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As some states ban gender-affirming care, Nevadans work to protect it

People, their shadows cast on a transgender flag, take part in a march celebrating International Transgender Day of Visibility, in Mexico City, Friday, March 31, 2023.
Aurea Del Rosario
People, their shadows cast on a transgender flag, take part in a march celebrating International Transgender Day of Visibility, in Mexico City, Friday, March 31, 2023.

Thirteen states have banned gender-affirming care for transgender youth, including neighboring states like Utah and Arizona, and at least a dozen more are considering bans.

In Nevada, lawmakers want to protect providers who give gender-affirming care to people from out of state, and make insurance companies cover more gender-affirming procedures.

What does this care look like in Nevada now? And why are so many states banning it or considering a ban?

State of Nevada host Joe Schoenmann was joined by medical professionals, and those who have been through treatment, both with different perspectives on gender-affirming care.

Gender-affirming care is an umbrella term for a variety of medical procedures, medications and practices. It can range from a female child starting puberty too early, and parents deciding to give her puberty blockers, a minor suffering with gender dysphoria (a distress caused by feeling like one was born in the wrong body) and wanting to pursue hormone treatment, all the way to an adult person deciding to transition and pursuing hormone treatment and sex reassignment surgery.

It's important to note that all gender-affirming care does require parental consent for minors. Treatment for sexually transmitted diseases or HIV on the other hand can be accessed at the age of 13 and older without parental consent.

Nationally, the conversation is spurred by debates on the legitimacy of gender dysphoria and as to whether gender-affirming care should be provided to minors.

Rob Phoenix, family nurse practitioner for the Huntridge Family Clinic, emphasized that gender-affirming care shouldn't be a debate, and that it's a matter of providing care to those that need it.

"I think the thing that many people miss is this is medically necessary care. If I'm a diabetic, I need access to care, if I have high blood pressure, I need access to medical care," said Phoenix. "Gender-affirming care, hormone management, surgical management options are medically necessary for all of our communities, not just the trans community."

Phoenix also emphasized that LGBTQ youth and those who deal with gender dysphoria are prone to increased odds of depression, anxiety and suicidality. Phoenix said he thinks access to quality gender-affirming care may save a life.

"Adolescence is a horribly hard time for most adolescents to go through. You've got puberty, all the stresses of bullying, all the stresses of school. You now are adding in gender complexities of like, 'I was born this way, but I don't identify this way,'" said Phoenix. "So when you give somebody access to care, it helps to take away that barrier, to break down that obstacle."

Sabastian Alcala, program manager for Gender Justice Nevada, a local nonprofit dedicated to consulting organizations and government on gender awareness and inclusion, echoed much of what Phoenix said.

Alcala is an Afro-Latino trans man and is currently going through gender-affirming care.

"It's been four years, I didn't start my transition until I was 30. I've been lucky to live here [in Nevada], actually, because there weren't very many obstacles for me being an adult," said Alcala. "But I think the importance of taking away the stigma is that if I had the language, if I had had the access to know myself without exterior factors making me afraid, I would have done this a long time ago."

Alcala said societal factors and norms have made it particularly hard for LGBTQ individuals to be comfortable in their own body and identity.

"I think assimilation is the key to survival, which is why there's so much disturbance around this, because people just don't understand it. But for me, I've assimilated in my body more. I feel more comfortable as who I am. I do want surgery going forward, but I feel like the last four years I've lived more life than I did in all of my twenties."

Rob Phoenix (L) and Sabastian Alcala with State of Nevada host Joe Schoenmann on May 11, 2023.
Rob Phoenix (L) and Sabastian Alcala with State of Nevada host Joe Schoenmann on May 11, 2023.

Nationally and internationally, gender-affirming care for minors has opposers, supporters and those who lie more in the middle. It's that middle where some scientists and medical professionals are.

Dr. Carrie Mendoza, an emergency room physician based out of Chicago and director of the Foundation Against Intolerance and Racism in Medicine, emphasized there should be more studies done on the effects of gender affirming care in minors.

"The area needs more study. We need to really focus on following up with these patients and being clear about the window at which they're being sampled," said Mendoza. "I think that's very important because there's a honeymoon period with any intervention, we see that a lot in health care when people are getting prescribed something new, and they're very excited it might be something that really gets them on track. But I think understanding what is the window with the treatments here is very important."

Mendoza pointed out the fact that there are trans individuals who go through gender-affirming care and later decide to de-transition.

"They were feeling optimistic and good through a pathway, and when they got to the end of the pathway, which was surgery for a lot of them, they reflected, 'Well, this actually didn't fix some of my problems,'" Mendoza said. "I'm open minded. I want all these kids to do well, but I want to make sure that we aren't irreparably harming them; causing sterility, or causing worse mental health issues later."

Clinical psychology also dives deep into the issues of gender dysphoria, with many psychologists recommending gender-affirming care to their patients.

Dr. Erica Anderson, a clinical psychologist based out of Berkley, California with Anderson Health Strategies LLC, is a trans woman and a pioneer for LGBTQ rights. She has helped many trans youth throughout their transition.

Anderson said as of late, we may be rushing to conclusions regarding gender-affirming care for trans patients.

"We are seeing a very huge disparity around the country. A lot of studies have been done to show that the numbers of teenagers in the current adolescent cohort has gone way up of kids who are questioning their gender, and asserting a sexual or gender minority label. And frankly, we haven't gotten to the bottom of that."

Anderson said gender-affirming care is being studied more rigorously, and that societal factors are thought to make the struggle with gender dysphoria worse. Some experts suggest it's those same factors that we should be focusing our attention to more.

"Some of the health authorities in Europe are doing a better job," said Anderson. "They're studying it more rigorously. And they have come to conclude that this large cohort of gender questioning kids is heterogeneous. And there may be some effects of social isolation, deteriorating mental health in the teenage population, and even consumption of social media that probably hasn't had a positive impact on teenagers. ... There clearly is a smaller subset of that group that are increasingly transgender, and they do need gender affirming care. The challenge is figuring out which group an individual child is in, and it's incumbent upon all health providers to understand the particulars of each individual child, because I want every child to get what they need."

Hear the full interview in recording above.

Guests: Sabastian Alcala, program manager, Gender Justice Nevada; Rob Phoenix, family nurse practitioner, Huntridge Family Clinic; Dr. Carrie Mendoza, director, FAIR (Foundation Against Intolerance and Racism) in Medicine, and emergency room physician; Erica Anderson, clinical psychologist, Anderson Health Strategies

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Christopher Alvarez is a news producer and podcast audio editor at Nevada Public Radio for the State of Nevada program, and has been with them for over a year.
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