This is a guest opinion column
I came to medical school to learn to take care of patients where I grew up. Because of bills like the ironically named Alabama Vulnerable Child Compassion and Protection Act 6 (HB 150 and SB 5), I would face up to 10 years in jail simply for giving my patients the care they deserve---care that they would certainly receive if they lived where I trained.
People who have been following the state of legislation in Alabama involving transgender people might think this bill seems familiar- and they would be right. In fact, this bill was introduced in 2021 and previously unsuccessful. Despite this previous attempt, it was refiled and approved by the Senate Healthcare Committee in Feburary.
I have had the opportunity to spend time in a transgender adolescent clinic in medical school. In our clinic, I have seen children blossom with the support of their parents, many of whom travel many miles to seek gender-affirming therapy.
What is gender-affirming medical care? For children who need more time to explore their gender before starting puberty, a puberty blocker is the first step, to simply delay puberty and allow time to gain clarity with the support of their families and physicians. These medications are reversible, which means that individuals can either come off of them and continue puberty that aligns with their sex assigned at birth, or start gender-affirming hormone therapy and puberty that better aligns with their gender identity. Other youth may choose to start hormones after going through puberty, while older teens might consider surgery. Some may not wish to use medications or surgery at all.
Nearly all gender-questioning youth who begin hormone therapy will continue to identify as transgender in adulthood, and therapy is approached in an age-appropriate, stepwise fashion with the guidance of physicians and mental health professionals. This directly contrasts the bill’s argument that a “substantial majority” of transgender children will ultimately identify with their sex assigned at birth after puberty, and does not take into account the significantly detrimental mental health effects that a non-affirming puberty can have on transgender children.
The American Medical Association and the American Academy of Pediatrics recommend gender-affirming care for transgender youth. While this bill claims that there is no evidence that gender affirming therapies are safe long-term and that they provide no long-term benefits, a review of recent research shows the exact opposite. An analysis published this year looking at a study of 27,715 transgender people found that those who received gender-affirming hormones during their teenage years had significantly lower odds of suicidal thoughts and mental distress than those who wanted it but did not receive it.
HB 150/SB 5 introduces politics into a conversation that should be between healthcare providers and families. The care of transgender and nonbinary children is nuanced; it involves the expertise of multiple healthcare professionals, but more importantly, the lived experience and priorities of transgender youth and their families.
Decisions about gender-affirming therapy are deeply personal and too complex to be regulated by black-and-white laws. This bill would criminalize healthcare providers with jail time for simply doing their jobs: offering evidence-based care, personalized to the needs of children and their families. It applies dangerously uninformed opinions to the very real lives of trans children in Alabama.
The legislation claims that gender-affirming therapies for youth constitute a “public health risk.” On the contrary, this bill is a far greater public health risk. Children who are trans also have higher rates of self-harm and suicide than their peers, and experts suggest this is due to unsupportive external environments. This bill would obligate school adminstrators to out a transgender student without their consent, only worsening students’ feel of being unsafe and unsupported.
Alabama’s transgender youth do need protection, but only from transphobic laws and the people who make them.
Mugdha Mokashi (@mugdhatweets) is an Alabama native and fourth-year medical student at Harvard Medical School.