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On April 1, 2021, 乌鸦传媒 wrote about laws being considered or passed that affect transgender minors, including laws implementing restrictions on gender transition-related medical care. As part of our review of the year's top stories, we explore what has happened since.

This past year saw a special focus in state legislatures on laws dealing with transgender persons, including bills affecting healthcare and sports participation.

"2021 was the worst year on record for anti-transgender legislation," Desirée Luckey, JD, director of policy at URGE: Unite for Reproductive & Gender Equity, a pro-transgender rights group, said in an email. "With over 100 bills introduced in legislatures across 33 states, most bills focused on regulating athletic participation in public education, access to gender-affirming care, and prohibitions on birth certificate corrections or proper gender markers for ID."

"At URGE, we have been and continue to be concerned about the direction of state legislatures as we head into the 2022 legislative sessions," Luckey said. "None of these laws are about solving problems or protecting the communities that they purport to protect. This is all about policing the bodies of marginalized people."

But others think the bills are a good idea. "We are dead set against ideology running medicine and making medical decisions," said Quentin Van Meter, MD, president of the American College of Pediatricians, which describes itself as a "socially conservative advocacy group of pediatricians" and whose members have testified in favor of some of the state bills. "These are decisions which have significant consequences; it's not just somebody deciding to dress up and then there's no harm. It is people changing their bodies to well-known disease states which will shorten their lives, and from which they cannot escape -- or escape is just so painful."

Van Meter said his group "wants to make sure the mental health issues are taken care of and that nothing permanent is done to anybody before the age of consent." Counseling for the whole family should be mandatory, but this would not be "conversion therapy," which has been widely panned. "It's helping the child learn to survive and to love their biologic body the way it is."

Roger Severino, JD, director of the HHS [Department of Health and Human Services] Accountability Project at the Ethics and Public Policy Center, a right-leaning think tank, cited as positive Texas's against pharmaceutical companies for profiting from selling puberty blockers to minors off-label, allegedly without disclosing the substantial risks.

"The Texas investigation has the potential to break open the entire sordid business of false medical promises being sold to vulnerable kids who are being pushed into ending their ability to ever have kids of their own," Severino, who headed the HHS Office for Civil Rights under President Trump, said in an email.

In Arkansas, the state legislature passed a law in March barring physicians and other clinicians from providing gender-transition-related services to minors, but the law has undergone several twists and turns.

The " states that "a physician or other healthcare professional shall not provide gender transition procedures to any individual under 18 years of age" and also shall not refer anyone under 18 for such services. It was passed by the Arkansas state legislature 70-22 in the House and 28-7 in the Senate, but was vetoed by Gov. Asa Hutchinson (R), it "creates new standards of legislative interference with physicians and parents as they deal with some of the most complex and sensitive matters concerning our youths ... While in some instances the state must act to protect life, the state should not presume to jump into the middle of every medical, human, and ethical issue. This would be -- and is -- a vast government overreach."

The legislature then overrode the governor's veto, and it appeared the law would take effect after all. However, the American Civil Liberties Union (ACLU), which opposes the law, sued to block it on behalf of four transgender youths and their families, as well as two physicians; they alleged that the law violates the Constitution.

"This is who I am, and it's frustrating to know that a place I've lived all my life is treating me like they don't want me here," Dylan Brandt, age 15 and one of the plaintiffs, said in a . "Having access to care means I'm able to be myself, and be healthier and more confident -- physically and mentally."

The ACLU said it is awaiting the scheduling of oral arguments before a federal appeals court in spring 2022.

Although Arkansas is the only state to actually pass a law barring provision of gender transition-related services to minors, other state legislatures are considering such bills. In Ohio, -- which, like the Arkansas law, is also called the SAFE Act, and is currently being considered by a legislative committee in the state House of Representatives -- would prohibit referrals for medicalized treatments for minors with gender dysphoria, would prevent private insurers from having to cover such care for adolescents, and also prohibits public insurers such as Medicaid from providing such coverage.

"This bill is an extreme attack on healthcare for transgender young people," Luckey, of URGE, said in an email.

In addition to the laws on medical care related to gender transition, nine state legislatures have passed a bill which bans transgender students from participating in the school sports teams that match their gender identity, and an executive order similar to those laws was issued in South Dakota.

The ACLU has sued over three of those laws; in two states -- Idaho and West Virginia -- they successfully blocked the laws from taking effect, while the suit in Tennessee is awaiting court action, an ACLU spokesman said.

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