Finding hope in court rulings on gender-affirming care for minors

Meredithe McNamara, an adolescent medicine specialist at Yale School of Medicine, is hoping to see courts overturn state laws barring gender-affirming care for minors. (Photo: Yale University)

With states passing laws to prohibit doctors and healthcare organizations from providing gender-affirming care for minors, healthcare advocates are welcoming recent court rulings.

An Arkansas judge struck down a law last month that bars gender-affirming care for anyone under the age of 18, including hormone treatment, puberty blockers or surgery. The case had been closely watched, as Arkansas passed the first such law in the country, and 19 other states have adopted similar restrictions.

Meredithe McNamara, an adolescent medicine specialist at Yale School of Medicine and an advocate for gender-affirming care, said she welcomes the Arkansas ruling.

“I wasn't surprised to see the Arkansas ruling, because I know that the states who have propped up these bans do not have a leg to stand on,” McNamara tells Chief Healthcare Executive®.

Still, McNamara says the ruling didn’t inspire jubilation. The Arkansas legislation, and measures in other states, are doing a lot of damage, she says.

“I did not feel the level of joy and satisfaction that one might expect because none of this ever should have happened in the first place,” she says. “So yes, I think that all of these courts have to strike down these bans, but a lot of harm has been done in the legal threatening and intimidation of trans youth, their families and their providers.”

In a recent interview with Chief Healthcare Executive, McNamara talks about the legislation, the danger of disinformation in healthcare policy, and why everyone should be paying close attention to the battles over providing gender-affirming care to minors.

“Passing laws based on abject falsehoods is a huge threat that can affect all of us, no matter what gender or sexual orientation or medical history we have,” McNamara says.

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‘Very optimistic’

The American Medical Association has urged governors to reject legislation aimed at preventing gender-affirming care for minors, describing such measures as “a dangerous intrusion into the practice of medicine.” The AMA approved a resolution last month to support access to gender-affirming care for young people, and the American Academy of Pediatrics, the American College of Obstetrics and Gynecologists, and other health organizations backed it.

McNamara has testified before Congress on the value of gender-affirming care for young people. She points to the Arkansas ruling, and a similar ruling in Florida, as signs of progress.

In Florida, the judge’s narrow ruling focused on three children in a lawsuit. Florida Gov. Ron DeSantis has said he’ll continue to keep the law in place barring gender-affirming care for other youths, The Associated Press reported.

But U.S. District Judge Robert Hinkle, the judge in the Florida case, criticized the state in his ruling for passing a law “for political reasons.”

“I am very optimistic,” McNamara says. “I do think that these laws do not hold up in court. I mean, if you look at the judge's rulings, both in Arkansas and Florida …. These judges are just abundantly clear transgender people exist. Trans people deserve healthcare.”

She notes state officials and policy leaders who are aiming to prohibit gender-affirming care for minors have pushed false claims about gender dysphoria and claims that offering such care leads to mental illness and suicide. Researchers have found that providing gender-affirming care is associated with reduced depression and suicidal thoughts.

“Before these bans even happened, we knew that trans people who desired and qualified for care and couldn't receive it have worse mental health outcomes,” McNamara says. “And, you know, the people that espouse these bans, claim that the gender dysphoria will resolve with time or that psychotherapy is appropriate. There's no evidence to back up those claims.

“It's really jarring how much evidence there is that these bans are not only unnecessary, but harmful,” she says.

Some hospitals and healthcare providers have received threats for providing gender-affirming care for children and teens. McNamara has also received threatening messages, which she attributes to disinformation campaigns.

She says she doesn’t see attempts to intimidate physicians and healthcare leaders having success.

“I've seen people be more resolute than ever,” she says. “But you know, we're just coming out of a pandemic. It was really hard on us and we don't really need personal threats and harassment to make it worse.”

Integrity in health policy

Healthcare organizations are going to have to become more adept at countering disinformation, as supporters of the state bans have attacked medical authority, McNamara says.

“I wish we didn't have to go through this,” she says. “But we do and I do believe that we will be better for it if we pay attention to the disinformation and come up with real strategies to eradicate it from health policy.”

McNamara notes that healthcare organizations have spoken out against legislation aimed at restricting gender-affirming care. But she says the threat of disinformation in healthcare policy has been “under-addressed.”

“I think this caught a lot of us off guard,” McNamara says. “I think that the medical community at large didn't really think that politicians would attack standard healthcare and use disinformation to accomplish it.”

In McNamara’s view, healthcare policy and legislation should be based on medical evidence with input from experts in the field. Health policies should acknowledge the reality of medical conditions and “do an honest inventory about the risks and the benefits.” The federal government should consider such standards in developing policies in healthcare, she says.

Looking at the question of gender-affirming care for minors, McNamara says, “I would really encourage anybody who is looking to protect this healthcare to talk to people who are experts and to give them platforms so that they can share what's known.”

McNamara, an assistant professor of pediatrics at the Yale School of Medicine, is one of the leaders of Yale’s Integrity Project to advance science in adolescent health policy.

“I honestly think this is going to be my life's work, trying to figure out how to infuse health policy with integrity standards, and the focus is on kids and adolescents because that's where you get the biggest bang for your buck,” she says. “Protecting young people protects us all. And as much as I wish this work wasn't necessary, I think this is kind of the big fight of our time.

“I hope everybody pays attention to what's happening with transgender people and their rights because if they don't have rights, none of us will.”

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