Opinion: National attacks on trans people, gender-affirming care reverberate in Maine / by Aspen Ruhlin

Across the country, conservative politicians have been fighting to ban access to gender-affirming care for members of the transgender community. While their overt actions have been focused on trans youth, the impact reaches further. Texas has gone so far as to investigate supportive parents of trans minors for child abuse, and while the federal government is taking action to intervene, other states like Missouri are trying to follow Texas’ lead

In many of these states, anti-trans politicians have worked hard to frame this health care for transgender people as equal measures frivolous and dangerous. In reality, gender-affirming care is not just vital, but safe. As with all medications and medical interventions, there can be risks or medical contraindications, but that’s what trained health care providers are for. It’s possible to get major liver damage from Tylenol–that doesn’t mean we ban it. Gender affirmation, from names and clothes to hormones and surgery, is essential and life-saving.

Anti-trans politicians also often greatly misrepresent what kind of care transgender minors are accessing. No one is giving a 6-year-old trans girl estrogen, because kids that age haven’t typically gone through puberty. Gender-affirmation for young trans kids looks like respecting them as the gender they know they are, such as with a chosen name, pronouns, and clothing. 

Puberty blockers can be an amazing medication for trans youth that, as the name implies, put a pause on puberty, and have been shown to significantly reduce suicidality in trans youth dealing with gender dysphoria. Puberty blockers aren’t just for trans youth, however, as they’re also used in children who have “precocious puberty,” or start to go through puberty much earlier than is typical. Anti-trans legislators don’t seem to take issue with that use, which raises questions about their supposed safety concerns. If they were actually concerned with safety, they’d support access to care that reduces suicidality and keeps trans kids alive.

There are similar double standards around the supposed safety concerns that anti-trans politicians have regarding intersex youth. Idaho’s HB 675, which would have criminalized gender-affirming care for trans minors, was only struck down by the Idaho Senate because it could have been interpreted as not allowing non-consensual procedures to be performed on intersex youth. The bill in Idaho, like many anti-trans bills across the country, did include language that would allow for the continued medical mistreatment of intersex minors. Those opposed to gender-affirming care for transgender youth consistently believe that non-consensual, cosmetic, and deeply damaging genital surgeries should be performed on intersex minors, including infants. This demonstrates that the issue is not a concern for wellbeing or bodily autonomy, but in trying to force children into fitting into the status quo.

Opposition to gender-affirming care does not stop at trans youth and transphobia does not stop at opposition to gender-affirming care. Someone who is opposed to hormone therapy or puberty blockers for a teenager does not suddenly become supportive of a trans person when they become an adult. 

Transgender adults, especially trans elders, face barriers to accessing care. While primary care providers are qualified to provide gender-affirming hormone therapy, many don’t. In a rural state like Maine, that adds the barrier of travel and even just finding a hormone provider. Additionally, because hormone therapy is often incorrectly considered to be above the level of a primary care provider, well-meaning PCPs will refer their trans patients to endocrinologists resulting in further travel, long waitlists, and expensive care. While endocrinologists are great and sometimes a better fit for gender-affirming hormone therapy, most patients would benefit more from working with a provider closer to home.

Though Maine has protection laws banning discrimination against transgender people, including in health care, it still happens. As someone who helps trans folks navigate gender-affirming care, I have talked to far too many patients who, when they came out to their PCP, were treated with derision and denied a referral to the care they needed. It is one thing to acknowledge that you aren’t knowledgeable about prescribing testosterone or estradiol or androgen-blockers, but it is something else entirely to discriminate against your patients.

Another huge barrier to gender-affirming care is a lack of community support. It is much harder to come out as trans, let alone start pursuing medical transition, if you know your friends, family and neighbors are transphobic, or if you don’t know how they’ll respond. 

Trans elders face the added barrier of ageism, both in general and specifically in relation to their coming out. If someone doesn’t come out as transgender until they’re well into their adult years, they face criticism that “they’re too old to transition,” or, “if they were really trans, they would have come out sooner.” Of course, if someone comes out in childhood or early adulthood, then they’re told that “they’re too young to know.” There is no winning. Trans youth and young adults, while still facing many struggles, often have more support resources that are lacking for our trans elders.

Banning access to gender-affirming care for transgender youth has never been about protecting children, and those transphobic attacks will not stop at trans youth. All people deserve the right to bodily autonomy and self-determination, and we should be fighting for the health, safety, and wellbeing of trans youth. 

The Transgender Day of Visibility was March 31, but we deserve so much more than just visibility. It is vital to stand against transphobia in our communities and across the country. Supporting organizations like MaineTransNet and taking action with groups like Trans Week of Visibility and Action and TEAR IT UP are important, but that support must go beyond when things are so dire. Fighting for us must happen year-round, and, as I’ve heard my friend and Executive Director of MaineTransNet Quinn Gormley say many times, “give us our flowers while we’re living.”

Aspen Ruhlin is a Client Advocate in the Bangor area, where they help people overcome barriers to accessing healthcare. They have a particular focus on serving the trans community and increasing access to gender-affirming care. In their off time, they enjoy embroidery, gardening, and participating in an array of activism.

Beacon, April 1, 2022, https://mainebeacon.com/