Gender-Affirming Care Restrictions: Impact on Access and Travel Time – US Study Analysis


According to a new study, at least 20 states have enacted policies restricting health care for transgender youth, and the loss of gender-affirming care clinics in these states has significantly increased the average travel time to a provider.

Approximately half of adolescents now reside more than an hour from the nearest gender-care clinic, nearly double the proportion before the restrictions were implemented. And more than a quarter of children reside more than a day’s commute, or at least 8 hours round-trip, from the nearest surgical clinic.

The average travel time to a gender-affirming care clinic increased from approximately 30 minutes to one hour, with the greatest increases occurring in Florida, Texas, and Utah.

What would occur if the average travel time to a primary care physician increased by one hour? People would find that preposterous, according to Mike Parent, chief researcher at Hopelab, a venture capital firm specializing in adolescent mental health and technology. It will have an immediate and negative effect on the well-being of these adolescents.

Major medical associations, such as the American Medical Association, the American Psychiatric Association, the American Academy of Pediatrics, and the American Academy of Child & Adolescent Psychiatry, concur that gender-affirming care is clinically appropriate for children and adults, and that access to this care can have substantial mental health benefits.

Early gender-affirming care is crucial to the health and well-being of transgender and nonbinary infants and adolescents, according to the US Health and Human Services Department’s Office of Population Affairs. Delaying care can exacerbate children’s stressors and health issues.

According to specialists, state-level restrictions exacerbate difficulties for a system that was already struggling to meet patients’ requirements.

For this study, University of Michigan researchers compiled a directory of clinics that publicize that they provide medical gender-affirming care for patients younger than 18, including puberty-suppressing medications and hormones.

They identified a total of 271 gender clinics to serve an estimated 300,000 transgender adolescents between the ages of 13 and 17 across the country. However, more than a quarter of these clinics, as well as more than 89,000 transgender adolescents, are located in states that restrict gender-affirming care.

This care has been provided by a limited but growing number of medical, surgical, and mental health specialists. Thus, waitlists have always existed. Dr. Scott Hadland, chief of adolescent medicine at Massachusetts General Hospital for Children, stated, “I’ve seen waitlists for specialist appointments grow from months to, in some cases, over a year.”

“Pressure is increasing on the remaining clinicians and clinics.”

Increased travel time to gender-affirming care has multiplicative cascading effects. The need for children to miss more school, or for the adults accompanying them to miss work, in order to travel these extended distances presents new challenges, and each journey increases the risk that care will be interrupted.

“What makes this situation distinctive is that gender-affirming care for youth involves the youth and their entire family. When we consider these barriers to access, they impede not only a young person’s access to care, but also the entire family’s,” said Hadland.

And gender-affirming care necessitates a multidisciplinary strategy that emphasizes regular, consistent appointments.

Parent stated that telehealth can be beneficial in some areas, but there are still limitations. If a patient needs to check their hormones, for instance, it is not as simple as transmitting data from a finger puncture to a healthcare provider.

According to experts, the negative effects will be palpable for the thousands who will be required to make these extended in-person journeys.

This means that (transgender adolescents) do not have access to potentially life-changing services, as stated by Hadland.

Elevating the limit

This year, at least four states have introduced legislation that would restrict gender-affirming care for adults over the age of eighteen, significantly raising the bar for Republican efforts to regulate such care.

A bill in Mississippi would have criminalized individuals who provided or assisted in the provision of gender-affirming care for individuals under the age of 21, with offenders facing “the felony crime of ‘gender disfigurement.'” A violator could have faced a maximum of five years in prison and a minimum sanction of $10,000 if found guilty. Late in January, this measure, however, expired in committee.

A Kansas bill would make violations of the prohibition a felony and prohibit medical professionals from “knowingly performing… or causing to be performed” gender-affirming care on a person under the age of 21. The bill makes certain exceptions, including for individuals born intersex.

In the meantime, a law in South Carolina would impose similar restrictions. The measure would, however, mandate that anyone over 21 seeking gender-affirming care first obtain a referral from their “primary care physician and a referral from a licensed psychiatrist who must certify that the person has been diagnosed with gender dysphoria or a similar condition by the psychiatrist and that the psychiatrist believes that gender transition procedures would be appropriate for the person.”

A number of well-funded national right-wing organizations, including the conservative American Principles Project, have made efforts to restrict gender-affirming care a central focus.

Terry Schilling, the organization’s president, told CNN that the organization collaborates with states to introduce and implement such bans, and that their ultimate aim is to eliminate gender-affirming care for all Americans, regardless of age. “The movement against (gender-affirming care) has never stated, ‘We care only about children,'” We’ve stated, ‘We want to protect minors,'” he said. But ultimately, we must begin with children because they represent the overwhelming majority of American citizens.”


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Source: CNN News


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