Widely used medical provider Kaiser Permanente is facing a federal lawsuit for providing gender-affirming surgery to 13-year-old Chloe Cole. According to NBC Bay Area, this lawsuit was filed by Cole and her family with the San Joaquin Superior Court.

Cole, who is now 18, de-transitioned back to her gender assigned at birth. However, according to the Los Angeles Times, she was unable to go “all the way back” because of her double mastectomy and hormone treatment. Both Cole and her lawyers claim that Kaiser performed the surgery prior to focusing on Cole’s mental health or concerns of gender dysphoria at the time. 

Cole’s lawsuits against Kaiser have brought up the larger question of what age it is appropriate for medical providers to administer hormone therapy and gender-affirming surgeries to youth. 

This could also affect the accessibility of gender-affirming health care, such as accessibility instated by healthcare acts like the Inclusive Care Act. California passed the Inclusive Care Act in early January, which increases the quality of healthcare for transgender, gender diverse and intersex (TGI) people. 

The act requires health plans and insurance companies in California to provide TGI competency training to staff by early 2025, and it also requires Physician Continuing Medical Education (CME), to include the same type of training. 

According to California Senator Scott Weiner’s website, the competency training must be facilitated by TGI-led organizations. 

Chapman University freshman Amelia Bayha, who is majoring in applied human physiology, spoke on the expectations and standards that healthcare providers often have for patients, excluding gender-diverse people.

“As a queer, gender nonconforming person, doctors' visits have not always been comfortable,” Bayha said. “As gender and sexuality are a spectrum, it can be hard to openly communicate your needs if they don’t fit black and white societal standards. There should be no fear in seeking help for your own health, and the relationship between TGI individuals and the current healthcare system is one of fear and ignorance.”

According to the National Health Law Program, along with the extra training of medical professionals, health plans and insurance companies must also include gender-affirming services in their Network directories, which would provide TGI people with resources and information on specialized healthcare. 

Gov. Gavin Newsom’s willingness to sign the Inclusive Care Act into law back in January sets California apart from other states that have made steps in the opposite direction, leaving gender-affirming health care more accessible in the state of California. 

Arkansas, Tennessee, Arizona and Alabama have passed laws that restrict gender-affirming healthcare, with various other states considering doing the same. 

When it comes specifically to gender transitioning healthcare, Bayha said that treatment should depend on individual patients and their experiences. 

“As someone who doesn’t plan on transitioning, it’s hard to know what age it is appropriate,” Bayha said. “I think gender transitioning services should always be provided at a time safest for the patient. The argument against early treatment I’ve always heard is that the patient may regret transitioning, but this can be eliminated with proper patient selection.” 

Eric Chier, a junior at Chapman studying computer science, said that TGI people can face a disrespect of privacy in healthcare.

“My identity and expression, though queer, do not impact my healthcare needs,” Chier said. “Answering from basic understanding of the community, I think that the biggest hurdles for TGI folks seeking healthcare is a lack of confidentiality, excluding care to those who are not publicly ‘out.’”

Chier believes that education is key for granting effective healthcare to diverse populations.

“The most impactful aspect of the Inclusive Care Act is educating healthcare providers,” Chier said. “A good portion, if not the majority, of the healthcare providers who claim that they are unwilling to provide inclusive healthcare make this claim because of a lack of expertise in the field, not because of an unwillingness to serve TGI patients. By removing fear of malpractice, I feel that more patients will be served and served properly.”

According to Bayha, the Inclusive Care Act would also help to create a more diverse-friendly medical environment.

“To best support queer or trans teens, health professionals need comprehensive education on gender identity and expression,” Bayha said. “The Inclusive Care Act makes sure TGI people see healthcare providers who honor their bodily autonomy and provide gender-affirming care regardless of cultural bias.”