England is limiting gender transitions for youths. US legislators are watching

Legislators in at least two U.S. states are citing a recent decision by England's public health service to restrict puberty blockers for transgender youths as support for their own related proposals

Transgender Health Policy Explainer (Copyright 2023 The Associated Press. All rights reserved.)

Legislators in at least two U.S. states are citing a recent decision in England to restrict gender transitions for young people as support for their own related proposals.

They weren’t the first to turn to other countries, notably in Europe, for policy and research ideas. Lawmakers across the U.S., where at least 23 states now have tightened or removed access to transgender health care for minors, have routinely cited non-U.S. research or policies as justification for their legislation.

Yet leading health organizations in the United States and Europe continue to decisively endorse gender-affirming care for both transgender youths and adults.

Among other things, they argue that restrictions on things like hormone therapy tend to single out transgender youths, even though other young people also can benefit from them. And transgender advocates and allies see a political attempt to erase them, cloaked as concern for children.

Some information and perspectives on the global patchwork of health and public policies on gender-affirming care:

WHAT DID ENGLAND CHANGE AND WHY?

England, through rules put forth by its public health system, is limiting the ability of people younger than 16 to begin a medical gender transition.

The National Health Service England recently cemented a policy first issued on an interim basis almost a year ago that sets a minimum age at which puberty blockers can be started, along with other requirements. NHS England says there is not enough evidence about their long-term effects, including “sexual, cognitive or broader developmental outcomes.”

Starting April 1, NHS England will not prescribe puberty blockers — drugs that suppress sex hormones during puberty — as a “routine treatment” to children and other young people seeking gender transitions. In practice, the decision also applies to Wales, which does not have any NHS gender clinics for children. Northern Ireland says it will adopt England's policy; Scotland is weighing it.

But it's not a blanket, nationwide restriction. NHS England is just one health provider in the country, albeit a major one.

Puberty blockers are available for a cost at a few private clinics. And young people already taking them through the NHS — fewer than 100 in England, according to the BBC — can continue. The drugs will also be available to participants in clinical trials.

Britain’s Conservative government, which has been broadly critical of youth gender transitions, welcomed the NHS England decision. Even so, a proposal in Parliament to flatly make it illegal to provide puberty blockers to those under 16 is unlikely to become law.

The use of puberty blockers is not limited to gender transitions, but they can be an early step in one. They can pause puberty for gender-questioning youths until they are old enough to decide, after discussions with their families and health providers, on treatments that bring more-permanent changes.

WHAT ARE US LEGISLATORS SAYING?

U.S. legislators and statehouse bills seeking to restrict transgender health care have often cited European science and policy, from countries including Finland, France, Sweden and Norway, as well as the U.K.

In Kansas, state Sen. Beverly Gossage cited England’s new policy last week when briefing fellow Republicans on a bill that would ban gender-affirming care for minors.

“In England, they’ve declared that there could be no gender-affirming care other than therapy for children because the scientific proof is not there,” Gossage said in comments that mischaracterized the NHS England guidelines. They do call for starting with counseling, as do those of other leading health organizations.

Republican leaders expect the ban to pass this week and hope they can override any veto by Gov. Laura Kelly, a Democrat.

In Georgia, Republican state Sen. Ben Watson pointed to Europe as he pushed a ban on gender-affirming care for children: “In light of the information and what’s been going on, not only in Europe, in the U.K., but here in the United States, this is the change that I’m proposing.”

‘DEEP CONCERNS ABOUT HOSTILITY AND HARM’

Puberty blockers for adolescents who meet certain criteria are endorsed by major U.S. medical groups, along with the World Professional Association for Transgender Health, when administered properly. Those criteria include no age requirement.

“Puberty blockers have been prescribed for more than 40 years for safe and effective treatment of medical conditions including early puberty. The fact that NHS England is targeting only trans and gender diverse youth with this policy raises deep concerns about hostility and harm to LGTBQ+ people and their families," WPATH and the European Association for Transgender Health said in a statement last week.

“Decisions about healthcare must be driven by clinical evidence, not by politics," the statement continued. "The NHS has provided no indication what criteria it will use to monitor the harm its decision may cause, putting youth and families at enormous risk for no legitimate medical purpose.”

Last year, the American Academy of Pediatrics, which represents 67,000 pediatricians, unanimously voted to reaffirm its pro-stance on gender-affirming care for transgender children, including hormone treatments when appropriate.

Iridescent Riffel, a 27-year-old transgender woman and activist from Lawrence, Kansas, said she views the English policy as too conservative.

Puberty blockers help prevent people from developing physical features not in line with their gender identity, such as beards or breasts. For most teenagers, puberty is well underway or nearly complete by age 16. Treatments to alter physical features later in life to align with one’s identity can be costly and painful.

Transgender youths may find it harder to begin the process of social transitioning — or how a trans person changes how they present themselves to other people — once they start puberty, she said.

“It’s not just, ‘Oh, I’m uncomfortable with my body.’ It’s, ‘How are people perceiving me? Am I going to get judged? Are people going to judge me? Am I going to be unsafe for going out this way?’” she said.

A ban on gender-affirming care isn’t the true goal, Riffel said. Instead, it’s, “We just don’t want to see trans people in public life at all.”

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McMillan reported from northeastern Pennsylvania. Contributing to this report were Associated Press writers Jill Lawless in London, John Hanna in Topeka, Kansas, and Jeff Amy in Atlanta.