Parents, advocates decry bill banning youth gender-affirming care

Overview:

Rebecca Bell and her husband David on Jan. 9 drove from their home in Charleston to the S.C. Statehouse — through what Rebecca described as “torrential downpours” — to testify to a House subcommittee about problems with a bill seeking to ban gender-affirming care for youths.

They were among 47 people, including doctors, advocates and parents, who braved the weather to advocate for transgender children. They opposed House Bill 4624, which, if passed, would ban gender-affirming care for minors and individuals younger than 26 who receive Medicaid. But last week, the House voted largely on party lines to pass the measure that one state senator now calls “institutional discrimination.” The bill, now in the Senate, has been referred to the Senate Medical Affairs Committee where it is expected to get a hearing in the future.

“My initial thoughts were that this bill is another example of the MAGA/GOP wasting critical legislative time on a non-issue,” state Sen. Margie Bright Matthews, D-Colleton, said last week. “When we should be tackling more important educational, infrastructure, insurance and budget issues, the so-called ‘less government control party’ is taking more liberties by forcing ‘big government’ on our families.

“This bill is akin to the outlandish ‘separate bathroom’ bills that have come out of that chamber. What’s next? ‘Tar and feather’ the LGBTQ?”

Doctors say care is “medically necessary”

The American Medical Association, the largest association of physicians and medical students in the country, has labeled gender-affirming care — what this bill is seeking to ban — “medically necessary” based on “an established body of medical research.” But under the House bill, if providers were to offer gender-affirming care, they would risk being referred to the state’s medical board — and potentially having their licenses taken away.

The legislation would also mandate public school employees to reveal students’ gender to parents if it were different from their sex assigned at birth, said Vicki Ringer, director of public affairs for Planned Parenthood South Atlantic (PPSAT), “forcing a teacher to betray the trust of a child.” A transgender student might feel “like they have no one they can talk to, and school needs to be a safe place,” she explained.

And then there’s the risk of an unsafe home environment.

“There are families that would shun their kids, kick them out, possibly cause them harm. We’ve seen it before,” Ringer added.

Bell, the Charleston father, said, at least in his generation, abusive families were all too common.

“Almost every single LGBTQ person I’ve ever met has some kind of trauma from a parent that didn’t love them or didn’t really support them,” David Bell added.

The only person to speak in favor of the bill was not in the room, instead opting to deliver remarks virtually on behalf of the far-right Alliance Defending Freedom — based in Arizona. Ringer said in South Carolina, the ban doesn’t align with the majority of public opinion.

Yet some members of the legislature have made H.B. 4624 their top priority, said Jace Woodrum, executive director of the state’s American Civil Liberties Union of South Carolina (ACLU-SC), adding that it was “taken up by the house on the first day of this year’s legislative session.”

‘Joy returned’

“What we are hearing from parents over and over is, ‘Once my child received gender-affirming care, joy returned,” Ringer said.

Beaufort resident Mary Foster, who also testified at the House subcommittee hearing, told the Charleston City Paper that she always knew something was different as her son, a transgender man, grew up. She said her family waited “for him to have the language to tell us.”

When her son came out as transgender, Foster said she “took him shopping and got new golf shirts and khaki pants. He was so happy. It was like this huge weight had come off of him. And so many people commented on this. People who’d known him his whole life were like, ‘Oh my gosh — his smile!’”

Her son, who is now 20 years old, started testosterone treatment after meeting with a psychiatrist and a months-long wait for an appointment with a pediatric endocrinologist. But that was five years ago, when gender-affirming care wasn’t under attack in South Carolina.

Now, Foster said her state representative – a neighbor who has known her son since he was an infant – recently signed on to be one of the bill’s cosponsors.

The Bells testified that their daughter — who wished to be referred to as Mia for privacy reasons – showed gender nonconformity as early as age 3: “Our daughter screamed at us during tantrums, ‘I would rather die than be a boy.’ She didn’t want to be around men and preferred feminine clothing,”

The Bells said they realized their daughter was transgender around second grade. She started seeing a psychiatrist, a behavioral therapist and a gender therapist as well as a pediatric endocrinologist to monitor potential signs of puberty. She’s always been certain of her gender, David Bell added.

The Bells added that their daughter initiated hormone replacement therapy at 13. In the few years since beginning treatment, her behavior has improved, and she “has blossomed into a beautiful young lady.”

But under H.B. 4624, however, Mia and others could be forced to end treatment by Jan. 31, 2025 – if it passes as proposed.

The bill, however, doesn’t apply to Foster’s son, who is now over 18 years of age.

“I am the lucky one because my kid is safe,” Foster said. “But I’m sitting in that [subcommittee hearing] with parents who are just terrified.” She said another child, her daughter, burst into tears in front of the committee while testifying and having to “beg these people to respect the humanity of her brother.” Foster added, “It’s unbelievable — that this is where we are.”

What’s next

Foster told the City Paper she posted her House committee testimony on Facebook and was inundated by comments of support and love. But opposing this bill — and protecting transgender youth in South Carolina — requires more, she noted.

“We need people to help us fight. We need people to contact their legislators and we need people to show up at the statehouse. I think a lot of people sit at home and feel angry. And that is not enough anymore.”

Advocates are also considering what they’ll do if the bill passes.

According to Woodrum, “We [at the ACLU-SC] would look at the landscape nationally before making any decision. But we would absolutely consider legal action in response to a bill that is so clearly unconstitutional— and so clearly harmful.”

Addressing health myths

“No minor receives gender-affirming care without parental involvement and without counseling. We make sure that they have thoroughly debated it, discussed it, reviewed it and considered all the options,” Ringer said. Planned Parenthood in South Carolina, she explained, currently “provides gender affirming care starting at age 16 with parental involvement. And counseling is a requirement of that.”

Regardless of misinformation spread by legislators, Ringer noted, no doctor is doing gender reassignment surgery on anyone under 18 in the state of South Carolina.

According to the ACLU’s Woodrum, it is already quite difficult to access gender-affirming care in the Palmetto State to begin with.

“It’s very often not covered by insurance. And so you often have to pay out of pocket, and in South Carolina, folks often have to travel sometimes great distances to other parts of the state to find a provider,” he said. “There are many specialists in pediatric endocrinology… but they are largely going to be in Charleston, Columbia and Greenville.”

Woodrum said individuals outside the state are traveling here to receive care, further increasing the demand for treatment options. “All the states around us have banned care … and so there is great pressure on the system right now.”

Ringer said like abortion, gender-affirming care is less accessible to marginalized people. And like the state’s 6-week abortion ban, the proposed bill prohibits “doctors from being able to provide what they would consider the standard of care,” which she said was “deeply disturbing.”

Suicide risk

Advocates noted that the bill, by restricting access to care and stigmatizing transgender youth, might worsen gender dysphoria, defined by the American Psychological Association (APA) as “caused by the body and mind not aligning and/or societal marginalization of gender-variant people.” The APA in 2013 noted that “the presence of gender variance is not the pathology.” Dysphoria, rather, is the distress caused when an individual’s sex does not align with their gender, which might persist without affirming medical treatment.

The experience of gender dysphoria and the depression, anxiety and suicidal thoughts that it can cause in young people is life-threatening, Woodrum said. In fact, after a similar ban went into place in North Carolina, transgender suicide hotline calls doubled. A Seattle-based gender clinic study found that gender-affirming care reduces suicide risk by 73% in transgender youth.

Rebecca Bell said she recently took her daughter to a store to buy snacks, and “we weren’t even asking, and she’s just like, ‘Why don’t they believe me? Why won’t anyone believe me?’

“She said it three or four times: ‘I am me. I know who I am. Why won’t they believe me?’ It broke my heart.

“When your child is hurting, you know, you want to help them.” As a mother, you want to be “telling them some reassuring words that it’s okay. But, yeah, what can we say?”

Foster added, “We are positioning families to potentially lose their children.”