Threat of Anti-Trans Legislation Makes Gender-Affirming Care Harder To Provide

This article was produced through the NPR NextGen/Texas Observer Print Scholars program, a new collaboration designed to offer mentorship and hands-on training to student journalists and recent graduates interested in a career in investigative journalism.

Texas lawmakers did not end up passing any of the record number of anti-trans bills filed this session, but the threat of such legislation is enough to limit the services that Bhavik Kumar is able to offer his patients. Planned Parenthood Gulf Coast, where Kumar, a physician, directs primary and trans care, has yet to expand hormone replacement therapy to patients under the age of 18. He says this is in part because of proposed bans on such care for minors, which would potentially interrupt long-term procedures. That means the specter of anti-trans legislation year after year effectively has the same impact as the bills would if they were passed. 

“Before the [legislative] session started, even thinking about starting to expand our services to folks that are younger than 18 was sort of put on hold because we weren’t sure how things were going to transpire,” Kumar says. “And so even if we did begin to offer these services, is this something they’re going to target again in two years? Probably.” 

Transitional care for youth isn’t a single procedure. It’s a series of conversations with patients and guardians, referrals to providers, counseling, and, depending on the patient, sustained hormone replacement therapy. The looming presence of anti-trans legislation has made it difficult for providers to plan for the future and offer a full range of medical services.

This year, Texas Republicans filed Senate Bill 1646, which would block access to transition-related health care for transgender youth, despite opposition to the measure from the Texas Pediatric Society, Texas Psychological Association, and the Texas Chapter of the American College of Physicians. The legislation proposed redefining the statutory definition of child abuse to include administering or consenting to puberty blockers for transgender children, and included penalties for performing or consenting to gender transition surgery.

In all, six bills seeking to criminilize evidence-based health care for transgender youth failed to pass in the Texas Legislature this year. Still, Kumar is not celebrating. He says it’s only a matter of time until an anti-transgender bill becomes law and he has to tell a patient that he is unable to continue their treatment. 

Kumar joined Planned Parenthood Gulf Coast in 2019, just as the organization was starting to have conversations about offering trans care. The legislative battles immediately felt familiar to Kumar, who has been an abortion provider in Texas for years. “I mean, the number of times when I say like, ‘oh my God, this is so similar to what we see in abortion care.’ Even just looking back at the legislation this past year, it doesn’t make sense: They deny science. They target people. They are relentless,” he says.

When transgender patients ask Kumar about pending legislation, they sometimes ask about services their friends recieved in other states. He wishes he could provide the same long-term care as out-of-state providers. “I don’t always ask, but sometimes I’m like, ‘Did you think about moving to that state? Is that something you would even consider?” he says.

Kumar moved to Texas about six years ago from New York City, where he did his residency at the Albert Einstein College of Medicine in the Bronx. There, “I don’t remember any patients asking me about politics, or something in the news and how it’s going to affect their care,” he says. “In Texas, it’s essentially an everyday conversation with patients.” 

This year, state legislatures across the country introduced at least 35 bills that would prohibit transgender youth from accessing medical care that affirms their gender identity. This spring, Arkansas became the first state to ban medical providers of transgender youth from prescribing cross-sex hormones and puberty blockers, performing gender-reassignment surgery, and referring patients to others who might provide this care. The ACLU sued to block the ban last month.

Megan Mooney, a licensed psychologist based in Houston with experience treating transgender clients, testified against SB 1646 this spring. During the hearing, she noticed many arguments in favor of restricting care for transgender patients are based on research that is more than 20 years old and rely on harmful assumptions. “Those statements to the effect of comparing gender dysphoria to schizophrenia or comparing children who assert a different gender identity as if it’s the same as a African American child trying to say that they’re white…that is not in keeping with any current research or guidelines for treatment,” she says.

According to Kumar, this rhetoric makes it harder to earn trust from patients and educate the guardians of transgender kids. “I worry, because they’re hearing all the things that are happening in the lege session. … Which is another reason why I have a little bit more urgency in starting to offer this care,” says Kumar. “A lot of times folks will look up things online and there’s a lot of misinformation. And again, similar misinformation that folks find online is the same stuff I’m seeing elected politicians talk about.”

Still, Kumar says he stays motivated by the memory of what it felt like coming to the United States as an immigrant, and growing up in Texas as a brown, gay man. “I know what it’s like to live in Texas and to sort of have your dignity and your humanity questioned by people that don’t know you or people like you,” he says. “So even though it’s difficult, it’s the stories that drive us,” he continues. “I remember all the people that are going to benefit…and say, ‘OK, I’m going to get through today. I’m going to get through this next patient. I’m going to get through this next ultrasound, or this next visit.’”