In an NBC News Article, “‘Keeps me up at night:’ Doctors who care for transgender minors brace for bans,” Dr. Stephanie Ho explains her fear that her teenage transgender patients will be prevented from receiving their hormone medication by state law.

Dr. Ho is a family medicine physician in Fayetteville, Arkansas and she has been providing gender-affirming care to transgender people in Arkansas since 2015. She is also an abortion provider, so she says she is not unfamiliar with the state restricting the care she can provide.

“I think that it’s kind of ridiculous that we’ve gotten to the point that we’re letting politicians dictate how health care is delivered and what kind of care can be given to whom.”

– Dr. Stephanie Ho

She says that the last time she wants on her mind as she’s providing care for a patient is having a politician standing in the back of her exam room (an experience she says is not unfamiliar to her) making her wonder whether she can legally provide the care she decides is best for her patient. She says that essentially, by influencing her decisions with their presence, the politicians are now practicing medicine without a license — a feat that is disturbing, not to mention incredibly wrong.

At the time of this article’s publication, in June 2021, Arkansas began the first state to pass a ban on transition care for minors. Tennessee was quick to follow suit, with Governor Bill Lee signing a similar bill shortly afterward preventing pre-puberty minors from accessing gender transition care (for example, hormone therapy). According to the Human Rights Campaign, US state legislatures have considered 35 bills/bans of this type that would limit gender transitioning care for transgender-identifying minors.

Physicians like Dr. Ho have noticed quickly that these bans/bills, even before they become law, have negatively impacted their patients health, not to mention require doctors to go against the medical standards of care. If the ban prevented a patient who was assigned male at birth from taking estrogen, that would mean that patient would effectively go through instant menopause. That means a year of hot flashes, night sweats, irritability, and frequent mood changes. For patients assigned female at birth, if they were to stop taking testosterone, they would experience low energy and lack of concentration.

Dr. Ho said that since the bill was passed in one legislative chamber, she’s had one patient attempt suicide. She worries that her patients will now turn to illegal methods to obtain their hormone therapy, and since the law bans her from referring her patients to physicians that might be able to provide them with the same type of care Dr. Ho would no longer be able to give, she feels helpless. She notes that unless her patients were able to leave the state to access their hormone treatments, it’s likely many will be forced to stop.

Not to mention, legally, the bill is forcing doctors to commit a form of malpractice. Section 1557 of the Affordable Care Act protects against discrimination based on sex, and there’s a strong case that Arkansas’s bill violates that section. Currently, Arkansas’s law allows doctors to presubscribe hormone therapy to cisgender teens, but not transgender teens. This implies discrimination based on sexual orientation. Moreover, the bill’s ban on physicians referring their patients to other physicians in different states where it would be legal to provide them with hormone therapy, it a form of malpractice — known as patient abandonment.

Arkansas’s bill has not been fully passed, and the American Civil Rights Liberty Union has filed a lawsuit against the state of Arkansas declaring that Arkansas’s bill on transgender health rights is unconstitutional. But in the meantime, Dr. Ho says that the dangers of this bill “keep [her] up at night” as she worries what the bill’s passing will mean for her patients and her ability to treat them.