As a part of a weeklong course for Health Equity Scholars in April 2021, students in the UAB School of Medicine researched current health issues around the world. The Lister Hill Center for Health Policy will be share these evaluations from different students over the next few weeks to shed light on various situations. This post was written by Jasper Kennedy before the end of Alabama’s 2021 Legislative Session. SB 10 passed the state senate this year but its counterpart in the state house of representatives (HB1) never came up for a vote. A similar bill may or may not be proposed next year.
I have lived in Alabama all my life. I was born, raised, and educated here, including my ongoing training as a medical student at the University of Alabama at Birmingham. I am also a transgender person surviving in this state, and I’m worried about what SB10, which would criminalize providing healthcare to trans youth, would mean for my trans community as well as my colleagues.
Transgender youth are an incredibly vulnerable population that is at a greater risk than their peers for violence from others as well as suicide1. We know that the risk of suicide for trans youth drops dramatically when their gender identity is affirmed by the people around them2,3. SB10 would do more than prevent trans youth from accessing affirming healthcare; it would also enlist teachers and school counselors in outing trans students to their parents. In a population that already experiences increased discrimination, harassment, and outright violence at school1, this removes any possibility of finding supportive adults in an educational environment. Trans young people can have healthy, happy lives when they are supported by their families and schools. This bill would disrupt the tenuous balance many trans youth in our state have found. Make no mistake, this legislation will cause suffering and harm to young Alabamians.
SB10 would not only endanger trans youth but also interfere with the provider-patient relationship and medical decision making. It would make it a felony to provide any kind of transition care, including puberty blocking medications. These therapies have been used safely for years in the treatment of a variety of conditions from early puberty in youth to prostate cancer in adults. Puberty blocking therapies allow time for trans youth to think about what they want for their future without the urgency of impending changes to their bodies. Even more compelling is the evidence on the mental health benefits of these medications– puberty blockers are associated with decreased lifetime suicidality in trans people who want access to them4. Under SB10, a physician who provides a patient with this lifesaving therapy would face up to a decade in prison.
Alabama has long struggled to keep enough primary care providers in its borders to provide for our population. At UAB and other medical schools across the state, students are familiar with entreaties to stay and practice in Alabama, particularly in our underserved rural communities. Like many of my classmates, I am excited to be part of the next generation of primary care physicians, but we have to weigh our desire to stay and help the community we love against the opportunity to get the medical training we need to be competent physicians. As someone who cares deeply about the wellbeing of all youth and particularly vulnerable populations like trans kids, I would not be able to learn about the full breadth of comprehensive pediatric care in Alabama if SB10 were made law. In a state with a shortage of primary care providers, it seems a particularly risky gamble to reduce the pool of thoughtful and compassionate trainees even further.
Within the trans community, we talk often about how our narratives are boiled down to trauma and fear without any room for nuance or joy. To be trans in this state is simultaneously a story of beauty, resilience, and sadness. It’s more than just trauma, but the risk of trauma looms large with the possibility of this legislation passing. SB10 represents a scramble by a select few in our state to deny the inevitable– trans children will continue to be trans regardless of what we do. The only thing we can influence is how many of them make it into adulthood.
1. Johns MM, Lowry R, Andrzejewski J, et al. Transgender Identity and Experiences of Violence Victimization, Substance Use, Suicide Risk, and Sexual Risk Behaviors Among High School Students — 19 States and Large Urban School Districts, 2017. Morbidity and Mortality Weekly Report. 2019; 68: 67–71. DOI: http://dx.doi.org/10.15585/mmwr.mm6803a3.
2. Russel ST, Pollitt AM, Li G, Grossman AH. Chosen Name Use is Linked to Reduced Depressive Symptoms, Suicidal Ideation and Behavior among Transgender Youth. Journal of Adolescent Health. 2018 Oct; 63(4): 503–505. DOI: https://doi.org/10.1016/j.jadohealth.2018.02.003.
3. National Survey on LGBTQ Youth Mental Health. Trevor Project, 2020. Access at: https://www.thetrevorproject.org/survey-2020/.
4. Turban JL, King D, Carswell JM, et al. Pubertal Suppression for Transgender Youth and Risk of Suicidal Ideation. Pediatrics. 2020; 145(2): e20191725. DOI: https://doi.org/10.1542/peds.2019-1725.
