As a highly polarized political debate over medical care for transgender youth has unfolded nationally, Oregon health officials behind the scenes have wrestled with questions about whether providers, insurers and families are getting the best guidance, newly released public records show.
Providers, civil rights advocates, medical experts and others say providing needed care to youths with gender dysphoria in a timely way can be life-saving given high reported rates of suicide and suicidal thoughts.
Such concerns drove Oregon in 2014 to become one of the first states to broadly cover transgender care through its Medicaid program for low-income people, the Oregon Health Plan.
State officials continue to support transgender rights and care. But since at least June 2023, records show, Oregon officials and experts have been quietly discussing questions that have divided the medical community around the U.S. and Europe over how the dominant transgender care guideline affects minors and whether they, their families and providers are receiving relevant information.
The discussion in Oregon serves as a microcosm of global tensions between the methods of evidence-based medicine, which are used to create formal standards to guide care, and the consumer-oriented philosophy embraced by advocates who view barriers as medical gatekeeping that has harmful consequences — for a population already shunned by some providers.
he debate captured by public records took place within an alone-in-the-nation program set up by Oregon lawmakers to advise the Oregon Health Authority and make decisions about health care coverage in public, based on medical evidence.
Members of the state’s Health Evidence Review Commission, known as HERC, sought to apply its standard approach to the issue of youth transgender care. However, HERC collided with contested science and increasingly fraught politics over gender medicine that activists say put the lives of an already vulnerable population at risk.
Public records show the following:
- Questions raised over the predominant guideline for youth gender care caused state-appointed experts to push health authority staff to revisit their earlier endorsement of the guideline to include other guidelines — essentially hedging their support.
- They were responding in part to advocates who obtained a previously unpublished Oregon Health & Science University report prepared for the commission that found questionable evidence for youth transgender care. Following lawmakers’ passage of a law in 2023 to ensure coverage of gender-affirming care, Oregon Health Authority officials halted work on the report.
- Records indicate that Oregon Health Authority leadership have been reluctant to let the discussion about care guidance happen in public, citing potential harm to patients, advocates and providers.
- Attorneys at the state Department of Justice appear to have registered concerns about the care guideline in a confidential memo. Health authority staff cited the memo in May 2024 to warn about “the risks” of a draft state press release highlighting the care guideline in question. For reasons that are unclear, the release was not issued.
The Oregon situation is mirrored on the national scene. In October, the New York Times reported that a $10-million National Institutes of Health-funded review of research on puberty-blocking drugs went unpublished due to concerns it would feed efforts to ban youth transgender care proliferating in red states.
