Alaska’s Medical Board Moves to Ban Gender-Affirming Care for Trans Minors

Board members were dodgy when asked about their expertise on trans medical issues.

Providence Medical Center // Wikimedia Commons // Wonderlane

An Alaskan podiatrist is leading the State Medical Board’s efforts to take away life-saving health care from transgender youth.

The Board unanimously approved a proposal last week spearheaded by Dr. Matt Heilala, of Anchorage, to move towards eradicating gender-affirming health care for trans minors by reclassifying such treatments—such as puberty blockers, hormone treatments and surgeries—as “unprofessional conduct.” If finalized, this would also give the board broad discretion over the enforcement and “sanctions” doled out, such as fines or loss of licensure. No such restrictions are proposed for the care of cisgender people.

The rule must still undergo a legal review followed by a 30-day public comment period, after which a final vote would determine whether the provision will be enacted.

“I think it will be pretty impactful,” Heilala told the Anchorage Daily News ahead of the vote. Heilala, a podiatrist, does not appear to have any clinical expertise in treating gender dysphoria. It is unclear whether the other five board members do, either. When Erin in the Morning requested information about whether any of the Board members—a general surgeon, a neurosurgeon, a cardiologist, a primary care physician, and a commercial pilot—had any experience serving trans patients, or had any professional training on gender dysphoria at all, a spokesperson declined to disclose due to “concerns with HIPAA.”

However, HIPAA, the gold standard of federal privacy law, does not prevent doctors from disclosing the demographics or diagnoses they have worked with.

“I think it’s very important that we, as medical professionals, can address and talk about what our professional expertise and experience is,” said Dr. Kevin Tarlow, a psychologist and assistant professor at the University of Alaska Anchorage. “How else can consumers evaluate our expertise if we can't talk about the types of care that we have provided?”

Almost 800 medical professionals in the state have signed a petition protesting the proposed restrictions.

“What I see is a very small number of political appointees who happen to be physicians, going against the consensus of the professions they're supposed to represent and regulate,” Tarlow added.

It’s not the first time Heilala and this Board have attempted to roll back Alaskans’ access to health care. Earlier this year, with Heilala as the legislative liaison, the Board urged legislators to ban most gender-affirming care for trans youth, treatment that fewer than 100 Alaskans across the state receive. (Heilala also recently announced his gubernatorial campaign, where July polls had him coming in sixth.)

When democratically-elected lawmakers didn’t pick up the offer, the Board decided to take matters into its own hands, with Heilala once again at the helm.

“[T]he Board is now going rogue—attempting to reclassify evidence-based treatment through a political maneuver,” said a press release from Identity, Inc., an LGBT health care provider and advocacy group, in the days leading up to the August 22 vote. “In the same discussion, the Board also moved to target abortion access, revealing a broader ideological agenda, not legitimate medical oversight.”

Ann, an Anchorage mother to a trans young person that had to leave the state, pointed to the state’s historic preservation of Alaskans’ right to privacy. (She requested her surname be withheld from publication due to the violent threats parents of trans kids are facing.)

“Alaska prides itself on its independence—like, the government staying out of our business,” Ann told Erin in the Morning. “I don't understand this slide into government and political interference for what can be the most personal issue for families and their medical providers.”

The current proposal draft states that the board will sanction physicians found to be “providing medical or surgical intervention to treat gender dysphoria or facilitate gender transition by altering sex characteristics inconsistent with the biological sex at birth, including but not limited to puberty blockers, cross-sex hormones, mastectomy, phalloplasty, or genital modification to a minor under the age of 18 years old.”

As with many anti-trans provisions, it glosses over the immense obstacles already standing between trans people’s access to care; suggests a misleading frequency of certain kinds of procedures, such as a phalloplasty, and carves out exceptions for the often invasive and needless medical interventions used on cisgender intersex children.

It also seeks to codify, within board guidelines, a definition of sex.

"Biological Sex,” the draft reads, is a “male or female designation based on chromosomes, gonads, hormones, and genitals at birth, irrespective of psychological identity.”

"Gender Transition," meanwhile, is “[a]ny process to align sex characteristics with a gender identity different from biological sex.”

Frequent Erin in the Morning readers may recognize the common mistakes with these definitions: They are highly unscientific, right-wing abstractions about notions of biological sex that don’t actually neatly exist. And they are certainly not recognized by major global medical organizations.

Instead, most every major medical association—including the American Academy of Pediatrics, the World Professional Association for Transgender Health, the Endocrine Society, and the American Medical Association—recognizes trans kids’ need for affirming health care. In response to this fact, Board Chairman Brent Taylor told Erin in the Morning that other countries, like Sweden or Britain, have “severely curtailed” health care for transgender people, a claim which Erin in the Morning previously found to be “thoroughly outdated” as “several European nations have moved in the opposite direction.”

He did not cite any particular studies in his statement, nor did the resolution the board passed. Almost 80 people attended the virtual hearing. Alaskans begged the bureaucrats not to interfere. Health care professionals, trans people, and the parents of trans youth showed up to hold the line. One speaker said he was a medical student who took time off from his rotation in pediatrics to advocate for reproductive health care. Another attendee simply sat behind a blank screen, camera and mic off, with the screen name: “Shame on you all.”

“We already are in such a crisis in Alaska and that the state medical Board is taking action that's one, not addressing that, and two, knowingly doing things that all the data suggests will make it worse,” Ann said after the hearing.

Indeed, mounting economic crises, skyrocketing care costs, and a dire shortage of health care providers means many Alaskans already do not get the care they need.

Tom Pittman, executive director of Identity, Inc., said in a press release that they would not capitulate to demands that seek to eradicate life-saving for trans youth. “We will continue delivering that care, and we will not back down from defending the right of Alaska’s families and providers to make these decisions free from political interference,” he said. “Our commitment is unwavering: to protect care, defend truth, and stand with trans youth.”