State actions against LGBTQ people could have catastrophic health consequences, experts say
State actions against LGBTQ people could have catastrophic health consequences, experts say

This story was originally published by 19th.

This year, states tried to prevent transgender people from using public restrooms and from being able to update identification documents such as driver’s licenses. Lawmakers in multiple states are trying to rewrite state code to define gender based on reproductive capacity and exclude gender identity from discrimination protections.

So far, these bills, which aim to weaken civil rights protections for trans people and deny them access to public facilities, don’t go very far. Only five anti-LGBTQ+ bills have been passed into law this year, according to the ACLU, and several states that have become known for advancing such legislation — such as Florida, Utah and West Virginia — have ended their legislative sessions for the year.

Still, these efforts would have a catastrophic impact on the lives of transgender adults, and medical health professionals worry about the long-term physical and mental health consequences of continued political efforts to curtail LGBTQ+ rights. What’s more, many of the current bills would create gaps in medical care for trans people during times of heightened anxiety.

Right now, Ashton Colby feels like he’s in a state of chronic stress. As a white, 31-year-old transgender man living near Columbus, Ohio, he felt whiplash as the state’s gender-affirming care policies changed unexpectedly in the past few months.

“Because my fundamental, basic humanity is out in the open and up for debate, in so many ways, I feel gutted and dehumanized and completely misunderstood for all that I am,” he said.

Colby has been stressed for several years about anti-transgender policies. But he never thought it was possible for transgender adults to be forced to go without medical care. In Ohio, it almost happened. Republican Gov. Mike DeWine has proposed limiting gender-based care for adults in lieu of supporting a statewide ban on care for minors; but after a public outcry, the state health agency said it would not enforce those restrictions for adults.

At first, Colby thought she was going to lose her doctor of eight years. He was considering moving to Denver. He also worries that his ability to access the documentation he needs — and his rights as a trans person — will be at risk if Republicans win the White House and Congress this year.

It’s something Dr. Carl Strid, president of the American Professional Association for Transgender Health (USPATH), thinks about all the time: the negative health outcomes of trans people who don’t feel safe as they navigate society. He believes anti-transgender policies will increase isolation during what the surgeon general has called an epidemic of isolation and loneliness in the United States.

“These policies that limit people’s public lives harm them directly, both in terms of immediate mental health issues, community connection, access to care in emergency situations, but in the long term, we’re going to see worse health outcomes.” results in probably the next five, ten years, if not sooner,” he said.

What do these worse health outcomes look like? Increased isolation and the inability to participate in public life and engage personally with the community leads to poorer cardiovascular health and a greater likelihood of high cholesterol and hypertension. This in turn creates a higher risk of heart attacks and strokes. Isolation is also linked to impaired cognitive function and reduced memory, Stried said.

“They definitely create quite a checkerboard of limited public spaces,” said Strid, a primary care physician at Boston Medical Center. “But the point is that these are national discourses. What’s happening in Florida is a conversation I have with my patients in the exam room.”

It’s understandable that transgender people in states without restrictions on their health care or the ability to access public spaces are concerned about similar policies in other states, he said. Restrictions may still affect them while visiting friends and family.

So far this year, the ACLU has tracked approximately 200 anti-LGBTQ+ bills still advancing in state legislatures — meaning those bills are active. While many other bills have been defeated, fear and apprehension in the transgender community and much of the larger LGBTQ+ community is still at an extremely high level.

In Florida, a slew of often confusing anti-LGBTQ+ policies are meant to stoke fear, said Simone Criss, an attorney at Southern Florida Legal Counsel and director of the transgender rights organization’s initiative, during a press conference in February.

“The intention is to create fear and make us not understand what our rights are so that we are cautious. The issue is the vagueness and the vagueness,” she said. She spoke to gathered advocates, local residents and members of the press in an emergency “town hall” to break down the legal implications of — and dispel myths about — Florida’s new driver’s license policy.

Angelique Godwin, an Afro-Latina transgender woman and advocate for Equality Florida, described to The 19th how transgender Floridians are supporting each other in the face of increasing restrictions on everyday life. Godwin lost access to her health care last spring when Gov. Ron DeSantis signed a law barring patients from accessing gender-affirming care from nurse practitioners. She then failed to refill her prescription for estradiol valerate as part of her gender confirmation care, which other trans Floridians experienced as pharmacies refused to serve patients in the confusion after the law passed.

“Luckily I had a stash, I had my own little stash of medicine for myself. But there were people close to me who were affected by it who didn’t have access,” she said. “It was out of the blue for them.”

Godwin later found a facility in Tampa with a doctor who worked on a sliding scale payment system where she was able to continue her care. She got coverage through the federal government’s health insurance marketplace, which also helped. And she was able to keep appointments with her regular doctor for mental health visits under the new law.

More gaps in care were covered by mutual aid grants and by organizations like Folx Health, an LGBTQ+ telehealth provider. Folx requires an in-person doctor visit where patients review and sign a consent form to receive care in accordance with state law.

“Those first three months from June to August, a lot of people struggled. Since then, most of the people I know here in Florida are still here,” she said.

Roughly 30 bills that would restrict how transgender youth and adults can access health care are still advancing in state institutions, according to the ACLU. These bills would ban gender-affirming care — meaning puberty blockers and hormone therapy — for transgender youth, block insurance or Medicaid coverage for gender-affirming care, and limit access to such care for incarcerated trans people.

Even without states enacting restrictions on gender-affirming care, it is already difficult for transgender people to access it in much of the country. And for many trans people, getting access to health care that is critical to their well-being already requires traveling across state lines.

Dr. Angela Rodriguez, a San Francisco-based plastic surgeon specializing in transgender care, often works with patients who travel to California. And it’s not just because they can’t find trans-affirming care; she has had transgender patients travel to her from Alabama, where a good dentist or primary care physician is hard to find.

She’s heard a similar refrain from out-of-state patients over the past few years: Who’s going to take care of them long term?

“I have patients who choose to come back, fly all the way from the East Coast because they don’t feel comfortable talking to a local doctor,” she said. She works with patients who travel out of state to ensure they have a support system, loved one or friend in California who can care for them after a surgical procedure.

Dr. Johanna Olson-Kennedy, the president-elect of USPATH, who works with adolescent and young adult patients at Children’s Hospital Los Angeles, said the mental health of her young trans patients has worsened as states ban gender-affirming care , for minors. Her patients also worry about the mere existence of public places in some states and whether they can safely use public restrooms. Florida and Utah have exclusive bans on public bathrooms, while eight other states prohibit trans people from using restrooms that match their gender identity in schools.

“I don’t think people have even really thought about the mental health burden of the pandemic, but to have it on top is really an extraordinary improvement for teenagers,” she said. Most of her patients go on to college and graduate school — and many plan to avoid pursuing higher education in states that pass anti-transgender laws.

Olson-Kennedy herself does not feel safe on social media. As a provider of gender-affirming care, it’s often a hostile environment for her and others in her profession, as her work is politicized by Republican lawmakers, lobbyists and far-right media personalities.

“You can only manage a certain amount of hearing that should be shot when you leave your clinic,” she said. “It’s not something they learn in medical school. … It’s not something that children’s hospitals or pediatricians have dealt with in the past.”

More people need to understand what gender-affirming care means, Olson-Kennedy said. Care is provided over a long period of time, with parents and guardians involved for minors, she said — and addresses the severe despair caused by gender dysphoria that many trans people experience.

“I wish people could put aside their own discomfort and lack of understanding and just realize that this care is medically necessary. It’s really important and it’s changing people’s lives and saving their lives,” she said.

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