Tennessee Governor Bill Lee signed a bill into law on Thursday that significantly expands the state's authority to collect information about transgender patients and their healthcare providers. The legislation mandates that clinics receiving state funding must submit aggregated data on transgender patients and their doctors, which will be made publicly available.
Details of the New Requirements
Healthcare providers are now required to report the age and sex of patients receiving any form of gender-affirming care, along with the type of procedure, names of drugs, dosages, frequencies, methods of administration, and any diagnoses of mental health or neurological conditions. Clinics must also disclose the name, contact information, and medical specialty of any provider offering gender-affirming care.
Additionally, state-funded clinics that provide gender-affirming care must supply similar information about patients who detransition, meaning those who once sought gender transition but now wish to stop or reverse aspects of it. LGBTQ+ and privacy advocates have condemned the law as a massive invasion of privacy. Although individual patients or clinics will not be directly identified in reports to the state legislature, experts fear that patients and providers remain at risk due to the small size of the transgender population.
First-of-Its-Kind Legislation
This law is the first of its kind in the United States. Its language is heavily based on model legislation from the conservative nonprofit Do No Harm, which has helped pass restrictions on gender-affirming care nationwide. The law's passage signals a growing effort among the conservative anti-trans movement to compel healthcare providers to produce data on patients receiving gender-affirming care, building on previous attempts by the Trump administration and state officials to investigate children's hospitals and clinics treating transgender youth.
Republicans have also implemented policies to support the small number of people who detransition, part of a broader strategy to discredit transgender identity. In Tennessee, access to gender-affirming care for both youth and adults is already limited. Last year, the Supreme Court upheld Tennessee's ban on gender-affirming care for minors in a 6-3 decision, ruling that the law did not violate the equal protection clause. Twenty-seven states have enacted laws banning treatments like puberty blockers and hormone therapy for transgender youth.
Enforcement and Privacy Concerns
Providers who refuse to comply with the new requirements face investigation by state Attorney General Jonathan Skrmetti. In 2022, Skrmetti investigated Vanderbilt University Medical Center after a right-wing media figure targeted its transgender health clinic, leading to the release of patient medical records. Under HIPAA, healthcare providers and insurers are permitted but not required to disclose patient data, and providers typically take a cautious approach.
Miriam Nemeth, executive director of the ACLU of Tennessee, wrote in a letter to Governor Lee that transgender and intersex Tennesseans, especially in less populated areas, risk having their health information revealed due to their gender identity and proximity to their healthcare provider. She warned that the law would create another roadblock for transgender Tennesseans seeking care, as many providers may close out of fear of government targeting. Nemeth described this level of governmental interference as excessive and dangerous, particularly since it applies only to gender-affirming care and not to other medical conditions.
Legislative Adjustments and Rationale
Republicans removed an earlier requirement that would have forced providers to note the county of residence of patients receiving gender-affirming care. State Rep. Jeremey Faison and state Sen. Brent Taylor, the sponsors, eliminated this provision after meeting with protesters concerned about HIPAA rights. Faison and Taylor argued that the bill is necessary for public transparency about the number of people who detransition.
Taylor stated at a recent Senate meeting, "What about the poor folks that took up this transition nonsense, and they transitioned to a sex or a gender that they thought would solve their problem, and they just want to be left alone? They want to be able to go back to their birth gender." He added, "The party that is always for universal healthcare and for choice... they’re for choice, but only one way."
Broader Context of Anti-Trans Legislation
Since 2020, state legislatures have enacted dozens of laws restricting transgender people's access to healthcare, sports, bathrooms, and the ability to update identity documents, as well as limiting LGBTQ+ themes in federally funded schools and universities. In recent months, Republican-led states have passed further encroaching policies. Idaho passed a law criminalizing transgender people for using bathrooms aligned with their gender identity, even in private businesses. Kansas invalidated 1,700 transgender people's driver's licenses overnight without notice.
