'Terrifying' transgender healthcare bans put patients at risk, experts say

Recent years have seen a flurry of legislation aimed at blocking transgender people from receiving gender-affirming care.

To date, legislation restricting transgender care has been signed into law in at least 18 states, with dozens of similar bills still being considered by lawmakers across the nation.

Becker's interviewed behavioral health leaders on what impact this trend could have on the behavioral health industry, and each said it could mean increased stress on a system already pushed to its limits.

Note: Responses have been edited lightly for clarity and brevity.

Are there mental health implications for transgender patients being denied services including hormone replacement therapy?

Ian Schroeder. Director of Behavioral Health at Prism Health-Belmont (Portland, Ore.): I believe there will be an increase in suicidal ideations, suicide attempts, and deaths by suicide. We are already seeing an increase in anxiety, depression and trauma-related symptoms with folks we are currently working with in a state where they still have full access to affirming care. I have witnessed folks having to make medical decisions based on questions such as, "What if I am no longer allowed access to my hormones?" or "What if my insurance denies coverage?" I can only imagine how detrimental this is to folks in states where their elected officials have created laws that strip away their rights and lifesaving medical care. Ongoing increases in fear and stress-related issues are detrimental to a person's physical and mental well-being.

As a person who identifies as transgender, this is terrifying for not only myself but for those in my care that are being targeted as less than, as being mentally ill, as being vile degenerates because we identify as different from the societal norm of binary gender. This targeted vitriol sets the stage and gives permission for discrimination and hate, which will in turn increase barriers to gainful employment, lifesaving medical care, housing, healthy supportive interpersonal relationships, and lack of resources. When a person does not have access to their basic needs, safety, and security, it creates an environment that causes or exacerbates anxiety, depression, and trauma. 

Rodney Villanueva, MD. Psychiatry Clerkship Director, Associate Director of Psychiatry Residency, Co-Medical Director of Behavioral Health Advanced Clinical Practitioner Fellowship at Atrium Health (Charlotte, N.C.): Transgender people are already at higher risk for conditions such as depression, anxiety, substance use disorders and suicide. Part of the reason for this is distress from having one’s birth sex not align with one’s identified gender. Gender-affirming therapies such as hormone treatment can help to reduce this distress and in turn, the risk for significant mental health issues. Denying transgender care services will place transgender people at increased risk for poor mental health not only because of the inability to receive medical care, but also because of discrimination and marginalization.

Tara Chandler. Co-owner, Appalachian Counseling and Psychological Services (Asheville, N.C.): I believe there are strong implications for gender expansive patients. If we look at research-based outcomes, it is clear that when individuals are allowed access to gender confirming care, they fare better. I believe that as professional gatekeepers, we have a responsibility to ensure we are providing our patients with high quality care in accordance with [World Professional Association for Transgender Health] standards. 

Jessica Clodfelter. Outpatient therapist at Thriveworks (Lynchburg, Va.): There most certainly are mental health implications for people who identify as transgender being denied gender-affirming services, including but not limited to hormone replacement therapy. Other forms of gender-affirming care include surgeries, facial hair removal, speech and communication modification interventions (voice therapy which helps modify gendered aspects of a person's voice or treatments which help with non-verbal communication patterns), and other behavioral interventions which include genital tucking, genital packing, or chest binding.

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