Senate Bill 2215/House Bill 2576—the latest addition to Tennessee’s infamous “Slate of Hate”— is a law currently making its way through the state’s General Assembly. The “Slate of Hate” is a group of bills that have been quietly passed by the General Assembly over the past few years which has consciously sought to institute policies which reinforce a political culture that devalues the health and wellbeing of the LGBTQ community in Tennessee. 

This bill attempts to legislatively restrict doctors’ discretion to provide gender-affirming medical treatment to transgender minors by banning it entirely for prepubescent minors and imposing substantial roadblocks to care for pubescent minors. The bill, as introduced by Senator Janice Bowling and Representative John Ragan, offers no differentiation in how it regulates different types of gender-affirming medical treatment despite their divergent long term effects, and instead indiscriminately bars access to care for a class of citizens already scarred by a history of oppression. Under the proposed law, any violation could be prosecuted as child abuse and used as grounds for revoking the doctor’s license to practice. These requirements trivialize the necessity of care for the transgender community and place doctors in an untenable position as they balance their ethical and legal obligations. The bill has already been recommended for passage by the House Judiciary Committee and will be taken up for consideration by the Senate Judiciary Committee on December 1st.

Over 1.8% of youths today identify as transgender and many transgender people begin experiencing dysphoria in their adolescence. This dysphoria has been directly linked to the epidemics of depression, anxiety, self-harm, and suicide which plague the transgender community. There are three main varieties of medical treatment for dysphoria available to transgender individuals: hormones to delay puberty, gender-affirming hormones (estrogen/testosterone), and gender reassignment surgery. Puberty blockers delay the onset of puberty to avoid worsening dysphoria— they lack serious long term side effects and are reversible. Gender-affirming hormones serve to feminize or masculinize one’s features to reduce dysphoria and are not reversible. Gender reassignment surgery is the most invasive class of procedures, seeking to modify one’s primary sex characteristics. 

Gender-affirming care is not a one-size-fits-all area and doctors regularly tailor their care to the individual based on their unique mental health needs. Different guidelines have been set forth by various authorities, but generally the potential long-term consequences of a given treatment and the patient’s age are weighed by the doctor against the severity and persistence of the patient’s dysphoria. Given the incredibly sensitive nature of dealing with gender dysphoria, the ability for doctors to personalize their treatment plans to each individual allows for the highest possible chance of achieving a positive outcome for the minor. Doctors often combine medical and non-medical treatments to provide holistic care to the individual, usually in conjunction with a licensed psychiatrist.   

Despite the radically different aims and outcomes of possible treatment plans, Tennessee SB 2215 fails to differentiate between them in the text of the law. The inflexibility of the bill’s categorical ban on gender-affirming medical treatment for all minors who have not yet reached puberty creates a situation where the state government is depriving individual doctors of the discretion to treat their patients as warranted by their individual circumstances. In depriving doctors this latitude, the legislature fails to account for any number of instances where a doctor may deem such treatment necessary and directly contradicts the guidelines released by the American Academy of Child and Adolescent Psychiatry. There is inherent danger in any legislature attempting to step between a doctor and their patient— the doctor is always better equipped to assess the best interests of the patient than a categorical ruling by far-away lawmakers, yet somehow this common-sense premise is at great jeopardy of soon being thrown by the wayside by the General Assembly.

Charitably, this legislation can be seen as a good-faith effort to protect children from abuse and medical malpractice; however, its authors have put forward an oversimplified bill that dictates medical treatment decisions without any consideration for the best interests of the children the bill purports to protect. This bill violates the rights of citizens to privacy and bodily autonomy and it is not in the public’s interest for the government to put itself in such a position. When doctors are forbidden from exercising their best professional judgment, they are forced to choose between risking prosecution in order to fulfill their ethical duty to their patient or to follow the law and compromise that ethical duty and their patient’s health. It is unfair and unwise to put doctors in such a position—and they agree. In one physician’s words, “legislation like HB 2576/SB 2215 threatens to send us to prison for following the [Hippocratic] Oath that we so proudly take,” compromising doctors’ prerogative to treat their patients to the best of their ability.

Investing in the advancement of legislation which dehumanizes and humiliates transgender Tennesseans serves to reinforce notions of transgender inferiority and unnaturality, and only further ostracizes a group already marked by persistent historical injustices. As we watch the legislature endorse yet another piece of ill-considered anti-LBGTQ legislation it should be abundantly clear to us all that the state itself is complicit in the systemic injustices facing transgender Americans and is increasingly out of step with the values of its citizens.