The National Center for Lesbian Rights is opening Transgender Awareness Weekwith the launch of #HealthcareIsCaring, a campaign aimed at transforming the narrative surrounding trans youth’s access to health care and empowering parents to support their trans children.
It comes at a time when gender-affirming care for young trans people is being banned in conservative states across the nation — 22 states at last count — and the provision of such care is sometimes being criminalized or being defined as child abuse. There has also been an effort by Republicans in Congress to ban such care nationwide.
NCLR seeks to tell what gender-affirming care and supportive parents mean for trans youth. The campaign includes a short film featuring trans young people their parents — Cameron and his mother, Myriam, from Texas; Allie and her father, Sean, from New York; and Luke and his mother, Jen, from Illinois. The film was created in collaboration with Emmy-nominated director Zen Pace and the Windy Films production agency.
“The families in our campaign, like so many other families with transgenderchildren, are proof that helping transgender youth get medically needed care can enable them to lead happy and successful lives,” NCLR Legal Director Shannon Minter said in a press release. “Still, many legislators continue to push harmful policies that prevent these young people from getting the health care they need and deserve. We’re working to take action against these bills and show the politicians behind them that transgender youth and their families are not alone.”
NCLR has successfully challenged state bans on medical care for transgender adolescents in Alabama, Florida, and Kentucky. This month, NCLR filed a petitionasking the U..S. Supreme Court to review the Sixth Circuit Court of Appeals’ decision in Doe v. Commonwealth of Kentucky reversing the victory in the Kentucky challenge. If the Supreme Court takes the case, it will be the first case involving transgender youth ever heard by the high court.
The campaign was created by public relations company Edelman and its Out Front LGBTQ+ task force. Edelman recently conducted a survey in which 74 percent of respondents said they believe parents want what’s best for their children when it comes to medical care.
“This campaign is proof of two things: the magic that happens when you bring people of every discipline together to drive meaningful change, and that having access to trans healthcare isn’t just critical to helping youth survive, but to thrive as well,” said Jordan Atlas, Edelman’s U.S. chief creative officer.
Of the film, Pace said, “This film is special to me because not only does it touch my community, but it helps put forward a much more accurate story of these families that simply doesn’t exist out there. It gives space to these parents; it’s a gift from their children.”
NCLR also has an open letter for the public to sign in support of health care for trans youth, and it offers a variety of resources explaining gender-affirming care..
The American Civil Liberties Union has asked the Supreme Court to block a Tennessee law banning gender-affirming care for minors.
On Wednesday, the ACLU, along with the ACLU of Tennessee and Lambda Legal, petitioned the court to review a Sixth Circuit Court of Appeals ruling allowing the state’s anti-trans law to go into effect. As The Hill notes, if the court accepts the case, it would be the first time the Supreme Court hears a case involving gender-affirming care.
Tennessee Republicans passed the state’s S.B. 1 in February, and it was signed into law by Gov. Bill Lee (R) in early March. In addition to banning Tennessee doctors from providing gender-affirming care, including puberty blockers and hormone therapy, to anyone under the age of 18, it also requires trans young people who are already receiving gender-affirming care to end their treatment by March 31, 2024, effectively forcing them to detransition.
Every major medical organization in the U.S. has recognized that gender-affirming healthcare — which can include puberty blockers and hormone therapy — is evidence-based, safe, effective, and can be medically necessary to treat gender dysphoria in young people.
In April, the ACLU and Lambda Legal filed a lawsuit in a federal court in Nashville on behalf of three families with transgender children and a Memphis doctor who provides gender-affirming care to block the law, arguing that that S.B. 1 unlawfully discriminates against transgender people based on their sex in violation of the Constitution’s Equal Protection Clause. A district court judge blocked the law from going into effect in June, but in July, the Sixth Circuit voted 2–1 to allow S.B. 1 to go into effect while the court challenged proceeded. Similarly, the Sixth Circuit ruled in August that Kentucky could enforce its own law banning gender-affirming care for minors.
Legal challenges brought by the ACLU of Kentucky and Tennessee, along with other organizations, in both cases were consolidated in July for consideration at the Sixth Circuit, which hears appeals from both states. In September, the court again voted 2–1 to uphold both laws.
In Wednesday’s legal filing, attorneys for the ACLU and Lambda Legal wrote that conflicting court decisions around laws banning gender-affirming care for minors are “creating chaos across the country for adolescents, families, and doctors.”
In addition to the Sixth Circuit decision regarding the Tennessee and Kentucky laws, the Eleventh Circuit Court of Appeals lifted an injunction against Alabama’s gender-affirming care ban in August. Meanwhile, similar laws in Florida, Montana, and Indiana have been blocked, and Arkansas’s ban was struck downin June.
“Neither the wave of state bans on gender-affirming medication nor the lawsuits challenging them are likely to abate in the near future,” the ACLU’s petition states. “Given the division among the courts of appeals on the appropriate level of scrutiny in these and related cases, any delay in this Court’s review only risks subjecting transgender adolescents, their parents, and their doctors to a patchwork of inconsistent laws and legal standards that obstruct their medical care.”
As The Hill notes, while the Supreme Court has not yet taken up a case involving bans on gender-affirming healthcare, conservative Justices Samuel Alito and Clarence Thomas appear eager to address transgender rights. According to HuffPost, both the Sixth Circuit’s decision in the Tennessee and Kentucky case and the Eleventh Circuit’s decision in upholding Alabama’s law cited the Supreme Court’s reasoning that the federal right to abortion is not “deeply root” in the “history and tradition” of the U.S. in its 2022 decision overturning Roe v. Wade.
Queer teens are twice as likely to experience binge eating disorders compared to their straight peers, a new study has found.
Binge-eating disorder (BED) is, according to the study, the most common type of eating disorder in the US, affecting up to 16.6 million Americans.
The disorder can act as a precursor for serious physical and mental health problems like cardiovascular disease, type 2 diabetes, high blood pressure or cholesterol, arthritis, depression, or anxiety, if not treated.
Based on data from the Adolescent Brain Cognitive Development Study, a large-scale 2020 study that recorded 10,000 adolescents aged 10-14, researchers were able to determine that teens from low-income households, teens of Native American descent, and teens who identify as queer were most likely to be associated with BED.
The study from the University of California at San Francisco points to stressors like bullying, discrimination, and internalised homophobia as the cause of heightened disordered eating and lowered self-esteem among gay, lesbian, and bisexual teens.
Lead study author Dr Jason Nagata writes: “Adolescents who identify as gay and bisexual face external and internal stressors, such as stigma, bullying, discrimination, and internalized homophobia, which all compound to an increased risk for disordered eating.
“This study found that adolescent males who identified as gay or bisexual had 12.5 times the odds of binge eating compared to their heterosexual counterparts.
“Similarly, adolescent girls who identified as lesbian or bisexual had twice the odds of binge eating and purging compared to their heterosexual counterparts.
“Given the emerging research that supports this association, future studies should explore the prevention, early identification, and management strategies of binge-eating behaviors for gay or bisexual adolescents.”
He continues: “Binge eating can result in psychological effects like depression and anxiety, and long-term physical health problems, including diabetes and heart disease.
“Given the higher risk of eating disorders in LGBTQ+ youth, it is important that health care providers foster a welcoming environment to youth of all sexual orientations and genders.”
The study also determined that, although disordered eating behaviours are often thought to primarily affect women and girls, data proves that male adolescents are more likely to display binge eating behaviours than their female counterparts.
“In male adults and adolescents, body dissatisfaction is often tied to a drive for muscularity and larger size as opposed to thinness,” the study reads.
“Over half of young men who report weight gain and bulking goals report eating more to achieve this goal, which leads to the consumption of larger volumes of food.”
It adds that men are more likely than their female counterparts to engage in “cheat meals” the practice of briefly indulging in prohibited foods before returning to a strict diet.
Cheat meals, the study says, are linked to over-eating, loss of control while eating, and binge-eating behaviours.
It determines: “The findings from our analysis further illustrate the prevalence of binge-eating behaviors in adolescent males and serve as a call for more studies focusing on eating disorders in this population, particularly on the relationship between muscularity-oriented eating goals and binge eating.”
Dr Nagata concluded that any teenagers experiencing eating disorder symptoms should immediately “seek professional help.”
“Eating disorders are best supported by an interdisciplinary team, including a mental health, medical, and nutrition provider.”
The Centers for Disease Control and Prevention along with the World Health Organization are raising red flags for the second time this year as cases multiply of a “super strain” of drug-resistant gonorrhea globally, but particularly among men who have sex with men.
This strain of gonorrhea has been previously seen in Asia-Pacific countries and in the U.K., but not in the U.S. A genetic marker common to two Massachusetts residents and previously seen in a case in Nevada, retained sensitivity to at least one class of antibiotics. Overall, these cases are an important reminder that strains of gonorrhea in the U.S. are becoming less responsive to a limited arsenal of antibiotics.
Gonorrhea is a STI with most people affected between ages 15-49 years. Antimicrobial resistance in gonorrhea has increased rapidly in recent years and has reduced the options for treatment.
Last February, cases of XDR, or “extensively drug resistant,” gonorrhea, are on the rise in the U.S., the CDC said.
Gonococcal infections have critical implications to reproductive, maternal and newborn health including:
a five-fold increase of HIV transmission
infertility, with its cultural and social implications
inflammation, leading to acute and chronic lower abdominal pain in women
ectopic pregnancy and maternal death
first trimester abortion
severe neonatal eye infections that may lead to blindness.
This past January, Fortune reported the U.S. is experiencing “a rising epidemic of sexually transmitted disease,” Dr. Georges Benjamin, executive director of the American Public Health Association, said with some experts referring to the issue as a “hidden epidemic.”
Cases of gonorrhea — an STI that often shows no signs, but can lead to genital discharge, burning during urination, sores, and rashes, among other symptoms — rose by 131 percent nationally between 2009 and 2021, according to public health officials. While rates of STI transmission in the U.S. fell during the early months of the pandemic, they surged later in the year, with cases of gonorrhea and syphilis eventually surpassing 2019 levels, according to the CDC.
U.S. health officials plan to endorse a common antibiotic as a morning-after pill that gay and bisexual men can use to try to avoid some increasingly common sexually transmitted diseases.
The proposed CDC guideline was released Monday, and officials will move to finalize it after a 45-day public comment period. With STD rates rising to record levels, “more tools are desperately needed,” said Dr. Jonathan Mermin of the Centers for Disease Control and Prevention.
The proposal comes after studies found some people who took the antibiotic doxycycline within three days of unprotected sex were far less likely to get chlamydia, syphilis or gonorrhea compared with people who did not take the pills after sex.
The guideline is specific to the group that has been most studied — gay and bisexual men and transgender women who had a STD in the previous 12 months and were at high risk of contracting one again.
There’s less evidence that the approach works for other people, including heterosexual men and women. That could change as more research is done, said Mermin, who oversees the CDC’s STD efforts.
Even so, the idea ranks as one of only a few major prevention measures in recent decades in “a field that’s lacked innovation for so long,” said Mermin. The others include a vaccine against the HPV virus and pills to ward off HIV, he said.
Doxycycline, a cheap antibiotic that has been available for more than 40 years, is a treatment for health problems including acne, chlamydia and Rocky Mountain spotted fever.
The CDC guidelines were based on four studies of using doxycycline against bacterial STDs.
One of the most influential was a New England Journal of Medicine study earlier this year. It found that gay men, bisexual men and transgender women who previously contracted STDs and who took the pills were about 90% less likely to get chlamydia, about 80% less likely to get syphilis and more than 50% less likely to get gonorrhea compared with people who didn’t take the pills after sex.
A year ago, San Francisco’s health department began promoting doxycycline as a morning-after prevention measure.
With infection rates rising, “we didn’t feel like we could wait,” said Dr. Stephanie Cohen, who oversees the department’s STD prevention work.
Some other city, county and state health departments — mostly on the West Coast — followed suit.
At Fenway Health, a Boston-based health center that serves many gay, lesbian and transexual clients, about 1,000 patients are using doxycycline that way now, said Dr. Taimur Khan, the organization’s associate medical research director.
The guideline should have a big impact, because many doctors have been reluctant to talk to patients about it until they heard from the CDC, Khan said.
The drug’s side effects include stomach problems and rashes after sun exposure. Some research has found it ineffective in heterosexual women. And widespread use of doxycycline as a preventive measure could — theoretically — contribute to mutations that make bacteria impervious to the drug.
Both Tennessee and Kentucky have been given the go-ahead by a federal appeals court to outlaw gender-affirming care for minors.
Earlier in 2023, both states passed legislation to restrict a number of rights for transgender youth, including access to gender-affirming care.
Both were challenged in court by the families of transgender children in each state and the American Civil Liberties Union, who had argued that bans on gender-affirming care discriminated on the basis of sex.
On Thursday (28 September), the 6th US Circuit Court of Appeals voted 2-1 to honour both states’ appeals, allowing the restrictive bans to go ahead, Reuters reports.
In both states, these bans will prohibit medical providers from treating transgender minors with gender-affirming care, including puberty blockers, hormones and, in rare cases, surgery.
Gender-affirming care for minors has been backed by all major medical associations, including the American Medical Association (AMA) which reaffirmed this summer that they “unequivocally support the health and welfare of people who identify as LGBTQ+, which includes trans and gender diverse people seeking and undergoing gender-affirming care.”
Such treatment can often be life-saving for people suffering from gender dysphoria, and young people will be put at serious risk by having their access blocked.
Despite the overwhelming evidence in favour of gender-affirming care for minors, Chief Judge Jeffrey Sutton wrote in his ruling: “This is a relatively new diagnosis with ever-shifting approaches to care over the last decade or two.
“Under these circumstances, it is difficult for anyone to be sure about predicting the long-term consequences of abandoning age limits of any sort for these treatments.”
Judge Sutton was joined by Judge Amul Thapar in his vote to allow the bans to go ahead.
In opposition was Judge Helene White, who had argued that neither Tennessee nor Kentucky should pass “constitutional muster” or “intrude on the well-established province of parents to make medical decisions for their minor children.”
Commenting on the ruling, the ACLU of Tennessee said: “This is a devastating result for transgender youth and their families in Tennessee and across the region.”
“Denying transgender youth equality before the law and needlessly withholding the necessary medical care their families and their doctors know is right for them has caused and will continue to cause serious harm. “
Meanwhile, the ACLU of Kentucky said in a separate statement: “Today’s decision is heartbreaking for trans youth across the state. It ignores evidence from medical experts & the trial court who agree that this care is necessary, effective, appropriate, & banning it undermines parents’ right to direct the upbringing of their children.”
“No one should have to decide between their health care and their home.”
Both ACLU chapters pledged to take further action in defence of their clients and the rights of all transgender people in their respective states.
Yellowing teeth. Wrinkling skin. A dry as hell cough. We’ve all seen the ads showing the dangers of smoking cigarettes. In middle school, our teachers would pass out red ribbons and “D.A.R.E.” us to be drug-free. “Just Say NO” still lingers in my brain all of these years later.
We’ve also seen at least one person close to us who has smoked a cigarette, had one too many shots of alcohol, or used some other form of substance to cope with the stresses of daily life. With the FDA declaring youth vaping an “epidemic” in 2018, it is clear that the scare tactics didn’t work. What schools didn’t teach us as kids is truly how stressful and hard being an adult (or even a kid for that matter) is and just how easy it can be to turn to a substance such as tobacco to ease your stress… especially if you are LGBTQ+.
September is National Recovery Month, and anyone on the road toward recovery from a substance addiction should be applauded. What many people get wrong about addiction is the belief that it is a matter of choice. I draw parallels between the experiences of queer people finding ways to cope in our hate-filled world and the experiences of one of my family members who became addicted to alcohol during the 2008 recession.
This family member’s addiction to alcohol was as much of a choice as they had in losing their job. It was as much of a choice as their father who abused them growing up. An addiction to tobacco is as much of a choice as it is to be discriminated against for being queer.
I had the (dis)pleasure of recently attending the Orange Unified School District (USD) Board meeting where they passed a forced outing policy that will undeniably put trans and non-binary students at increased risk for homelessness and depression.
The disgusting display of bigotry from the MAGA supporters and Proud Boys who shouted “groomers” at the top of their lungs made me thankful that I am not a teenager who is just discovering my own identity at an Orange USD school. Needless to say, I believe it’s harder to come out now than it was in 2014 when I graduated high school. It was ironic to see so many people who said to the Board that they wanted to “protect our kids”, all the while supporting a policy that had the potential to increase teen smoking, suicide and depression. A study by the Trevor Project showed that queer youth who had at least one accepting adult were 40% less likely to report a suicide attempt in the past year.
With increased stress, people look for ways to tangibly cope. People look for ways to ease the pain and trauma. One of the tangible ways used by many in our community is reliance on tobacco products. The rush of nicotine can calm a headache… at least in the short term. Nicotine is a powerful drug that can make you feel more at ease and calm when you first start to use it. But as you become more and more reliant on nicotine, your mind and body slowly grow more and more dependent on it to the point where you can’t function without it.
For decades, the Tobacco Industry has targeted the LGBTQ+ community through advertisements featuring drag queens, and for decades, tobacco companies have relied on this path towards nicotine to fill their pockets with cash. They know full well that many of us live with trauma because they relish in it by funding ads and Pride events to grow their queer consumer base. This targeting has led to dire consequences for our community. For instance, many doctors will postpone trans-affirming care for people who smoke because tobacco can make it harder for the body to heal from surgeries. More generally, tobacco is a leading cause of premature death in queer people.
All of this doom and gloom can make it seem like it’s a lost cause to even attempt to fight giant corporations such as Juul or Philip Morris. But just as the LGBTQ+ rights movement has always done no matter what we’ve faced, we are fighting back. We need to go beyond the “Just Say NO” rhetoric; we need systemic change. We need to do the actual work to address why people even start to use tobacco in the first place.
Increased LGBTQ+ rates of tobacco use are a symptom of larger systemic issues. It is a lack of accessible mental health care, livable wages, and stable housing. We Breathe, a program of the LGBTQ+ Health and Human Services Network, aims to create systemic change and reduce tobacco’s place in LGBTQ+ lives.
What good is stopping someone from smoking if they are still depressed, stressed, and anxious? All of which increase other health issues such as heart attack and stroke later in life.
Many of my peers who are also working to eliminate tobacco from all Californian’s lives (Endgame as it’s called) are trying to do so without the slightest idea of how to speak to queer people. We Breathe is working to change that. For more information on how to get involved with We Breathe, contact [email protected].
Ryan Oda (he/him) is the We Breathe Coordinator for The California LGBTQ HHS Network, working to reduce tobacco’s impact on the LGBTQ+ Community. Ryan earned his BA in Political Science at Cal State Long Beach in 2019.
The CA LGBTQ Health & Human Services Network directs We Breathe, the Statewide Coordinating Center to reduce LGBTQ tobacco-related disparities. We Breathe provides expertise on working with LGBTQ communities, preventing and reducing tobacco use among LGBTQ Californians, and addressing tobacco-related health disparities within LGBTQ communities, to help funded projects reach their goal to eliminate tobacco use by 2035 in California.
If you or someone you know is trying to quit using tobacco, call Kick It CA at 800-300-8086 or visit https://kickitca.org/quit-now to speak to a Quit Coach.
If you or someone you know is struggling or in crisis, help is available. Call or text 988 or chat at 988lifeline.org. The Trans Lifeline (1-877-565-8860) is staffed by trans people and will not contact law enforcement. The Trevor Project provides a safe, judgement-free place to talk for youth via chat, text (678-678), or phone (1-866-488-7386). Help is available at all three resources in English and Spanish.
As Republican-led states have rushed to ban gender-affirming care for minors, some families with transgender children found a bit of solace: At least they lived in states that would allow those already receiving puberty blockers or hormone therapy to continue.
But in some places, including Missouri and North Dakota, the care has abruptly been halted because medical providers are wary of harsh liability provisions in those same laws — one of multiple reasons that advocates say care has become harder to access even where it remains legal.
“It was a completely crushing blow,” said Becky Hormuth, whose 16-year-old son was receiving treatment from the Washington University Gender Center at St. Louis Children’s Hospital until it stopped the care for minors this month. Hormuth cried. Her son cried, too.
“There was some anger there, not towards the doctors, not toward Wash U. Our anger is towards the politicians,” she said. “They don’t see our children. They say the health care is harmful. They don’t know how much it helps my child.”
Since last year, conservative lawmakers and governors have prioritized restricting access to transgender care under the name of protecting children. At least 22 states have now enacted laws restricting or banning gender-affirming medical care for transgender minors. Most of the bans face legal challenges and enforcement on some of them has been put on hold by courts.
All the laws ban gender-affirming surgery for minors, although it is rare, with fewer than 3,700 performed in the U.S. on patients ages 12 to 18 from 2016 through 2019, according to a study published last month. It’s not clear how many of those patients were 18 when they received the surgeries.
There’s more variation, though, in how states handle puberty-blockers and hormone treatments under the new bans. Georgia’s law does not ban those for minors. The others do. But some states, including North Carolina and Utah, allow young people taking them already to continue. Others require the treatments to be phased out over time.
These treatments are accepted by major medical groups as evidence-based care that transgender people should be able to access.
James Thurow said the treatment at the Washington University center changed everything for his stepson, a 17-year-old junior at a suburban St. Louis high school who is earning As and Bs instead of his past Cs, has a girlfriend and a close group of friends.
“His depression, his anxiety had pretty much dissipated because he was receiving the gender-affirming care,” Thurow said. “He’s doing the best he’s ever done at school. His teachers were blown away at how quickly his grades shot up.”
For its part, the center said in a statement that it was “disheartened” to have to stop the care. Its decision followed a similar one from University of Missouri Health Care, where the treatment for minors stopped Aug. 28, the same day the law took effect.
Both blamed a section of the law that increased the liability for providers. Under it, patients can sue for injury from the treatment until they turn 36, or even longer if the harm continues past then. The law gives the health care provider the burden of proving that the harm was not the result of hormones or puberty-blocking drugs. And the minimum damages awarded in such cases would be $500,000.
Neither state Sen. Mike Moon, the Republican who was the prime sponsor of the Missouri ban, state Sen. Justin Brown nor state Rep. Dale Wright, whose committees advanced the measure, responded immediately to questions left Thursday by voicemail, email or phone message about the law’s intent.
In North Dakota, the law allows treatment to continue for minors who were receiving care before the law took effect in April. But it does not allow a doctor to switch the patient to a different gender dysphoria-related medication. And it allows patients to sue over injuries from treatment until they turn 48.
Providers there have simply stopped gender-affirming care, said Brittany Stewart, a lawyer at Gender Justice, which is suing over the ban in the state. “To protect themselves from criminal liability, they’ve just decided to not even risk it because that vague law doesn’t give them enough detail to understand exactly what they can and cannot do,” Stewart said.
Jasmine Beach-Ferrara, the executive director of the Campaign for Southern Equality, said it’s not just liability clauses that have caused providers to stop treatment.
Across the South, where most states have adopted bans on gender-affirming care for minors, she said she’s heard of psychologists who wrongly believe the ban applies to them and pharmacists who stop filling orders for hormones for minors, even in places where the laws are on hold because of court orders.
“It’s hard to overstate the level of kind of chaos and stress and confusion it’s causing on the ground,” she said, “particularly … for people who live in more rural communities or places where even before a law went into effect, it still took quite a bit of effort to get this care.”
Her organization is providing grants and navigation services to help children get treatment in states where it’s legal and available. That system is similar to networks that are helping women in states where abortion is not banned get care.
But there’s one key difference: gender-affirming care is ongoing.
For 12-year-old Tate Dolney in Fargo, North Dakota, continuing care means traveling to neighboring Minnesota for medical appointments. “It’s not right and it’s not fair,” his mother, Devon Dolney, said at a news conference this month, “that our own state government is making us feel like we have to choose between the health and well-being of our child and our home.”
Hormuth’s son is on the waiting list for a clinic in Chicago, at least a five-hour drive away, but is looking at other options, too. Hormuth, a teacher, has asked also her principal to write a recommendation in case the family decides to move to another state.
“Should we have to leave?” she asked. “No one should have to have a plan to move out of state just because their kid needs to get the health care they need.”
In the meantime, the family did what many have: saving leftover testosterone from vials. They have enough doses stockpiled to last a year.
A federal appeals court is considering cases out of North Carolina and West Virginia that could have significant implications on whether individual states are required to cover health care for transgender people with government-sponsored insurance.
The Richmond-based 4th U.S. Circuit Court of Appeals heard oral arguments in cases Thursday involving the coverage of gender-affirming care by North Carolina’s state employee health plan and the coverage of gender-affirming surgery by West Virginia Medicaid.
During the proceedings, at least two judges said it’s likely the case will eventually reach the U.S. Supreme Court. Both states appealed separate lower court rulings that found the denial of gender-affirming care to be discriminatory and unconstitutional. Two panels of three Fourth Circuit judges heard arguments in both cases earlier this year before deciding to intertwine the two cases and see them presented before the full court of 15.
Tara Borelli, senior attorney at Lambda Legal — the organization representing transgender people denied services in both states — said excluding the coverage is a clear example of discrimination outlawed by the 14th Amendment.
“The exclusion here is actually quite targeted, it’s quite specific,” Borelli said in court, arguing that a faithful interpretation of the U.S. Constitution and the equal protection clause ensures transgender people coverage.
“One of the most important things that a court can do is to uphold those values to protect minority rights who are not able to protect themselves against majoritarian processes,” she said.
Attorneys for the state of North Carolina said the state-sponsored plan is not required to cover gender-affirming hormone therapy or surgery because being transgender is not an illness. Attorney John Knepper claimed only a subset of transgender people suffer from gender dysphoria, a diagnosis of distress over gender identity that doesn’t match a person’s assigned sex.
Knepper said North Carolina’s insurance plan does not discriminate because it does not allow people to use state health insurance to “detransition,” either.
In updated treatment guidelines issued last year, the World Professional Association for Transgender Health said evidence of later regret is scant, but that patients should be told about the possibility during psychological counseling.
West Virginia attorneys said the U.S. Centers for Medicare & Medicaid Services has declined to issue a national coverage decision on covering gender-affirming surgery.
Caleb David, attorney for the state defendants, said West Virginia’s is not a case of discrimination, either, but of a state trying to best utilize limited resources. West Virginia has a $128 million deficit in Medicaid for the next year, projected to expand to $256 million in 2025.
“West Virginia is entitled to deference where they’re going to take their limited resources,” he said. “They believe that they need to provide more resources towards heart disease, diabetes, drug addiction, cancer, which are all rampant in the West Virginia population.”
Unlike North Carolina, the state has covered hormone therapy and other pharmaceutical treatments for transgender people since 2017. “That came from a place of caring and compassion,” he said.
In June 2022, a North Carolina trial court demanded the state plan pay for “medically necessary services,” including hormone therapy and some surgeries, for transgender employees and their children. The judge had ruled in favor of the employees and their dependents, who said in a 2019 lawsuit that they were denied coverage for gender-affirming care under the plan.
The North Carolina state insurance plan provides medical coverage for more than 750,000 teachers, state employees, retirees, lawmakers and their dependents. While it provides counseling for gender dysphoria and other diagnosed mental health conditions, it does not cover treatment “in connection with sex changes or modifications and related care.”
In August 2022, a federal judge ruled that West Virginia’s Medicaid program must provide coverage for gender-affirming care for transgender residents.
U.S. District Judge Chuck Chambers in Huntington said the Medicaid exclusion discriminated on the basis of sex and transgender status and violated the equal protection clause of the 14th Amendment, the Affordable Care Act and the Medicaid Act.
Chambers certified the lawsuit as a class action, covering all transgender West Virginians who participate in Medicaid.
An original lawsuit filed in 2020 also named state employee health plans. A settlement with The Health Plan of West Virginia Inc. in 2022 led to the removal of the exclusion on gender-affirming care in that company’s Public Employees Insurance Agency plans.
A Missouri clinic will stop prescribing puberty blockers and cross-sex hormones to minors for the purpose of gender transition, citing a new state law that the clinic says “creates unsustainable liability” for health care workers.
A statement released Monday by the Washington University Transgender Center at St. Louis Children’s Hospital said patients currently receiving care will be referred to other providers. The center will continue to provide education and mental health support for minors, as well as medical care for patients over the age of 18.
“We are disheartened to have to take this step,” the statement read. “However, Missouri’s newly enacted law regarding transgender care has created a new legal claim for patients who received these medications as minors. This legal claim creates unsustainable liability for health-care professionals and makes it untenable for us to continue to provide comprehensive transgender care for minor patients without subjecting the university and our providers to an unacceptable level of liability.”
As of Aug. 28, health care providers in the state are prohibited from prescribing gender-affirming treatments for teenagers and children under a bill signed in June by Gov. Mike Parson. Most adults will still have access to transgender health care under the law, but Medicaid won’t cover it. Prisoners must pay for gender-affirming surgeries out-of-pocket under the law.
Parson at the time called hormones, puberty blockers and gender-affirming surgeries “harmful, irreversible treatments and procedures” for minors. He said the state “must protect children from making life-altering decisions that they could come to regret in adulthood once they have physically and emotionally matured.”
Every major medical organization, including the American Medical Association, has opposed the bans on gender-affirming care for minors and supported the medical care for youth when administered appropriately. Lawsuits have been filed in several states where bans have been enacted this year.
Parson also signed legislation in June to ban transgender girls and women from playing on female sports teams from kindergarten through college. Both public and private schools face losing all state funding for violating the law.
Shira Berkowitz, of the state’s LGBTQ+ advocacy group PROMO, said in a statement that Parson, Attorney General Andrew Bailey and the state legislature “blatantly committed a hate crime against transgender Missourians.”
“We are working quickly with coalition partners to explore all possible avenues to combat the harm being inflicted upon transgender Missourians,” Berkowitz said.
The St. Louis clinic fell under scrutiny early this year after former case manager Jamie Reed claimed in an affidavit that the center mainly provides gender-affirming care and does little to address mental health issues that patients also faced. Republican U.S. Sen. Josh Hawley and Bailey announced investigations after Reed’s claims.
Missouri’s bans come amid a national push by conservatives to put restrictions on transgender and nonbinary people, which alongside abortion has become a major theme of state legislative sessions this year. Missouri is among nearly two-dozen states to have enacted laws restricting or banning gender-affirming medical care for transgender minors.
In April, Bailey took the novel step of imposing restrictions on adults as well as children under Missouri’s consumer-protection law. He pulled the rule in May after the GOP-led Legislature sent the bills to Parson.