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What LGBTQ community, allies say are 'misconceptions' about transgender care

Several bills rolling through the Alabama legislature have negative impacts on the lives and mental well-being of the state's transgender community.

HUNTSVILLE, Ala. — Multiple bills currently making their way through the Alabama legislature could negatively affect the lives of Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ) people across the state. Though none have been signed into law at this juncture, there are concerns from that community about the future, plus misconceptions regarding these groups that the bills aren't helping.

"I love my state," said Beck Boggs, who identifies as a non-binary, androgynous lesbian. "I wish my state loved me back," they added.

Psychologist Sarah Mulder considers herself an ally to the LGBTQ community. "I would estimate roughly 85-90 percent of my caseload is LGBTQ+," she said.

Mulder has particular expertise in gender-affirming care, one of the topics singled out in the recent swath of proposed laws. She says it's normal for the legislation to come up in discussion with her clients.

She says most of what she hears from them is "a lot of anger, a lot of feelings of powerlessness, extreme anxiety and fear."

"It feels like the legislation that has come through has really impacted the morale of the LGBT community," Boggs added.

Currently under consideration in Montgomery is House Bill 401. If passed, it would add Alabama to the growing list of states attempting an outright ban on drag performances in public. It was introduced by six legislators from central and north Alabama who want to label such performances as "obscene."

"How do you cognitively define what a woman is or what it is to be a performer, an entertainer?" Boggs argued. "I've been in theater all my life. If I'm wearing makeup and performing in the role of a woman who's performing as a man, what does that mean? Is that drag? Is that banned?"

"So many of my clients are deeply afraid of how that law may be enacted in practice," said Mulder. "A client who dresses and affirms herself femininely but was assigned male at birth, is she going to be considered doing drag if she is out and going to a restaurant or walking down the street?"

Another bill focuses on limiting access to gender-affirming care, especially to younger people - a talking point that Mulder says has developed from a misconception that young children are receiving it at all.

According to the Association of American Medical Colleges, the term "gender-affirming care" is a collective name for services that can include medical, surgical, mental health, and non-medical treatments for people who are transgender and/or nonbinary.

The biggest misconception, Mulder said, is that this care, in particular, surgical treatments - are easy to access.

"There's a perception that somebody could just walk into their physician's office and walk out with a prescription for hormones or be signed up for surgery the next day. And that's simply not true."

In order to obtain surgery, which is considered the last step in transitioning, a person must first go through many rounds of therapy sessions.

"On average, by the time folks are receiving a prescription or going in for surgery, they've met anywhere from 2 to 3 doctoral level health professionals with expertise in the area  who are evaluating them, who are making sure that this is a safe and appropriate decision for their health care at this time," said Mulder.

Another misconception, she said, is that surgical treatment is allowed in adolescents.

"What is often touted, because it's so sensationalist in the media, is that kids are getting mutilated or having surgery, and that is simply not true."

In April 2022, Gov. Kay Ivey signed Alabama Senate Bill 184 into law, which prevents minors from receiving gender-affirming care - including puberty blockers, hormone therapy, and surgical intervention. However, Mulder pointed out, doctors do not perform this type of surgery on adolescents to begin with.

"Surgeons are not going to put a child down for surgery before their body is finished developing," she reiterated. "In general, the age is about 18 or 19 before surgeons [and] affirming providers are going to be considering gender-confirming surgery as an appropriate option."

In lay terms, a transgender minor, even with consent of the parent, will not receive gender-affirming surgery anywhere in the United States.

As Mulder and Boggs want to make clear, they say members of the LGBTQ community are just like everyone else, in that, "they want to raise their families. they want to go to school," Mulder said. "They want to be able to have family photos on their desks and to proudly talk about and live their lives just like anybody else."

"I want to eventually go back to school and get my master's," Boggs said, "take my kid to school in the mornings and drop him off. 

"I'm just a normal person."


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