Fight or Flight: Transgender Care Bans Leave Families and Doctors Scrambling

The field of gender transition care for minors is relatively new, and prominent clinicians have disagreed on issues such as the ideal timing and diagnostic criteria for these treatments as demand has soared. These debates have recently led several European countries with nationalized health care systems to review the evidence and limit which children can receive gender-related medications. In June, England’s health agency ruled that children could only receive puberty blocking drugs as part of clinical research trials.

“Our position is we cannot see this as just a rights issue,” said Thomas Linden, director of Sweden’s National Board of Health and Welfare in an interview last year after the country’s health service announced it would limit hormone treatments for minors while more research is conducted. “We have to see patient safety and precision in the judgment.”

In the United States, the debate has instead largely taken place in statehouses, becoming among the most highly charged political issues of the last year. Republican-led legislatures began in 2021 passing bills banning access to gender transition care for minors. They argue that children lack the maturity to consent to treatments, some of which are irreversible, that they may later regret. Many Republican lawmakers have taken this further, calling the treatments mutilation.

Officials in some states have made it a felony to provide transition-related treatment for minors and have raised the prospect that parents could be investigated for child abuse. Other measures are more limited, exempting from bans, for instance, patients who were already receiving treatment.

There is broad agreement among major medical associations in the United States, including the American Academy of Pediatrics, that this form of health care can be beneficial for many patients and that legislative bans are a dangerous intrusion into complex decisions best left to doctors, patients and their families.

In the Batchelders’ home state of Iowa, Gov. Kim Reynolds, a Republican, told reporters in March that she had met with families with transgender children before signing that state’s laws affecting transgender youths. “This is an extremely uncomfortable position for me to be in,” she said. Still, she called the new laws prudent measures. “We need to pause, we need to understand what these emerging therapies actually may potentially do to our kids,” the governor said.