LGBTQ+ Health Updates

LGBTQ+ Health Updates

Issue: May 2021
Source: Healio interviews
Disclosures: Frey-Vogel and Lee report no relevant financial disclosures. Safer reports he received consultant fees from ENDO pharmaceuticals in 2018.
April 07, 2021
3 min read
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Arkansas outlaws gender-affirming treatment for minors, prompting outcry from providers

Issue: May 2021
Source: Healio interviews
Disclosures: Frey-Vogel and Lee report no relevant financial disclosures. Safer reports he received consultant fees from ENDO pharmaceuticals in 2018.
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Arkansas on Tuesday became the first state to outlaw any gender-affirming medical treatments for minors who may be transgender, overriding a veto from the governor and prompting outcry from providers and advocates.

The bill, approved by the Arkansas House and Senate, overrides an April 6 veto by Gov. Asa Hutchinson and would prohibit providers from prescribing medical treatments, such as pubertal blockers, for minors who may be transgender. The bill also prohibits the use of gender-affirming hormone therapies or surgeries or referring minors for gender-affirming surgeries — treatments that are not endorsed by any professional medical society.

Transgender legislation callout
Lee is an assistant professor of pediatrics and medicine at the University of California San Francisco.

“It is not standard in the United States for the government to try and weigh in and dictate to physicians how to care for patients,” Joshua D. Safer, MD, FACP, FACE, executive director of the Center for Transgender Medicine and Surgery at the Mount Sinai Health System, and professor of medicine at the Icahn School of Medicine at Mount Sinai, told Healio. “That is left to medical organizations, and it certainly is not standard for government to try to make decisions related to health care without enlisting your major health care authorities in the process. That is the part that surprises me.”

Joshua D. Safer

Arkansas is one of 18 states across the country that have introduced or are considering legislation that would prohibit medical treatment for children who may be transgender, including the use of pubertal blockers. As Healio previously reported, the trend has alarmed clinicians who say such bills reflect widespread misunderstandings and go against evidence-based practices.

“To say this is disappointing would be an understatement,” Janet Y. Lee, MD, MPH, MAS, assistant professor of pediatrics and medicine at the University of California San Francisco, told Healio. “I’m part of the Pediatric Endocrine Society Transgender Health Special Interest Group, and about a year ago, we started our advocacy subcommittee. We have known that these bills have been multiplying and getting closer and closer to getting passed for the last few months. From a professional standpoint, it is disappointing, but it is devastating for our patients.”

In a statement issued to its members on April 1, the Pediatric Endocrine Society affirmed its opposition to any legislation that goes against evidence-based medical treatment.

“If signed into law, some of these bills would criminalize medical providers who provide medically necessary care to transgender and gender-diverse youth,” the statement reads. “Pediatric Endocrine Society opposes the proposed legislations across the United States that aim to restrict the rights of transgender and gender-diverse youth or the ability of health care professionals to provide medical care.”

The flurry of bills introduced in statehouses across the U.S. has worried some providers, who fear the legislation will only serve to further stigmatize and alienate transgender and gender-diverse youths during a vulnerable time.

Ariel S. Frey-Vogel

“What I worry about most is suicide attempts,” Ariel S. Frey-Vogel, MD, assistant professor of pediatrics and director of child and adolescent services within the transgender health program at Massachusetts General Hospital, told Healio. “When trans youths cannot get the care that allows them to be affirmed in their gender, there is an increased risk for suicide and depression. I very much worry about that and think it is a huge unintended consequence.”

The legislation could also lead to unintended consequences for children with other endocrine conditions. Pubertal blockers, also known as synthetic pituitary hormone blockers, have long been used to treat central precocious puberty and certain pediatric growth disorders.

The legislation has also led to fear among endocrinologists and other providers, Frey-Vogel said.

“There is a fear that the years of training we have had, the evidence we base our decisions on, is going to be discounted,” Frey-Vogel said. “Instead, state governments are going to make medical decisions based on bias and incorrect assumptions. The idea that there is something pathologic about being transgender is absurd. The basis of this legislation is not based in science. It is based in prejudice. For a physician, if it is a felony to do the work that we do, what does that mean?”

Professional societies are working to provide resources for clinicians on how to handle legislation that prohibits certain medical treatments.

“We are trying to provide our members with tools,” Lee said. “One organization doing a lot of advocacy work is the American Academy of Pediatrics. AAP has local chapters that can help those on the ground affected. Regardless of whether you are affected directly, it is important for all pediatric endocrinologists, pediatricians and adolescent medicine providers to get involved.”

For more information:

Ariel S. Frey-Vogel, MD, can be reached at afrey@partners.org; Twitter: @AFrey_Vogel. Janet Y. Lee, MD, MPH, MAS, can be reached at janet.lee@ucsf.edu; Twitter: @MedPedsEndoMD. Joshua D. Safer, MD, FACP, FACE, can be reached at joshua.safer@mssm.edu; Twitter: @JoshuaSafer.