Front Burner - The impact of anti-trans laws in the US

Episode Date: April 18, 2023

This year alone, hundreds of new laws targeting trans people have been introduced by Republicans in the United States. Many of them make it harder for doctors to provide gender-affirming care for young people, or ban it completely. On this episode, Ryan Sallans, a transgender author and consultant focused on gender diversity based in Nebraska, and Dr. Hussein Abdul-Latif, an endocrinologist who works with trans kids in Alabama, discuss the impact of the new bills. For transcripts of this series, please visit: https://www.cbc.ca/radio/frontburner/transcripts

In the Dragon's Den, a simple pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization, empowering Canada's entrepreneurs through angel investment and industry connections. This is a CBC Podcast. Hi, I'm Saroja Coelho, in for Jamie Poisson. What do you want people to know about you, about the trans community that you feel like people in this state, you know, sometimes just don't get? That we're just like, we're like, we're just kids. We're often reduced to just body parts. We have so many other parts of ourselves and a lot of representatives don't get that. A report last year using government health

data estimated only 1.4 percent of American kids identify as trans. But for being such a small proportion of the population, they have become an obsession for Republican lawmakers. If you're an adult and that's what you want to do, go at it. But as a child, you're telling me that a 10, 11 and 12 year old child absolutely knows what gender that they want to be. I do not believe that. Since the beginning of the year, according to translegislation.com, there have been nearly 500 bills introduced by politicians

across the United States targeting trans people. For example, this week, North Dakota became the latest state to bar trans girls from joining girls' sports teams. And Democrats and advocates are worried the consequences of those bills could be fatal. How dare you? You're going to kill kids.

Their blood will be on your hands. This is against every medical guideline. They are scaring you on purpose. Look into the eyes of those parents and tell them that you're voting for this bill knowing that it could potentially kill their child. So today I have two guests to try and understand why trans people, and trans kids in particular, have become such a lightning rod for Republicans and how that's affecting the kids themselves and the people who love them. Ryan Salins is a transgender author and consultant focused on gender diversity. He lives in Nebraska.

Dr. Hussein Abdul-Latif is an endocrinologist who works with trans kids in Alabama. Both of those states are still grappling with laws that would restrict life for trans children. Hello. Hello. Hello. I want to speak specifically about each of your states in just a moment, but let's start in Texas as an example. This year, lawmakers have filed 140 bills targeting LGBTQ people. These bills would ban gender affirming health care, censor what teachers can talk about and what books they can have, and punish district attorneys who refuse to prosecute parents for child abuse for providing gender affirming care to their children. for providing gender-affirming care to their children. Ryan, I want to come to you. That's just one state. What are you seeing when you look at Texas and other states that has you most concerned?

Well, all of this has me concerned because this is not guided by medical evidence or science. This is guided by politics and fear of the unknowns around what happens with our younger generations when they do have access to more visibility, ways to connect, and access to information to be able to share with their families or their peers or their teachers about what they're learning about themselves, which we older folks didn't have the luxury to have because this topic was largely taboo. I mean, in some ways it still is. So I'm just concerned because the politicians are trying to oversee what medical standards and guidelines and research has been guiding us through over, I mean, really the past hundred years with the medical technologies and advances that we've had for transgender care. And in Texas, Governor Greg Abbott actually told the state's Department of

Family and Protective Services to investigate at least 15 families for child abuse because they sought gender-affirming health care for their children. Amber and I had somebody call in on us, and we were put under investigation on the allegation of child abuse simply for raising a trans child. So this is pure politics for them. But for us, it's our life. That is really difficult to wrap your mind around. Hussein, are the parents you see worried about this? Yeah, I mean, in the state of Alabama, the law that was passed by the legislature did not threaten the parents with punitive actions.

It was like a law that threatened the physicians and the medical providers in general. So in a way, when our parents in Alabama are looking at the state of Texas, they are horrified because although the state of Alabama is egregious in its own law, Because although the state of Alabama is egregious in its own law, it kept them protected and it did not infringe on them and on their rights put with more friendly custodian parents to the policies of the state. And that is very scary to any parent. Ryan, when you're listening to that answer from Hussein, how does that make you feel? Well, again, I'm flabbergasted by what worked the current onslaught and attack, especially for families and making decisions with their children that is guided not only with the family and the child, but also by a mental

health care provider and a medical provider. So this complete lack of respect to the nuances of this and the, I don't know, it just makes my mind go a little bit wonky. Because then families aren't going to be seeking care and we're going to see further negative impacts both psychologically and physically for the children. Hussein, let's make sure we got everybody on the same page here. When we talk about gender-affirming health care for trans kids, what are we actually talking about? We're not actually talking about irreversible treatments here. We're not talking about surgery. Is that correct? I mean, yes, in my field, certainly, we're not talking about surgery. Yes, in my field, certainly we're not talking about surgery.

Surgery is a subject that rises in the discussion as the child gets older to become an older teenager, but it's certainly not the beginning of the discussion. When I'm talking about gender-affirming care, I'm talking about a physician or a team of physicians that are willing and are happy to take care of kids who are transgender, who identify as transgender, with humility and understanding and an openness to understanding where the kid is coming from and where the parents are coming from. It includes mental health support, it includes medical health support, and it includes social support, as in changing names on legal records, making sure that our electronic and medical records are registering the correct gender of the child that they identify with, and that we're calling them by their preferred name. calling them by their preferred name. All of that is gender-affirming care, and medical management is part of it, whether it is, which we do offer in our clinic, you know, puberty blockers and cross-hormone affirming hormone therapy to the gender that the person identifies with.

As he gets older, what we're looking at is first puberty blockers. So medication that would prevent puberty from happening in the natural course at its core really to buy us time. What you're describing sounds like a very nuanced, long conversation with the child in that large group of caregivers that you've described. What is the difference then between a young person who is experimenting with gender norms or asking a lot of questions and a kid who is trans and needs your medical services? You know, it is normal for any kid to be questioning where they are and stuff like that. But a kid who is questioning does not continue to be on that path. So certain

words that we use is that a trans kid is a kid who is consistent, persistent, and insistent over a period of time on the gender that they identify with. It's not something that changes, you know, every weekend or something like that. And so that's part of our discussion with the kid is that, where are you on that journey? When did you come out? Is it a gender journey that is already fixed? Or is it a gender journey that's evolving and we need to work together on it? So that would be the big difference between them. on it. So that would be the big difference between them. In Alabama, this is a conservative state, and the majority of the parents that come to us are of conservative backgrounds, or at least initially conservative. So the parents themselves, they do not bring the child right away. They will

wait and see if it is a phase or it's not. And by the time they come to see us, because it's a clinic that's busy and it has a long wait list, the kids have already been out and insistent, consistent, pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization. Empowering Canada's entrepreneurs through angel investment and industry connections. Hi, it's Ramit Sethi here. You may have seen my money show on Netflix.

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To listen to this podcast, just search for Money for Couples. Ryan, in your home state, Nebraska, Democrats have been filibustering for weeks trying to stop a bill that would outlaw gender-affirming care. We are blowing up this session. The session's over. The session's over and it's on your terms

because the terms were made clear to you for the last four to six weeks. And you ignored that. You didn't care. Hating trans kids in Nebraska is more important to you than the rest of this entire session. And that message is received loud and clear. Nothing else has been passed in this entire session. Why do Republicans care so much about this particular issue, so much so that they're willing to sacrifice other legislative priorities? Because they feel they're doing the right thing,

even though they're not. The Republicans are concerned that we are pushing forward the language they use is like an ideology onto young people and that 10 years down the road, these young people are going to realize they made a huge mistake and have great regret. So they feel that they're coming from a place of compassion and a place of caring for children. There's evidence that this is harmful to children. And that's our job is to protect children, and that's what we're doing here. The risks of puberty-suppressing treatment with GnRH analogs and gender-affirming hormonal treatment currently outweigh the possible benefits. I believe that our party is protecting the most innocent.

When in reality they're coming from a place of ignorance and not taking in what's really happening, like Hussein described, the process transition does not happen overnight. It takes time. It takes money as well. And so we need to be able to respect the families and their journeys. Hussein, in Alabama, you actually had a bill that was passed last year that affected how you could do your job, at least briefly. Can you explain what happened? So it was actually a year ago when the legislature signed, you know, they passed a bill banning affirming care for kids. Two controversial bills passed by Alabama lawmakers today. The first prohibits doctors from prescribing medications or performing surgeries altering a minor's gender.

Lawmakers also passed the transgender bathroom bill requiring... And including another part of it related to school counselors that they have to out the kids to their parents. decided that it's a criminal act by a physician or a medical care provider to prescribe gender-affirming medications, including puberty blockers and hormone therapy. So if the bill went into effect, and it actually did go into effect for a week before it was stopped, I would be a criminal if I prescribe any of those hormone treatments for my kids. So for the bill to take effect, it had to wait about a month pending appeals and so on. And so during that month, basically, I was in a position of scrambling to find the names of all the kids that I was treating and calling prescriptions, the names of all the kids that I was treating and calling prescriptions, refill prescriptions, that will hold them and cover them for at least six months after the bill has passed. Luckily,

the judge stopped the bill a week after it took effect. And so now we're back to where we were before. And we're really working as usual. We have not changed our clinics. We have not stopped our clinics. Our doors keep being open. Although some parents come to us oftentimes thinking that the law is in effect already. So what will you do if the legal challenges that stopped the bill for now are not successful in the future? are not successful in the future? This is a very hard question because as a physician, I have an oath to do no harm for kids. And I genuinely believe that withholding care for a kid that deserves it, whether it is puberty blocker or it is hormone therapy, it is puberty blocker or it is hormone therapy, then I am missing a very important part of my oath to uphold my profession. So the bill will put me in a very difficult situation where

I have to protect myself from legal consequences, but I'm also feeling very guilty for not providing what I believe I should be providing. Ryan, you travel all over the country talking and consulting on trans inclusion. What are you hearing from trans adults and trans kids right now on this issue? People are scared because if we even go to the state of Missouri, there's a question of where will they stop? Are they going to just stop with youth or are they now going to also try to take away care from adults? So people are worried about what's going to happen within not only the state, but with our present Supreme Court, because all these lawsuits will be taken to the U.S. Supreme Court. So there's concern about whether they're going to protect trans identities or align with the Republicans'

views. Where do you think the conversation's headed? I, in my hearts of hearts, believe that this will be found as unconstitutional and it will be taken down in the court of law. But it's hard to give that hope to other people when they're just exhausted. Our country is exhausted. I think our world is exhausted by just everything going on. So hope is something that I'm working to keep moving forward because if we look at the suicide rates, it is disproportionately impacting our transgender community. Hussain, I want to come to some of the arguments that you are very likely hearing in your practice. People who disagree with this work say it's not a great idea to give hormones and puberty blockers to kids. Is there any evidence to support that? Is there any evidence to support that?

I could not find any, interestingly, because I do find, like, for example, the use of puberty blockers, which is kind of what oftentimes the discussion goes about. You know, the state of Florida, I looked at their document and all the articles that they brought up about the dangers of puberty blockers. And interestingly, the same article that one of the articles that they used as their support thing was an article that actually was talking about what is reported to be potential side effects of puberty blockers. And the article ends up concluding that none of those are credible side effects of the puberty blockers. And the article itself was not looking at puberty blockers in kids who are transgender. It was looking at use of puberty blockers for kids with precocious puberty, like people who develop puberty early, and we use puberty blockers to stop them. So it was looking at a totally different subject. And interestingly, again,

none of those states is going to ban us from using puberty blockers for early puberty, but they ban us specifically from using it for transgender kids, which hits me as hypocritical. As you described earlier, these young people are already facing very big decisions about their futures. They face that conversation, a very large team of people. They discuss their identity at length.

Are they still able to have that deep, nuanced conversation about gender and their bodies when everything political is so loud and polarized around them? So the kids that come to us, they're afraid. They're nervous. Many of them really have high blood pressures at the time of the visit because one, they really do not predict what I will say and what I decide and that scares them. Another one is that they do feel the atmosphere around them as being very hostile in the state in general as a society, but also as a political system. So that's kind of the background that they are dealing with. And they certainly feel that they need lots of support. Mentioning the Missouri situation, one of my kids that I follow is 18 years old. So I was telling

him that, you know, you're 18, you would be turning 19 soon, so you'll be safe. He said, no, I don't feel safe anymore because of all those starting laws that are going to ban gender affirming care for adults as well. So I believe many of them are feeling, when does this stop? Like, where is this going to be? Why are we targeted? And it's very much like Ryan brought up, the ideation of suicide is high in this group, and it becomes higher as they are dealing with an additional external reason for them to be anxious. I want to turn to that very difficult topic right now. You are both hearing parents and advocates say that Republicans voting for these bills are putting kids' lives at risk. A survey of trans youth said half of them had seriously considered suicide. Almost one in five had made a suicide attempt.

Ryan, do we know how these things have changed in the past year or so under this flurry of Republican bills? changed in the past year or so under this flurry of Republican bills? Well, if we were to look at the Center for Disease Control and Prevention's youth risk behavior surveys, looking at high school students, we started noting that in 2015, there was an ongoing increase of mental health issues among all of our youth. And so we started noticing in 2015, an ongoing loss of hope and persistent sadness and an ongoing increase in making a suicide plan or suicide ideation. 2017, that increased again. 2019, that increased again. And then we hit the pandemic. And now we have this. So we're just seeing an ongoing on pile, I feel, of just distress in this country and the question of what is life and can I

actually live my life and experience happiness? And so we have multi-pronged layers of trying to reach our youth today as elders to help guide them through this time. And I like to remind them too, we didn't even have marriage equality in the United States until 2015. This morning, the Supreme Court recognized that the Constitution guarantees marriage equality. In doing so, they've reaffirmed that all Americans are entitled to the equal protection of the law. So oppression is not new. It's something that we're continually fighting. And we should have that hope in the future that we're going to see change. Hussein, I want to come to you because this political backdrop is going to have impact on your work.

It already has in some cases. What happens to you and other health professionals if you break these laws? I mean, I will go to jail, I think, if they catch me. Or if I end up breaking the law for some reason and they catch me, then I will go to jail and there will be some kind of a financial liability as well, maybe $10,000, $15,000. So that's kind of what the law was threatening in my case in Alabama. Why do you keep doing it? Why do you keep offering medical services in this heightened, tense political situation? Because it's the right thing to do. I do remember my first trans kid that I saw, it was 15 years ago. And that's my first trans kid. And they came afraid, you know, I do remember the child and the mother

sitting, you know, pretty tight in the room, but also armed with medical literature and guidelines and all that kind of stuff. And, you know, they were armed with whatever they wanted or needed to have in order to convince me. And so luckily I was open-minded and I heard them and I heard their concern and I read all of what they brought, which is very credible information. The mother was a nurse. And that started me in that path. Now, this kid from 15 years ago is a grown adult who is a trans woman, happy, practicing life, and thriving. practicing life and thriving. And seeing that and comparing it with the child that I saw that was afraid in the beginning is something that makes me believe that what I'm doing is the right thing.

Ryan, this is a grim situation that's being described here. Where are you finding hope in what's going on? Just seeing the opportunity for being able to provide further education. I mean, to be honest, and seeing the bills that are introduced in Nebraska and seeing the language use, I never thought politicians would ever even be discussing these medical issues. So there is an opportunity to provide further education. I also see some politicians on the Republican side starting to break down their understanding and recognize that puberty blockers and hormone therapy are not a threat. And so we are going through a time of growth and change, and it's highly uncomfortable.

We just have to have people stick with us as we navigate through it. I'd like to thank you both for your time and your insight on this topic. Thank you so much. Oh, thank you for having us. Thank you. And that's it for this edition of FrontBurner. I'm Saroja Coelho. Jamie will be back tomorrow. For more CBC Podcasts, go to cbc.ca slash podcasts.