The Senate voted Tuesday to require MaineCare reimbursement for “medically necessary treatment for or related to gender dysphoria,” following a similar vote from the House earlier in the week.
Senate Democrats rejected on party lines an amendment that would have ensured coverage for complications related to, or the reversal of, such so-called “gender-affirming care.” House Democrats had killed a similar amendment earlier in the week.
The amendment, introduced by Rep. Katrina Smith (R-Palermo) in the House and Sen. Stacey Guerin (R-Penobscot) in the Senate, would have guaranteed that those who received gender-affirming care would have access to health care for any complications arising from their treatment, as well as to “detransition” procedures if so desired.
Sens. Eric Brakey (R-Androscoggin) and Rick Bennett (R-Oxford), the only Republicans who voted in favor of LD 1040, also supported extending MaineCare to detransition-related services.
Gov. Janet Mills extended MaineCare reimbursement to include puberty blockers, cross-sex hormones, and certain sex change surgeries during her first term in office, so Wednesday’s vote will do little to change current MaineCare policy. However, it does mean that the policy may only be reversed by a future act of the legislature.
The known risks associated with gender-affirming interventions and operations have been increasingly documented by the medical community in recent years.
According to the American College of Cardiology, one such treatment, known as hormone replacement therapy, creates a “substantially increased risk of serious cardiac events, including stroke, heart attack and pulmonary embolism.”
A study cited by the American College of Cardiology found that those experiencing gender dysphoria who had used hormone replacements “saw seven times the risk of ischemic stroke (a blockage in a vessel supplying blood to the brain), nearly six times the risk of ST elevation myocardial infarction (the most serious type of heart attack) and nearly five times the risk of pulmonary embolism (a blockage in an artery in the lung)” when compared to those experiencing gender dysphoria who had not received this kind of treatment.
Another study, published in the peer-reviewed medical journal Metabolism Open, stated that “there are reasons to believe that gender affirming hormone therapy may have important effects on cardiovascular risk and bone health in transgender individuals.”
A 2022 study published in the peer-reviewed journal Innovations in Clinical Neuroscience cites a number of potential complications associated with “gender-affirming” surgeries. Although the study does not explicitly address how likely a given patient is to experience these complications, their analysis shows that they are present nonetheless.
There is also an increasing recognition of the unknowns concerning the long-range health outcomes for those who undergo “gender-affirming care.”
An article published by the American Academy of Pediatrics entitled Ethical Issues in Gender-Affirming Care for Youth stated that while “innovative treatment options” can help to resolve a minor’s gender dysphoria and mitigate many of the short-term side-effects associated with non-treatment, “little is known about the long-term effects of both hormonal and surgical interventions in this population.”
LGBT advocates claim that “detransition” is a rare phenomenon
However, Reuters released an investigative piece late last year exploring the phenomenon of “detransitioning,” with a focus on those who received medical treatment as adolescents.
“No large-scale studies have tracked people who received gender care as adolescents to determine how many remained satisfied with their treatment as they aged and how many eventually regretted transitioning. The studies that have been done have yielded a wide range of findings, and even the most rigorous of them have severe limitations,” the article said. “Some focus on people who began treatment as adults, not adolescents. Some follow patients for only a short period of time, while others lose track of a significant number of patients.”
Dr. Kinnon MacKinnon, a transgender assistant professor of social work at York University, told Reuters “doctors need to provide detransitioners the same supportive care they give to young people to transition, and that they need to inform their patients, especially minors, that detransitioning can occur because gender identity may change.”
The amendment to LD 1040 introduced by Rep. Smith and Sen. Guerin would not have impacted coverage of, or access to, treatment related to an individual’s gender dysphoria. On the contrary, it would have expanded it.
As the law stands now, it remains uncertain whether MaineCare would cover a transgender individual’s expenses should they face complications caused by “gender-affirming care” or if they wish to “detransition.”
“I am very disappointed in the actions the Democrats took today to deny long-term care to the transgender community,” Smith told the Maine Wire.
“It is proven fact that massive complications arise from hormone replacement therapy and sex change operations,” Smith said. “To encourage these practices and then deny help to people when they find themselves in medical crisis is reprehensible.”