Let Me Be Brief: LGBTQ+ Healthcare Under Attack Across Texas

A series of briefs by Texas Medical Students

By Amanda Block, Parminder Deo, and Zoe Davis

The onslaught of anti-LGBTQ+ legislative proposals continues to rise among Texas lawmakers amid already skyrocketing negative rhetoric and violence towards the LGBTQ+ community¹. Some legislation calls for book bans in school libraries, questions the legality of gender-affirming care for transgender youths, and paints drag shows as grooming children for sex.

The United States Department of Health and Human Services defines gender-affirming care as a supportive form of health care which can include medical, surgical, mental health, and/or non-medical services for transgender and nonbinary people². This early gender affirming care is essential to overall health for transgender or nonbinary children, allowing them to focus on social transitions which can increase their confidence while navigating the healthcare system. 

LGBTQ+ people are more visible in their communities than ever before. A Public Religion Research Institute (PPRI) survey found that 70% of Americans report that they have a close friend or family member who is gay or lesbian, while the number of Americans who say they personally know someone who is transgender has nearly doubled, from 11% to 21%³. Texas is home to approximately 7 million youth under 18, and holds the second largest LGBTQ youth population in the U.S., according to an analysis by Williams Institute at the UCLA School of Law and Gallup Daily⁴.

LGBTQ+ Demographics in Texas:

% of Adults (18+) who are LGBTQ+	Total LGBTQ+Population (13+)	% of Workforcethat is LGBTQ+	Total LGBTQWorkers	% of LGBTQ+ Adults (25+) Raising Children
4.1%	1,053,000	5%	647,000	29%

As of February 2023, the American Civil Liberties Union (ACLU) has identified 23 anti-LGBTQ bills in Texas– 10 of which directly target access to healthcare⁵. Many of the healthcare bills seek to limit or ban gender-affirming care for transgender youth by declaring gender-affirming care as “child abuse” and target medical providers with threats losing licensure and pressing criminal charges, and removing state funds for gender-affirming care. Other bills attempt to limit classroom instruction on sexuality and gender identity. Introduction of legislation like this affects the emotional and physical well-being of this historically marginalized patient population. 

Key Bills this Session:

• Senate Bill 1029, filed by Texas Republican Bob Hall, would ban public funding for gender modifications and treatments, which includes castration, vasectomy, and hysterectomy regardless of age⁶. It would also bar some health plans from providing “gender modification procedure” and increase legal liability for medical professionals who offer the care.
• Senate Bill 1082, filed by Texas Republican Bob Hall, relating to the definition and use of the terms “male” and “female” for purposes of certain government documents⁷. This would restrict all government-produced communications that request or provide information on someone’s sex to only use “male” and “female.”

The proposed Texas legislations are a direct insult to the mental-well being of LGBTQ+ people and their quality of life. Transgender and gender nonbinary adolescents are already at increased risk for mental health issues, substance use, and suicide. The Trevor Project, a suicide hotline for LGBTQ youth, reported that LGBTQ youth of color reported higher rates of attempting suicide than their white peers in 2022, and that for 86% of respondents in Texas, recent politics further negatively impacted theirwell-beings⁸.

A safe and affirming healthcare environment is critical in fostering better outcomes for transgender, nonbinary, and other gender diverse children and adolescents. Medical and psychosocial gender affirming healthcare practices have demonstrated lower rates of adverse mental health outcomes, increased self-esteem, and improvement in overall quality of life for transgender and gender diverse youth⁹.

As future healthcare professionals, it is our duty to ensure equitable healthcare for all individuals, regardless of gender identity. Furthermore, it is our duty to take actions of non-maleficence, avoiding doing any harm to individuals. If bills that restrict the healthcare for these individuals are put into place, this population will not have the same opportunity to advance their mental health and physical health as their non-transgender counterparts. Their mental health will undoubtedly undergo negative impacts as a consequenceThese pieces of legislation decry appreciation for LGBTQ community members and the autonomy and dignity these individuals deserve and are inappropriate for any policy, especially those pertaining to the healthcare legislature . 

TMA Policy

The LGBTQ Health Section of the TMA is charged with addressing important issues of interest to LGBTQ medical students, residents and fellows, and physicians. The goal is to advance the association’s leadership role in providing physicians and patients with evidence-based, scientific information on care for lesbian, gay, bisexual, transexual, and queer/questioning individuals. TMA specifically wants to protect the patient-physician relationship. Below are policy examples.

60.008 Rejection of Discrimination: The Texas Medical Association does not discriminate, and opposes discrimination, based on race, religion, disability, ethnic origin, national origin, age, sexual orientation, sex, or gender identity. TMA supports physician efforts to encourage that the nondiscrimination policies in their practices, medical schools, hospitals, and clinics be broadened to include “race, religion, disability, ethnic origin, national origin, age, sexual orientation, sex, or gender identity” in relation to patients, health care workers, and employees. (CSPH Rep. 1-A-18)

60.010 Opposing Legislation that Mandates Physician Discrimination: The Texas Medical Association (1) supports the removal of “opposite sex” as a requirement for affirmative defense to prosecution within the Texas Penal Code, and (2) opposes legislation or regulation that mandates physicians and other health professionals discriminate against or limit access to health care for a specific patient population (Res. 111-A-19).

265.028 Improving LGBTQ Health Care Access: The Texas Medical Association recognizes that lesbian, gay, bisexual, transgender, queer, or questioning (LGBTQ) individuals have unique health care needs and suffer significant barriers in access to care that result in health care disparities. TMA will provide educational opportunities for physicians on LGBTQ health issues to increase physician awareness of the importance of building trust so LGBTQ patients feel comfortable voluntarily providing information on their sexual orientation and gender identity, thus improving their quality of care. TMA also will continue to study how best to reduce barriers to care and increase access to physicians and public health services to improve the health of the LGBTQ population. (CSPH Rep. 8-A-18)

For LGBTQ mental health support, call the Trevor Project’s 24/7 toll-free support line at 866-488-7386. You can also reach a trained crisis counselor through the Suicide and Crisis Lifeline by calling or texting 988¹⁰.

Sources

1. Legislative Bill Tracker 2023: Equality Texas. equalitytexas.org. https://www.equalitytexas.org/legislature/legislative-bill-tracker-2023/. Published March 13, 2023. Accessed March 31, 2023. 
2. Lesbian, gay, bisexual, and Transgender Health. Centers for Disease Control and Prevention. https://www.cdc.gov/lgbthealth/index.htm. Published November 3, 2022. Accessed March 31, 2023. 
3. How social contact with LGBT people impacts attitudes on policy. PRRI. https://www.prri.org/spotlight/lgbt-pride-month-social-contact-gay-lesbian-transgender-individuals/. Published October 13, 2021. Accessed March 31, 2023. 
4. The Williams Institute. https://williamsinstitute.law.ucla.edu/visualization/lgbt-stats/?topic=LGBT&area=48#density. Accessed March 31, 2023. 
5. Mapping attacks on LGBTQ rights in U.S. state legislatures. American Civil Liberties Union. https://www.aclu.org/legislative-attacks-on-lgbtq-rights. Published March 28, 2023. Accessed March 31, 2023. 
6. Texas SB1029: 2023-2024: 88th legislature. LegiScan. https://legiscan.com/TX/bill/SB1029/2023. Accessed March 31, 2023. 
7. Texas SB1082: 2023-2024: 88th legislature. LegiScan. https://legiscan.com/TX/sponsors/SB1082/2023. Accessed March 31, 2023. 
8. 2022 National Survey on LGBTQ Youth Mental Health by State. The Trevor Project. https://www.thetrevorproject.org/wp-content/uploads/2022/12/The-Trevor-Project-2022-National-Survey-on-LGBTQ-Youth-Mental-Health-by-State-Texas.pdf. Accessed March 31, 2023.
9. Tordoff DM;Wanta JW;Collin A;Stepney C;Inwards-Breland DJ;Ahrens K; Mental health outcomes in transgender and nonbinary youths receiving gender-affirming care. JAMA network open. https://pubmed.ncbi.nlm.nih.gov/35212746/. Accessed March 31, 2023. 
10. For young LGBTQ LIVES. The Trevor Project. https://www.thetrevorproject.org/. Published February 27, 2023. Accessed March 31, 2023.