States’ Anti-LGBTQ Moves May Have Disastrous Health Impacts, Experts Say

This blog originally appeared at TRUTHOUT.

Medical professionals are worried about the long-term physical and mental effects of anti-LGBTQ legislation.

This year, various states have endeavored to prohibit transgender individuals from using public restrooms and updating identity documents such as driver’s licenses. Legislators across multiple states are pushing to amend state statutes to define sex based on reproductive capability and to omit gender identity from discrimination safeguards.

Thus far, these bills aimed at undermining civil rights protections for transgender people and barring them from public facilities have faced limited success. According to the ACLU, only five anti-LGBTQ+ bills have been enacted into law this year, and several states notorious for promoting such legislation—like Florida, Utah, and West Virginia—have concluded their legislative sessions for the year.

Nevertheless, these endeavors could have dire consequences for the lives of transgender adults, prompting concerns among medical professionals about the long-term physical and mental health implications of the ongoing political campaign to curtail LGBTQ+ rights. Furthermore, many of the active bills could lead to gaps in medical care for transgender individuals during a period of heightened anxiety.

Currently, Ashton Colby finds himself enduring chronic stress. As a 31-year-old transgender man of White ethnicity residing near Columbus, Ohio, he has experienced significant turmoil as state policies regarding gender-affirming care have unexpectedly shifted in recent months.

He expressed, “With my fundamental, basic humanity being up on the public chopping block and up for debate, in so many ways, I feel gutted and dehumanized and completely misunderstood for all that I am.”

Colby, burdened by stress for years over anti-trans policies, never imagined the possibility of trans adults being denied medical care. In Ohio, such a scenario nearly materialized when Republican governor Mike DeWine proposed restrictions on gender-affirming care for adults in lieu of supporting a statewide ban on minors’ care. However, following public outcry, the state’s health agency declared it would not implement those restrictions for adults.

Initially fearing the loss of his medical provider of eight years, Colby contemplated relocating to Denver. He also harbors concerns that his access to necessary documentation and his rights as a transgender individual could be jeopardized if Republicans secure victories in the White House and Congress this year.

Dr. Carl Streed, president of the U.S. Professional Association for Transgender Health (USPATH), constantly reflects on the adverse health outcomes resulting from trans individuals feeling unsafe while navigating society. He believes that anti-trans policies will exacerbate feelings of isolation during what the surgeon general has termed an epidemic of isolation and loneliness in the United States.

“These policies that restrict people’s public life are effectively directly harming them, both in terms of immediate issues around mental health, connection to community, accessing care in urgent situations, but long-term, we’re going to see worse health outcomes in probably the next five, ten years, if not sooner,” he stated.

These worse health outcomes could include increased isolation and the inability to engage in public life and in-person community interactions, leading to diminished cardiovascular fitness and a higher risk of heart attacks and strokes due to elevated cholesterol and hypertension levels. Streed also noted that isolation is linked to impaired cognitive function and reduced memory.

“They’re definitely creating quite the checkerboard of restricted public spaces,” remarked Streed, a primary care physician at Boston Medical Center. “But the issue is, these are national discourses. What happens in Florida is a conversation I have with my patients in the exam room.”

Transgender individuals in states without healthcare restrictions or limitations on accessing public spaces are understandably anxious about such policies in other states, he noted. These restrictions can still impact them while visiting friends and family.

The ACLU is currently monitoring approximately 200 active anti-LGBTQ+ bills advancing through state legislatures this year. Although many bills have been defeated, fear and apprehension within the transgender community, and much of the larger LGBTQ+ community, remain alarmingly high.

In Florida, a series of often convoluted anti-LGBTQ+ policies are designed to instill fear, according to Simone Chriss, an attorney with the Southern Legal Counsel in Florida and director of the organization’s transgender rights initiative. Speaking on a press call in February, she described the intent as creating fear and confusion to obscure individuals’ rights, leading them to err on the side of caution.

Angelique Godwin, an Afro-Latina transgender woman and advocate with Equality Florida, shared with The 19th how transgender Floridians have supported each other amidst mounting restrictions on daily life. Godwin recounted losing access to healthcare last spring when Gov. Ron DeSantis signed a law preventing patients from accessing gender-affirming care from nurse practitioners. Additionally, she faced challenges refilling her prescription for estradiol valerate following the law’s passage, as pharmacies refused service amid the ensuing confusion.

“Thankfully, I had a stash, I had my own little reserve of medications for myself. But there were people close to me that were affected by that who had no access,” she recounted.

Godwin eventually found a facility in Tampa with a doctor offering care on a sliding-scale payment system, maintained coverage through the federal government’s health insurance marketplace, and continued appointments with her regular doctor for mental health visits under the new law.

Mutual aid grants and organizations like Folx Health, an LGBTQ+ telehealth provider, have helped fill gaps in care. Folx requires an in-person doctor’s visit, during which patients review and sign a consent form for care compliant with state laws.

“Those first three months from June to August, a lot of people struggled. Since then, most of the people I know that are here in Florida are still here,” she observed.

Approximately 30 bills seeking to restrict transgender youth and adults’ access to healthcare are still progressing through statehouses, per the ACLU. These bills would prohibit gender-affirming care—such as puberty blockers and hormone therapy—for transgender youth, block insurance or Medicaid coverage for gender-affirming care, and limit access to such care for incarcerated transgender individuals.

Even in states without restrictions on gender-affirming care, accessing it remains challenging for many transgender people across the country. For some, accessing essential healthcare necessitates traveling across state lines.

Dr. Angela Rodriguez, a plastic surgeon specializing in transgender care based in San Francisco, often treats patients who travel to California. She has encountered patients from Alabama, where finding a good dentist or primary care physician is difficult.

She noted a common concern among out-of-state patients over the last several years: who will care for them in the long run?

“I have patients that elect to come back, fly all the way from the East Coast because they don’t feel comfortable talking to a local physician,” she said. She ensures that patients traveling from out of state have a support system, such as a loved one or friend in California who can assist them after a surgical procedure.

Dr. Johanna Olson-Kennedy, the president-elect of USPATH who works with adolescents and young adult patients at Children’s Hospital Los Angeles, observed that the mental health of her young transgender patients has deteriorated as states ban gender-affirming care for minors. Her patients also express concerns about existing in public in certain states and whether they can safely use public restrooms. Florida and Utah have enacted extreme public bathroom bans, while eight other states prohibit transgender individuals from using restrooms aligning with their gender identity in schools.

“I don’t think people have even really grasped the mental health toll of the pandemic, but to have this added on top of it is truly an immense burden for adolescents,” she remarked. A majority of her patients are preparing for college and graduate school — and a significant portion of them intend to steer clear of pursuing higher education in states enacting anti-trans legislation.

Olson-Kennedy herself doesn’t feel secure on social media. As a provider of gender-affirming care, it’s often a hostile environment for her and her colleagues, as their work has been politicized by Republican lawmakers, lobbyists, and far-right media personalities.

“You can only handle so much of hearing threats of violence when you leave your clinic,” she noted. “That’s not something they teach you in medical school… This is uncharted territory for children’s hospitals and pediatricians.”

Olson-Kennedy emphasized the need for more people to comprehend the significance of gender-affirming care. This care is administered over an extended period, with parents and guardians involved for minors, she explained, and it addresses the profound despair caused by gender dysphoria experienced by many transgender individuals.

“I wish people could set aside their discomfort and lack of understanding and truly acknowledge that this care is medically necessary. It’s incredibly important, and it transforms and saves lives,” she stressed.