Statement opposing legislation targeting transgender and gender diverse people

Division 44 Public Policy Committee

The Society for the Psychology of Sexual Orientation and Gender Diversity (Division 44) of the American Psychological Association strongly opposes legislation targeting the health and well-being of transgender and gender diverse (TGD) people. In 2023, anti-transgender legislation has been introduced in the legislatures of 49 of the 50 U.S. states (Trans Legislation Tracker, 2023opens in new window). Dozens of these bills have already been signed into law (ACLU, 2023opens in new window; Trans Legislation Tracker, 2023opens in new window). This onslaught of hundreds of anti-TGD bills is intended to limit or restrict access to gender-affirming care for patients or criminalize providers who provide gender-affirming healthcare (e.g., Mallory et al., 2023opens in new window; Yurcaba, 2023opens in new window). Anti-TGD legislation introduced or passed in state legislatures across the United States also limit access for TGD people to public accommodations (e.g., Brasch & Javaid, 2023opens in new window), restrict participation in educational and extracurricular activities (e.g., Forrest et al., 2023opens in new window), and prevent the exercise of freedom of expression (e.g., Reagan, 2023opens in new window).

Restricting access to care contradicts science and professional expertise

There is no scientific or health justification for legislation which restricts access to gender-affirming care. In fact, the medical and mental health professions support gender-affirming care, recognizing the scientific fact that gender identities are diverse and rigid notions of sex and gender are barriers to good healthcare for all patients (e.g., Coleman et al., 2022opens in new window; American Academy of Pediatrics, 2021opens in new window; American Medical Association, 2021opens in new window; American Psychological Association, 2015opens in new window; American Psychiatric Association, 2020opens in new window; American Psychological Association, 2021opens in new window; National Association of Social Workers, 2023opens in new window). Research has shown that social stigma, prejudice, discrimination, and even violence that TGD people experience, including stigma and discrimination created by anti-transgender laws and policies, creates minority stress processes that are associated with adverse mental and physical health outcomes for TGD people (Horne et al., 2022opens in new window; Redfield et al., 2023opens in new window). Instead of helping TGD people, these laws harm them.

These legislative acts are based in anti-TGD stigma and the politicization of gender-affirming healthcare (c.f. Turban et al., 2021opens in new window; Walch et al., 2020opens in new window). Arguments supporting these legislative acts recast gender diversity and gender-affirming care as baseless “gender ideology,” “extremism,” and even proof of a conspiracy by medical and mental health professionals to convince people they are TGD and/or abuse children. Proponents of these bills argue that they are protecting TGD people from gender-affirming medical and mental healthcare, which they claim is harmful rather than helpful to TGD people. Similar strategies and rhetoric were used by legislators attempting to restrict lesbian, gay, bisexual, and other sexual minority people from enjoying the right to marry the person they love. Division 44 recognized these arguments as based in stigma, not science, and consequently opposed those attempts then (American Psychological Association, 2011opens in new window), just as we oppose the current onslaught of attacks on TGD people as based in stigma, not science, now.

Therefore, APA Division 44 affirms the legitimacy of gender affirming care and stands in strong opposition to attempts by local, state, and federal governmental bodies to misinform the public, interfere in the patient-provider relationship, and infringe upon the rights of TGD people and their families to seek and receive appropriate care and accommodations which evidence indicates is supportive of their health.

Restricting access to care undermines ethical principles

The recent legislative actions banning gender-affirming care undermine ethical principles that guide psychological practice. Specifically, gender-affirming medical and psychological care has been shown to mitigate the negative effects of gender dysphoria, satisfying the ethical principles of Beneficence and Nonmaleficenceopens in new window. Recent legislative policies threaten providers’ ability to engage in beneficent clinical practice and minimize the harmful effects of gender dysphoria, placing psychologists in a compromising position of abiding by law, or following ethical code of conduct benefiting our patients. It is anticipated that lack of access to gender affirming health, and the increasingly hostile anti-transgender rhetoric which fuels these restrictions, will have dire ramifications for the health of TGD people (Holt et al., 2023opens in new window), particularly TGD youth (Redfield et al., 2023opens in new window).

Legislative intrusions into clinical practice that prohibit gender affirming care are inconsistent with the general ethical principle of Integrityopens in new window. The principle of Integrity states that “Psychologists seek to promote accuracy, honesty, and truthfulness in the science, teaching, and practice of psychology” (APA, 2017, p. 3-4). Psychologists who provide truthful, evidence-based information to patients may risk being charged with “aiding and abetting” criminalized medical care. Laws or regulations that cast gender affirming mental health care as “aiding and abetting” could create a conflict between law or governmental regulations and the Ethics Code, which states that “psychologists take reasonable steps to resolve the conflict consistent with the General Principles and Ethical Standards of the Ethics Code” (APA, 2017, p. 4; also see Flynn et al., 2021opens in new window).

Anti-TGD policies are also irreconcilable with the ethical principle of Justiceopens in new window, i.e., the equitable distribution of access to health care (APA, 2017). Geographic disparities in the access to quality medical and mental health care are expected to increase as a result of anti-TGD legislative efforts, further hampering the ability of multiply marginalized and otherwise vulnerable individuals to access needed care (Holt et al., 2023opens in new window; Truszczynski et al., 2022opens in new window). Respect for People’s Rights and Dignityopens in new window affirms “the rights of individuals to privacy, confidentiality, and self-determination,” as well as respect for individual differences including gender identity (APA, 2017, p. 4). Further, psychologists “do not knowingly participate in or condone activities of others based upon…prejudices” (APA, 2017, p. 4). Ethically, therapy clients should have basic rights to self-determination and autonomy, free from the prejudicial views that discourage gender diversity, and access to psychotherapy facilitated by psychologists who understand TGD people (Puckett et al., 2023opens in new window).

Legislative attacks on TGD youth and adults impair and criminalize ethical psychological practice, placing psychologists at risk of conflicts between governmental law and regulation and professional ethics. Therefore, Division 44 stands in strong opposition to restrictions on access to gender affirming healthcare.

Restricting Access to Sports is Discriminatory

Bills that restrict TGD youth’s access to sports are discriminatory, reduce participation in sports, particularly girls’ sports, and contradict the goals of youth sports. Science finds participation in sports results in positive outcomes, such as better grades, greater homework completion, higher educational and occupational aspirations, and improved self-esteem (Darling et al., 2005opens in new window; Fredericks & Eccles, 2006opens in new window; Marsh & Kleitman, 2003opens in new window; Nelson & Gordon-Larsen, 2006opens in new window; Ortega et al., 2008opens in new window; U.S. Department of Health and Human Services, 2008opens in new window). TGD-inclusive policies increase girls’ sports participation (Center for American Progress, 2021opens in new window). Excluding TGD children from sports is discriminatory and psychologically harmful to them. Requiring TGD youth to athletically compete on teams based on their sex assigned at birth is the same as banning them from athletic competition entirely (ACLU, 2020opens in new window). Excluding just some youth from sports runs contrary to the goals of sport. Excluding any subset of youth from sports encourages divisiveness and compromises group cohesion, undermining the benefits all youth deserve from team sports (ACLU, 2020opens in new window).

All youth should have access to these benefits. Denying TGD youth access to these benefits is discrimination. Thus, Division 44 stands in strong opposition to restrictions on TGD youths’ participation in educational activities including in sports.

Efforts to ban or restrict inclusive school curricula cause harm

Efforts to ban or restrict instruction of topics which touch on the experiences of TGD people, including efforts to remove books from school libraries, compound long-standing problems of invisibility and negative representations that harm TGD students and erode the broader school climate. The latest GLSEN National (2020) surveyopens in new window shows less than 20% of schools taught students about lesbian, gay, bisexual, transgender, or queer (LGBTQ+) history, culture, and people; worse, 17% of schools reinforce negative stereotypes about LGBTQ+ people in their curricula, contributing to the stigma of TGD students. GLSEN (2020)opens in new window finds that only 21.4% of Black youth are taught positive representations of LGBTQ+ history, culture, or people at school. The stigma that many TGD youth face at school negatively impacts their education, as TGD students in unsupportive school environments experience greater absenteeism, have higher rates of dropout, and have lower GPAs (GLSEN, 2020)opens in new window.

Offering comprehensive, inclusive education reduces stigma and marginalization of LGBTQ+ youth more broadly, including TGD youth, leading to improved school climates. Students at schools with inclusive education reported hearing fewer slurs, lower levels of victimization, felt safer, missed fewer days of school, and had a higher GPA in comparison to students whose schools did not cover LGBTQ+ topics in education (GLSEN, 2020)opens in new window. TGD students whose schools had inclusive curricula also report feeling safer and more accepted (GLSEN, 2020)opens in new window. And, because it is not just TGD youth who are the target of gender-based bullying (for instance, heterosexual students who are not TGD can also be called anti-gay slurs, teased for being too effeminate or masculine, etc.; Fisher et al., 2012; McCarty-Caplan, 2013opens in new window), inclusive educational environments improve the school climate for all students. Similarly, Snapp et al. (2015) found that LGBTQ+ youth who attend schools which included LGBTQ+ youth in anti-harassment curricula reported lower harassment, less victimization, and felt safer and more supported in their school. And, schools that have implemented inclusive health curricula find that students are subsequently more likely to intervene when witnessing bullying (Baams et al., 2017opens in new window; Proulx et al., 2019opens in new window).

Division 44 stands in strong opposition to anti-TGD restrictions on instruction and/or curriculum and calls on policy makers to support inclusive policies.

Anti-TGD legislation causes harm

Anti-TGD legislation and policies have a host of negative impacts on the lives of youth, adults, families, and communities. These policies lead to individuals losing access to medically necessary and appropriate healthcare, being excluded from school curriculum and sports, being disallowed from public bathrooms and changing rooms which match their gender identity, permitting or requiring teachers to use the incorrect name and pronouns for children and adolescents, and other actions. These actions lead to many serious harms including increased mental health symptoms and distress, feelings of marginalization, decreased school engagement, and poorer health (Dubois et al., 2018opens in new window; Goldberg & Abreu, 2023opens in new window; Horne et al., 2022opens in new window; Perez-Brumer et al., 2015opens in new window; Redfield et al., 2023opens in new window). Additionally, anti-trans stigma has been identified as a driver of violence experienced by TGD communities (James et al., 2016opens in new window). In a recent national survey, 86% of TGD youth reported increased distress due to these anti-transgender bills and the debates around them (Trevor Project, 2023opens in new window). This is particularly concerning because TGD youth were already reporting higher levels of emotional distress and more barriers to accessing care which these latest restrictions, such as gender-affirming care bans and increasingly emboldened and hostile local and societal contexts, will only exacerbate (Abreu et al., 2022opens in new window; Price-Feeney et al., 2020opens in new window). Furthermore, transgender and gender diverse people who experience racism and other marginalizing experiences tend to be even more deeply impacted (James et al., 2016opens in new window; Ryan et al., 2018opens in new window; Trevor Project, 2022opens in new window). These anti-TGD bills add stress, infringe upon TGD people’s rights (American Counseling Association, 2023opens in new window), and further limit the availability of protective resources, putting transgender and gender diverse people at significant risk of harm. Anti-TGD legislation is in sharp contrast to the health-promoting effects of gender-affirming healthcare and other inclusive policies and practices.

Research has clearly demonstrated the safety and effectiveness of gender-affirming care and inclusive policies (Olson et al., 2016opens in new window; Tordoff et al., 2022opens in new window; van der Miesen et al., 2020opens in new window). Public conversations often incorrectly cast gender-affirming care as “new” or “experimental” and therefore do not accurately reflect the careful, rigorous body of research evidence that informs the practice of gender-affirming care (e.g., Swan et al., 2023opens in new window). Rather than rely on anecdotes, we encourage parents, school staff, community members, and elected officials to refer to evidence-based resources to increase their understanding of transgender people and gender-affirming care.

Conclusion

The Society for the Psychology of Sexual Orientation and Gender Diversity (Division 44) of the American Psychological Association stands in strong opposition to the wide range of legislative attacks targeting TGD people’s safety, rights, freedom of expression, and access to care. These legislative attacks increase stigma towards TGD people and LGBTQ+ people more broadly, run contrary to science, and violate ethical principles established in the discipline of psychology. Please see below for additional resources.

Resources

Clinical Education and Training Resources

General

Society for the Psychology of Sexual Orientation and Gender Diversityopens in new window - American Psychological Association Division 44
American Psychological Association LGBTQ Resources and Publications
opens in new window UCSF Center of Excellence for Transgender Healthopens in new window
The National LGBTQIA Health Education Centeropens in new window
A Resource for Incorporating Trans and Gender Diverse Issues into Counseling Psychology Curriculaopens in new window
Guidelines for Psychological Practice With Transgender and Gender Nonconforming Peopleopens in new window
Stanford University - Health Across the Gender Spectrumopens in new window (*Free Course)
Standards of Care for Transgender and Gender Diverse Peopleopens in new window

Youth and Families
A Practitioner's Resource Guide: Helping Families to Support Their LGBT Childrenopens in new window
Providing Services and Supports for Youth who are LGBTQI2-Sopens in new window
Trans Teen and Family Narratives Conversation Toolkitopens in new window

Resources for supporting trans youth in schoolopens in new window from GLSEN

Mental Health Resources

Transgender Crisis and Suicide Prevention
The National Suicide Prevention Lifelineopens in new window at 800-273-TALK (8255)
The Trevor Projectopens in new window - 1-866-488-7386 OR Text START to 678-678
Trans Lifelineopens in new window - 877-565-8860
LGBTQ National Youth Talklineopens in new window - 1-800-246-7743
LGBT National Hotlineopens in new window - 1-888-843-4564

Mental Health

Legal Resources

Community and Advocacy Resources

Community and Advocacy - Youth and Families
Trans Student Educational Resourcesopens in new window
Gender Spectrumopens in new window
Gender Diversityopens in new window
TransFamiliesopens in new window
Trans Youth Family Alliesopens in new window
Trans Youth Equality Federationopens in new window
Human Rights Campaign LGBTQ+ Youth Resourcesopens in new window

Community and Advocacy - General

Harriet Hancock Center Foundationopens in new window - List of Resources for LGBT people in the midlands region of South Carolina
Them.usopens in new window
Black Trans Advocacy Coalitionopens in new window
PFLAGopens in new window
Columbia Gender Identity Programopens in new window
Trans Latina Coalitionopens in new window
GLAADopens in new window

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