An Exploratory Space: Arkansas and the Future of Trans Healthcare

Arkansas has become the first state to pass an anti-trans healthcare bill banning gender-affirming treatment, causing Tufts students and activists across the country to call for systemic change in how governing bodies and healthcare institutions approach trans identities and well-being. 

Arkansas House Bill 1570, also known as the “Save Adolescents From Experimentation” Act, was signed into law on April 13 after the Republican-controlled House voted to override Governor Asa Hutchinson’s veto on April 6. The bill prevents doctors from offering gender-affirming care, such as hormone treatment or surgery, to trans minors. It also rescinds care from minors already being treated for gender dysphoria. Furthermore, it removes state funding for clinics or organizations that provide gender-affirming care and prevents the Arkansas Medicaid Program from reimbursing or covering gender-affirming care for patients under the age of 18. 

Restricting trans rights is not a new consideration for lawmakers. The bill was passed amid a swath of other anti-trans bills currently being proposed or passed through 28 state legislatures across the country. According to the ACLU, over 100 anti-trans bills are being considered as of April 20, and approximately 20 states are seeking to restrict trans people’s access to healthcare. 

In an email to the Tufts Observer, Joel Guttierez, the program administrator for the Tufts LGBT Center, said, “As someone who has worked with trans and non-binary youth for several years, I know how deeply crucial access to gender-affirming care is for young trans people … and it scares me to no end to think that so many young people could lose access to critical gender-affirming care with no notice, no alternatives, no escape.”

The issue that this bill hinges on is the treatment of trans children with puberty-blockers and trans adolescents with cross-hormone therapy. Puberty blockers, as indicated by the name, pause or “block” puberty for a limited amount of time. According to the World Professional Association for Trangender Health, they are prescribed after a patient has started the process of puberty and has indicated that they have significant body aversion or distress surrounding the changes. Blockers allow trans minors to explore their gender nonconformity and potentially “facilitate transition by preventing the development of sex characteristics that are difficult or impossible to reverse” after one goes through puberty. Blockers are reversible and are often prescribed alongside various social interventions, like wearing gender-affirming clothes or going by a different name.

Siddhant Talwar, a junior, expanded on the importance of giving children the space and time needed to explore their identities and said, “Any queer person I know … knew about their sexuality or their gender way before they were 18, and by the time they were 18, they were comfortable with the concept a little bit … and that started before they were teenagers.” They continued, “That process, that stage where you’ve accepted things and then you can further explore your identity, that’s an amazing area to be in, and I think [this bill] would make you doubt yourself when you’re in that space.”

The bill characterizes puberty blockers as “risky” and gender-affirming care as “experimentation,” claiming that “the prescribing of puberty-blocking drugs is being done despite the lack of any longitudinal studies evaluating the risks and benefits of using these drugs.” However, these accusations are not accurate. There have been many widely accredited studies done about the effects of puberty blockers on children and adolescents. Most indicate that puberty blockers help minors with the distress they feel around their gender, that risks associated with the blockers are minimal, and that they should be considered a valuable option in the clinical treatment of gender dysphoria.

As a result, the bill has been widely criticized by LGBT activists and medical organizations alike. The denigration of a widely-recognized and research-backed treatment for gender dysphoria in minors is indicative, for many providers, of the increasing devaluing of medical consensus and the prioritizing of misinformation in legislation. Ariel Watriss, a gender-affirming nurse practitioner at Tufts, called this characterization “insulting to everyone involved,” and said that the bill “uses just enough scientific and medical language to come across as potentially legit … [the legislators] did some research on what things mean, but then they took the data and completely manipulated it and used it to their advantage and it’s just simply not true.”

Sophomore El Kocay also spoke on the bill’s description of puberty-blockers, and said that “the use of words like risky and experimental is definitely done on purpose and … it’s definitely not how policy should be written.” They explained some of the societal effects of this mischaracterization of gender-affirming care: “You look to legislation as fact—people reading the legislation assume that the lawmakers are using objective fact, and there’s just a constant cycle of public opinion and culture affecting policy and legislation and vice versa. People are going to come away from this misinformed … the effects of that will definitely be felt from this bill.”

In addition to anxieties surrounding misinformation, the bill has also facilitated discussions about the importance of access to gender-affirming care. Given that Arkansas already has limited access to this kind of treatment, Watriss spoke on the importance of reforming healthcare to center gender diversity and said, “as a baseline component of health care, we have to be inclusive of gender expression beyond the binary in whatever capacity that means.” She continued, “Unfortunately, the places where there’s still this sort of seeping ignorance and this anger towards things that don’t fit into these very narrow lines are the very places it’s getting more vocal … and I’m very curious to see how it’s going to shape access in the states around Arkansas and what that’s going to do.” 

Guttierez, when speaking on the limited access to care that many young trans people face, advocated for a sweeping approach to healthcare reform. “Many youth, particularly trans youth of color, don’t have the financial, familial, and/or physical means to access care in the first place … so when we’re taking action and advocating for the ‘rights’ of transgender youth, we must be fighting for access for all. That means making gender-affirming care accessible to working-class, racially marginalized, homeless, and closeted youth—and, most importantly, we must prioritize eliminating the systems of oppression and the policies that create these circumstances,” said Guttierez.

In an email to the Tufts Observer, Dr. Tucker, a staff clinician with CMHS, suggested that in order to do this, “[people in power] would first have to acknowledge the harm that has been done and then re-build systems to allow for healing. Unfortunately, we’re not historically very good at that part.”

Thus, the main response to House Bill 1570 is fear that this bill will endanger trans youth. WPATH explains that when providers decide to remain neutral on prescribing gender-affirming treatment, they are actually making the active decision to prolong gender dysphoria, as well as the higher rates of suicide, self harm, anxiety, and the poorer quality of life associated with it. 

Talwar elaborated on the emotional effects of this medical neglect. “Without access to such surgery … or treatment, you’re harming a person constantly, 24/7, for a long period of time. You’re telling them that, ‘well, you’re uncomfortable in this body … this body makes your skin crawl, but you have to exist within it because we hate you and our hate is stronger than your identity,’” they said.

In the absence of state-certified healthcare, there are concerns about the alternatives to which trans youth will turn. Watriss compares it to the fears surrounding abortion rights: “I am reminded of access to abortion and how people have gone to whatever ends that they need to go to get what they need. And it just makes me think about all of these families in Arkansas who are trying to help the young people in their lives … There are ways that there’s access in certain states to get medical care beyond the traditional pathways … but what lengths are they going to go to to get this care?”

There has been a persistent movement to remove this law and oppressive structures like it by various organizations and LGBT advocacy groups. Legal repercussions are in the works, according to Chase Strangio, the deputy director for transgender justice with the ACLU’s LGBTQ & HIV Project, who said in a statement that “the ACLU is preparing litigation as we speak.” 

Tucker encouraged cisgender allies to consider their place in the movement and to “step up, donate, and support trans and nonbinary folx who are doing this work, feeling unsafe, and needing support during this time, without expecting credit or acknowledgment for something that we should have already been doing for each other as humans.” 

They also encouraged allies to “check on your close trans & nonbinary family/friends/loved ones who might be impacted, but not in a way that requires labor or acknowledgment from them (“hey, I heard about the anti-trans legislation that was just proposed in [their state]—how have you been managing? Is there any way I can support you?”).”

Within the Tufts community, Guttierez emphasized the importance of communal support during this time and suggested that people come to the LGBT Center for resources, encouraging students to “find and reach out to trans-affirming organizations, communities, and networks near them or in their state.” 

Ultimately, there is a sentiment of solidarity and urgency building in the trans community around this issue. Calls are being made all across the country for widespread change in relation to trans healthcare and the wellbeing of trans youth. As Watriss said, “[the bill] is sending a really horrific message to kids who really, really need our support, so [healthcare] just has to be better … it’s just basic humanity.”