Health workers decry hasty House bills to ban gender-affirming care for children: ‘They hurt people’

Nicholas Mitchell took a deep breath and reached for the door handle. He never knew what to expect inside. Sometimes, the staffers for US House representatives were friendly; sometimes, he’d heard, they tore up their copies of the informational sheets Mitchell carried on a clipboard.

This time, they were receptive. A policy aide for a Democratic representative said he had five minutes to talk, and Mitchell didn’t waste any time as they settled into a conference room.

“We’re here to discuss two bills coming up, HR 498 and HR 3492,” Mitchell said.

The two bills, introduced this week for a planned vote on Wednesday, both targeted gender-affirming healthcare for children – the first time Congress has voted over national care bans and a major escalation of anti-trans rhetoric from conservative US lawmakers.

As one of her last acts before retiring from the House next month, Marjorie Taylor Greene introduced a bill to criminalize providers offering gender-affirming care to anyone under the age of 18, making it a federal felony punishable by up to ten years in prison.

The other bill, introduced by Dan Crenshaw, would ban Medicaid coverage of gender-affirming care for children. Under the law, transgender children on Medicaid would no longer have access to puberty blockers, hormone therapy and surgical care, though cisgender children would.

Both of the bills would “be causing a lot of needless suffering. Morally, it’s the right thing to do – to stand up against it”, Mitchell said.

As an unusually bitter cold snap loosened its grip on Washington and the sun softened the snow lingering in front of the Capitol on Tuesday, Mitchell and Odile Saint-Flour, partners who live in Maryland, joined a handful of activists with the group Bulletproof Pride in a last-minute canvass of lawmakers after the bills were announced.

Saint-Flour, who is nonbinary and uses they/them pronouns, is a nurse who has worked with inpatient and outpatient psychiatric patients.

Nicholas Mitchell and Odile Saint-Flour wait in the office of their representative, Steny Hoyer, to express opposition to bans on gender-affirming care for children. Photograph: Melody Schreiber/The Guardian

“Trans people make up a very small percentage of the population, but they’re very over-represented in psychiatry because the suicide rate is incredibly high,” they said. “Based on the research we have, it’s pretty obvious that it’s society that tells people they shouldn’t exist, and that really has a profound effect on the whole community.”

​​Nearly half (46%) of transgender and nonbinary young people seriously considered suicide and 12% of LGBTQ+ young people attempted suicide in 2024, according to a survey by the Trevor Project.

In comparison, 20.4% of high school students said they seriously considered suicide and 9.5% attempted suicide in 2023.

A few years after Mitchell finished medical school, Texas banned abortion early in pregnancy, and the repercussions were immediately felt across healthcare. Providers weren’t sure of what care they could offer to their pregnant patients; lawyers for medical centers interpreted the law widely in order to avoid potential scrutiny.

That’s a big reason why Mitchell, a psychiatrist, left Texas. He dreaded “the idea of having to look over my shoulder every time I see a patient and having my moral and my ethical and my professional obligations put in one corner against my legal obligations”, he said.

He would like to see laws formulated with feedback from patients, providers, and experts.

“We’ve seen repeatedly that good, open access to gender-affirming care has been extremely effective in lowering the rates of suicide amongst trans youth,” Mitchell said in one meeting.

Gender-affirming care is a broad term. It can mean prescribing medications; very rarely, it may involve surgery. But most gender-affirming care, especially for kids, is far simpler than that: it looks like providers using the correct pronouns and offering support to their patients.

Losing that support and respect can be devastating to patients’ physical and emotional well-being, Mitchell and Saint-Flour said.

Trans youth are more at risk than their cis peers for anxiety, depression, and suicide, which may “reflect lack of societal acceptance,” according a survey of studies on the topic. The study found that healthcare interventions result in significantly lower rates of mental health issues.

“Bills like this are dangerous,” said Saint-Flour. “They hurt people. They say that it’s to protect children, but they’re trying to prevent people from getting healthcare that actually lowers the rate of suicide for trans youth and trans people in general.”

Bills to limit healthcare for some people can be harmful for all, Mitchell said. Even when laws are narrow and specific, they end up having ripple effects – as the anti-abortion law in Texas has blocked access to healthcare for miscarriage management and life-threatening infections, among other serious concerns.

“Even at its most basic level, even if these things are practiced in their most narrow way, it will still be hurting people,” Mitchell said on Tuesday. “That suffering by itself is reason to not pass these bills.”