UPDATE: On 3/23/2023, Governor Kemp signed Georgia Bill SB140 into law, which bans many forms of gender-affirming care for youth in the state.

On 4/13/2023, the Missouri Attorney General released the text of the “emergency regulation.”  While the AG’s office spoke of the measure previously specifically about youth under 18,  restrictions on the “emergency regulation” apply to people of all ages. This is an unprecedented restriction on the right to gender affirming care for people of all ages. It demonstrates that the goal of current bills is restricting the rights of all transgender folks.

The Missouri regulation discriminates based on disability. It will create barriers to gender affirming care for autistic people and people with mental health disabilities. The regulation requires that medical practitioners do not provide gender affirming care to patients until they have received a “comprehensive screening to determine whether the patient has autism[.]”

This is not a ban on autistic people accessing gender affirming care. However, it will prevent access to care in many cases. 

It is not clear what patients will have to do to meet this screening requirement, but this will likely add cost, difficulty, and delay to what is already an arduous process. Adult autism assessments are incredibly difficult to get. They are not offered in many communities. Where they are, they are expensive and rarely covered by health insurance. Some adults who seek autism assessments are asked to provide information from the people who cared for them in childhood, a barrier for people who have been rejected by transphobic families of origin. The screening requirement will only increase the burden on transgender people of all ages seeking care and make health care providers less likely to prescribe gender-affirming care. 

The regulation may still prevent transgender autistic people who are able to meet this requirement from accessing care in other ways. The regulation also requires providers to keep records regarding a long list of criteria for providing care, including the autism screening requirement. Forcing providers to record that they are knowingly giving gender affirming care to autistic people will make them fearful of providing that care. Some may find pretextual reasons to deny care to autistic patients. Whole health care systems may become concerned about liability and set policies that hold autistic people seeking gender affirming care to higher standards of informed consent than most patients or try to avoid treating this population at all.

This requirement further stigmatizes autism and perpetuates the discriminatory myth that autistic people are “too disabled” to know our own genders. It creates barriers to care that will be insurmountable for many people. The regulation is intended to stop transgender autistic people from accessing gender affirming care, and it will have that effect.

The regulation also discriminates against people with mental health disabilities. It requires “existing mental health comorbidities” to be “resolved” before gender affirming treatment can begin. This is discriminatory because it excludes people with active mental health disabilities from seeking gender affirming care even if they can provide informed consent to treatment for no other reason than that they have disabilities. If providers must certify on pain of legal liability that a patient’s mental health disability is “resolved,” many will be afraid to treat a patient who could have another bout of mental health symptoms later in life even if the patient is not symptomatic at the date of treatment. 

This may discourage anyone who believes they may pursue gender affirming care in the future from seeking mental health treatment even if it would benefit them. This also ignores the fact that experiences of dysphoria and transphobia can cause or exacerbate depression, anxiety, PTSD, and other mental health disabilities. This puts transgender people in the impossible bind of needing to cure mental health disabilities caused by dysphoria or transphobia due to a lack of gender-affirming care -- without being able to access the care that would help resolve their mental health disabilities. As with autism, the record-keeping requirement about mental health history will give pause to individual health care professionals considering offering gender affirming care to transgender people with any record of treatment for mental health disabilities and further stigmatize this population. 

The “emergency regulation” sets a precedent for future laws that restrict the right to gender-affirming care in other states. The Movement Advancement Project reports that, although 14 other states have banned at least some forms of gender-affirming care for transgender youth, Missouri is the first to ban or extremely restrict access to this care for all transgender people. To be clear, any legal ban or restriction on gender-affirming care for anyone of any age is unacceptable. But the Missouri “emergency regulation” shows that the end goal of bans on gender-affirming care for transgender youth is ending gender-affirming care for transgender people of all ages. 

ASAN condemns these and similar laws that seek to deny gender-affirming health care. We will look for opportunities to fight against these restrictions, especially those that use disability as a justification, or that specifically target people with disabilities. We stand with LGBTQ+ community organizations that are working to stop these measures in states.

Original Statement: 

ASAN condemns Georgia Bill SB140 and other attempts to deny gender-affirming health care to autistic people and people with other developmental disabilities and mental health disabilities. ASAN strongly believes that all transgender people should have access to gender-affirming care and is deeply troubled by any use of autism as a justification for transphobic efforts that would create barriers to care.

A bill that has passed the Georgia House and Senate and will likely be signed into law, SB140, cites the fact that transgender people are more likely to be autistic or to have other developmental disabilities as a reason to ban gender-affirming care for all minors. In its first section, the bill includes the line “Gender dysphoria is often comorbid with other mental health and developmental conditions, including autism spectrum disorder.” This is cited as a justification to prohibit certain types of gender-affirming care for people under age 18. LGBTQ+ advocates have asked anyone living in Georgia to urge Governor Kemp to veto the bill. Georgia Equality has provided an online tool to do so, or Georgians can reach Kemp’s office at 404-656-1776.

We see a similar line of thought in a proposed “emergency regulation” in Missouri, which would require providers of gender-affirming care to “ensure that any existing mental health comorbidities of the patient have been treated and resolved” and “ensure that the patient has received a comprehensive screening to determine whether the patient has autism” before providing care. Under this regulation, autistic people and those with mental health disabilities would presumably be barred from receiving gender-affirming care of any kind.

Autistic people are more likely to be LGBTQ+ than non autistic people. We do not know why this is, but ASAN embraces our LGBTQ+ community members. All of our community has the right to be who we are, as autistic people and as LGBTQ+ people. We know who we are, and efforts to claim that we do not know ourselves and our identities – and to deny us care based on who others believe we should be – harm us.

Transgender people are more likely to have mental health disabilities, just as autistic people are more likely to have mental health disabilities. One reason, that has been shown over and over again, is that experiences of transphobia, ableism, and other forms of discrimination cause trauma. This does not change the fact that the gold standard and most effective treatment for gender dysphoria is gender-affirming care, including puberty blockers, hormones, and surgeries. For both autistic and transgender people, society needs to let us people who we are – and ASAN will fight to protect that right.

The Georgia bill, and the proposed Missouri regulation, are component parts of an ongoing state-level onslaught against affirming care for transgender and gender non-conforming children. States have taken actions ranging from banning certain types of medical care such as puberty blockers, to mandating that parents who help their children access gender-affirming care can be investigated for “child abuse.” The goal of these policies is to “eradicate” transgender people from public life by making gender-affirming care impossible to access. The overlap between the autistic and transgender communities makes these policies extremely harmful to the autistic community. ASAN stands against all transphobic policies that seek to criminalize gender-affirming care. We will not allow autism to be used as a justification for these policies, whose only goal is to harm transgender children.

The Autistic Self Advocacy Network seeks to advance the principles of the disability rights movement with regard to autism. ASAN believes that the goal of autism advocacy should be a world in which autistic people enjoy equal access, rights, and opportunities. We work to empower autistic people across the world to take control of our own lives and the future of our common community, and seek to organize the autistic community to ensure our voices are heard in the national conversation about us. Nothing About Us, Without Us!

Autistic Self Advocacy Network

PO Box 66122
Washington, DC 20035

 

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