© Katie Bernard/Kansas City Star/TNS Adam Kellogg, a 19-year-old transgender man, testifies against a Kansas bill banning gender affirming care.

Missouri legislators debated a set of bills Tuesday that criminalize physicians who provide gender-affirming health care for minors in the state.

Kansas legislators also debated a bill Tuesday morning that would strip doctors of their medical licenses for providing gender-affirming health care to minors. It would also allow patients to open civil lawsuits against physicians who provided this care to them as minors in the past.

© Emily Curiel/ecuriel@kcstar.com/Kansas City Star/TNS Pride flags are displayed on W. 47th St. at Country Club Plaza during Pride month on Wednesday, June 10, 2022.

But what is gender-affirming health care, really? Here’s a quick overview of this concept and some common misconceptions around it.

What is gender-affirming health care?

Most people are assigned a sex of either “male” or “female” at birth, based on their external genitalia. But that assignment at infancy may not match up with someone’s gender identity later in life, according to the American Psychological Association.

Some people, even young children, have a gender identity that doesn’t match their sex assigned at birth. Those people are generally considered members of the transgender community.

Gender-affirming health care is a combination of services including mental and physical health care that help people better align with their gender identity, according to the American Association of Medical Colleges.

While it’s commonly discussed in the context of the LGBTQ community, cisgender people, whose gender matches their assigned sex, can also receive gender-affirming health care. For example, a cisgender man may seek treatment for erectile dysfunction in order to better align his physical characteristics with his gender identity.

Gender-affirming health care can involve a variety of services, writes the U.S. Department of Health and Human Services’ Office of Population Affairs. These include talk therapy, puberty-blocking medication, hormone replacement therapy, social and emotional support, body hair electrolysis, speech therapy, cosmetic procedures and surgeries.

Adam Kellogg, a transgender man currently studying psychology at the University of Kansas, found these medical interventions crucial to his gender transition.

“Medical transition is not just about saving lives, it’s about emboldening and freeing them,” he told Kansas lawmakers Tuesday. Kellogg used puberty-blocking medication starting at age 13 before starting testosterone just days before his 17th birthday.

What types of gender-affirming care do minors receive?

Social and mental health care:

Transgender minors typically receive minimally invasive social and mental health-oriented gender affirming care, according to Columbia University. These include using a new name and pronouns, joining social groups aligned with patients’ gender identity and receiving support from a therapist.

According to The Trevor Project’s 2020 survey on LGBTQ youth mental health, 52% of transgender and nonbinary youth have considered suicide, while over 75% reported symptoms of generalized anxiety disorder.

“Affirming gender identity among transgender and nonbinary youth is consistently associated with lower rates of suicide attempts,” the study found.

Puberty-blocking medication:

Medical interventions for transgender minors may include the use of puberty-blocking medication, which is fully reversible and commonly used on cisgender children as well, according to the Pediatric Endocrine Society.

This medication blocks the release of hormones, which cause the bodily changes associated with puberty.

“Pubertal suppression, also considered fully reversible, allows for a ‘pause’ on puberty and for further development of gender identity,” Columbia doctors Kareen M. Matouk and Melina Wald wrote last year.

Hormone Replacement Therapy (HRT):

Some transgender adolescents also seek out hormone replacement therapy, or HRT, in order to better align their bodies with their gender identity. For example, estrogen therapy can stimulate breast growth, while testosterone can help stimulate masculinizing body hair.

Gender-affirming surgeries:

Gender-affirming surgeries, especially those that alter external genitalia, are typically only performed on adults.

“There’s a lot of misinformation out there about children getting surgeries, and none of that has any basis in reality,” said Emily High, the director of the Kansas City Center for Inclusion. “This is fear-mongering and it harms real people… it feels like a strategic attack on a community that is already depleted.”

What do the Missouri and Kansas bills say about gender-affirming health care?

Missouri’s SB 236, SB 164 and SB 49 are three nearly identical bills introduced by three members of the state Senate. All three bills would remove the medical licenses of physicians who provide gender-affirming health care to minors.

“Under this act, no physician or other health care provider shall provide gender transition procedures to any minor or refer such minor to another health care provider for such procedures,” the bills’ summaries read.

According to the bill, this includes prescribing puberty blockers, hormone therapy and any surgeries related to gender or sex presentation. Mental health care is not included in this definition.

SB 164 in Missouri goes one step further than the other two bills: It expands the legal definition of child abuse to include “coercion of a minor child to undergo surgical or hormonal treatment for gender reassignment.”

Kansas’ SB 233 revises state statutes to add gender-affirming health care for minors to a list of reasons a physician can lose their medical license in the state.

SB 233 comes on the heels of a more extreme bill that makes gender-affirming care a crime for doctors to perform. This more extreme bill may not be debated by legislators following a schedule change on Monday.

“A physician’s license shall be revoked upon a finding that the physician has performed a childhood gender reassignment service,” the SB233 bill text reads. According to the bill, a “gender reassignment service” means prescribing puberty blockers, hormones and performing any type of surgery. It doesn’t include mental health care.

The bill would also allow adults to file civil lawsuits against physicians for providing these services to them as minors. Former patients would have until their 21st birthday to open such a case.

If these bills become law, transgender Missourians and Kansans could still seek gender-affirming treatments in other states. But those seeking care from medical institutions in the metro would be unable to access this care unless doctors are willing to risk their licenses.

If passed, Kansas’ bill could impact access to gender-affirming health care throughout the Midwest. Currently, the Gender Affirming Medicine clinic at The University of Kansas Health System serves patients in Kansas, Missouri, Nebraska, Oklahoma, Arkansas, Alabama and Tennessee.

The Star’s Katie Bernard and Kacen Bayless contributed reporting to this piece.

Do you have more questions about LGBTQ issues in Kansas City and beyond? Ask the Service Journalism team at kcq@kcstar.com.

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