general transition process is as follows:

  1. Social Affirmation: This stage involves changes to an individual’s gender expression. Changes can include dressing differently and using a different name. This is typically the extent of transition for young children. There is no medical aspect to this stage.
  2. Legal Affirmation: This stage involves changes to official government identification, such as a driver’s license, to accurately reflect an individual’s name and gender. This stage may occur before or after medical transition, varying by case.
  3. Medical Affirmation: This stage involves gender-affirming treatments including puberty blockers and hormone therapy. Puberty blockers are used to delay physical changes that affect gender expression, giving a child more time to explore transition options. It should be noted that pubertal suppression is temporary and can be halted at any time. This treatment is typically started during early puberty. Hormone therapy refers to treatment that alters an individual’s hormone levels in order to align with their gender identity. This treatment typically begins around age 16. 
  4. Surgical Affirmation: This stage involves the surgical alteration of an individual’s sexual characteristics in order to better align with their gender identity. It is important to note that not all transgender individuals choose to undergo gender-affirming surgery and that it is never performed as a first step. The choice to undergo surgery is made only after other options have been explored. Gender-affirming surgery is typically only performed on adults. For a minor to undergo gender-affirming surgery, there are a number of requirements including parental consent and support from an M.D. and a therapist.

If passed, SB 514 would strip transgender youth throughout the state of their right to undergo any form of medical or surgical transition. The consequences of such an act would be devastating. While all aspects of the proposed legislation are incredibly dangerous, arguably the largest threat posed is the loss of access to puberty blockers.

A 2020 study found that access to pubertal suppression reduces the risk of suicidal ideation in transgeder youth, a group already predisposed to higher rates of suicidal ideation than their cisgender peers. I will reiterate here that puberty blockers are not permanent. If a child wishes to undergo hormone-driven puberty that aligns with their biological sex, all they need to do is stop treatment. Something that supporters of SB 514 have failed to consider is that, while pubertal suppression is easily reversible, hormone-driven puberty is not.

Another issue with this legislation is that it demonstrates a fundamental misunderstanding of what it means to be transgender. If a person is transgender, their gender identity does not align with the sex assigned to them at birth. Transgender individuals often experience gender dysphoria, defined by the American Psychiatric Association as “psychological distress that results from an incongruence between one’s sex assigned at birth and one’s gender identity.” Gender dysphoria is diagnosed in association with clinically significant impairment in important life functions. In other words, it is very real and has very real consequences. These consequences were dismissed entirely by SB 514.

While it was announced on Tuesday that the bill would not be coming to the floor for a vote, its significance still stands. North Carolina has a history of anti-trans legislation, most notably the infamous “Bathroom Bill” of 2016. The bill, officially called the Public Facilities Privacy and Security Act, drew criticism for its provisions requiring that all individuals use bathrooms that aligned with the sex listed on their birth certificate in schools and government buildings. The bill was ultimately repealed, but the introduction of SB 514 five years later shows that the fight for transgender rights in North Carolina is far from over.

In addition to SB 514, legislation attacking trans youth has been introduced nationwide, with Arkansas becoming the first state to ban gender-affirming care for minors on April 6th. In a testimony before the Texas senate regarding the state’s own anti-trans legislation, ten-year-old Kai Shappley spoke up on behalf of transgender youth across the country:

“When it comes to bills that target trans youth, I immediately feel angry. It’s been very scary and overwhelming… It makes me sad that some politicians use trans kids like me to get votes from people who hate me just because I exist.”

Her words serve as a reminder that the issue of transgender rights is not purely political. Attacks on the transgender community affect the lives of real people, particularly children. If North Carolina legislators truly wish to keep children safe, as the name of their bill suggests, I call on them to listen to the perspectives of those children, as well as those of their doctors and parents, and to understand that transgender youth are not a problem to be solved. They are people, and they deserve to live authentically in a world where they are accepted for who they are.

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