Regulating Gender: The Ethical Dilemma of Government Influence on Trans Healthcare

By Elizabeth Cannan-Knight 

The fight for transgender individuals, particularly transgender youth, to access gender-affirming care is an ongoing struggle that has harmed thousands across the United States and heavily in Southern states. This battle for bodily autonomy has been a decisive political issue that many politicians use as a bargaining chip in elections, promising to “protect the youth” from “invasive surgeries and procedures.” But how harmful are these practices, and how much of the hysteria surrounding trans youth medicinal treatment is based on noncomprehensive viewpoints or, worse, misinformation?

One of the major battleground states in this conflict has been Tennessee. Not only has a full ban on gender-affirming care for minors been passed in the form of Tennessee HB1/SB1 but also a variety of other bills have been proposed. This includes a bill that would severely restrict gender-affirming care for adults by way of making gender-affirming care uncoverable by Tennessee state-based insurance organizations. Other bills target transgender people’s ability to use the restroom that aligns with their gender identity or prohibit the discussion of LGBTQ+ topics in schools, as happened at Northeast High School in Clarksville last November.

Kota, a trans activist and the owner of the @stop_trans_genocide_ account on TikTok gave their input. 

“I feel like it’s going to lead to lots of added [gender] dysphoria, and people being forced to go through the puberty of their assigned gender, not that of their gender identity, causing a lot of added mental health issues… I know that the suicide rate will go up for trans kids, and the trends make us scared that more discriminatory laws are coming.”

This fear is very real among those in the trans community, spurring organizations, such as the Tennessee Equality Project, to keep a closer and keener eye than ever on the legislation as this session comes to a close, for fear that legislators could pass a bill even worse than Tennessee HB1/SB1, which is currently being challenged in court by the American Civil Liberties Union (ACLU), the ACLU of Tennessee, and Lambda Legal.

“The government shouldn’t insert themselves in the business of the people seeking care,” Kota said. “We trans people are scared and people are going to start losing their lives because they can’t get the care they need.”

This notion that trans lives are directly threatened by these discriminatory laws is corroborated by a number of studies, including one by the Trevor Project involving over 9,000 transgender children and adolescents that clearly showed a linkage between gender-affirming hormone therapy and a decreased rate of suicide attempts and ideation.

It’s not clear why lawmakers have chosen to use this issue as a political tool in their policy agenda. Transgender children deserve access to healthcare as much as their cisgender peers, but it’s clear from the wording in the bills presented that lawmakers aren’t against the surgeries per se, but against gender nonconformity in general. 

In fact, many bills banning hormone replacement therapy and gender-affirming surgery on minors have a hefty exception clause that includes those born with intersex characteristics. This exception means that babies fresh out of the womb, who clearly do not have the ability to give informed consent, can receive surgeries to alter their sex characteristics. Whereas transgender people who often have years of therapy before even accessing gender-affirming healthcare, are denied because, to lawmakers, anything that does not fit into their ever-shifting boxes of male and female is anathema. 

Unfortunately, this is the reality that transgender children must contend with today. Hopefully, as more and more studies are done on transgender people and as new voters begin to shift demographics in the voting population, lawmakers will be unable to ignore the scientific consensus anymore and will have to allow trans children to live freely and be themselves.

About the Author

Elizabeth Cannan-Knight is a transgender woman and youth advocate for reproductive and LGBTQ+ rights based out of Clarksville, Tennessee. She is the founder of her high school’s Gender-Sexuality Alliance as well as the Youth Coordinator for the Clarksville Kaleidoscope Network and a lead graphic designer for the Montgomery County Democratic Party.