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Why Republicans are suddenly in a rush to regulate every trans kid’s puberty

Proposals in eight states would ban puberty blockers and hormones for trans minors.

Trans pride SOPA Images via Getty Images

Greyson was already menstruating when he started taking puberty blockers at age 12, so when he stopped getting his period because of the drug, he was “over-the-moon happy.” His mother, Lauren Rodriguez, worried about the risks she read about online, specifically loss of bone density. However, after further reading, she learned that the side effect pops up only after long-term use, or about seven to 10 years — and most trans kids take blockers for just a year or two. In the year and a half Greyson was on them, the most difficult side effect he faced was hot flashes.

Before his transition, Greyson was on antidepressants just to deal with his dysphoria, Rodriguez said. “If I had known what was making my ‘daughter’ at the time so unhappy, I would have done it at 3, which is just a social transition,” she said, referring to respecting transgender kids’ chosen names, pronouns, and style of dress, without any medical interventions before puberty.

Deciding whether to allow a trans adolescent to go on puberty blockers is a decision most parents don’t take lightly. They often talk to doctors and psychologists, and the general guidelines of most major American medical associations recommend affirming a child’s gender exploration in order to improve their mental health. Transitioning is a slow, deliberative process for minors, and only adolescents who are insistent, persistent, and consistent in their gender identity over long periods are recommended for medical intervention.

However, some conservative politicians want to take that decision out of the hands of doctors and parents who know these teens best — and put it in the hands of the state. In fact, in Greyson’s home state of Texas, lawmakers have promised to introduce legislation that would essentially ban, midway, his medical transitioning once their next legislative session begins in 2021.

Eight state legislatures — including Missouri, Florida, Illinois, Oklahoma, Colorado, South Carolina, Kentucky, and South Dakota — have already introduced bills this year that would criminally punish doctors who follow best practices for treating adolescents with gender dysphoria. In South Dakota, for example, doctors who prescribe puberty blockers or cross-sex hormones could face a $2,000 fine and a year in prison under the proposed law. South Dakota’s version of the bill was even prioritized and became the first bill of the decade to pass out of committee. On Wednesday, it passed the House in a 46-23 vote.

Lawmakers in Texas, Utah, and Georgia have promised to introduce similar bills once their legislative sessions begin. And while a New Hampshire bill wouldn’t criminalize doctors, it would classify gender-affirming care for minors as child abuse.

In other words, should any of the bills become law, they would effectively cut off many adolescents from medically necessary and, often, lifesaving treatment for gender dysphoria. There are approximately 150,000 transgender youth between the ages of 13 and 17 in the United States, according to the Williams Institute at the UCLA School of Law, and studies show that kids in Gen Z identify as more queer and trans than previous generations. A 2018 study found that the risk of developing a mental health condition was three to 13 times higher for transgender and gender-diverse youth than for their cisgender peers.

“The crisis that trans youth are facing right now is not a hypothetical,” said Gillian Branstetter, a spokesperson for the National Women’s Law Center. “It is real and it is well-documented and it is extremely severe. Efforts to limit the very solutions to that crisis are ignorant in the extreme and are a dangerous manifestation of rank partisanship and political opportunism.”

Bills banning trans care for kids are the new bathroom bills, part of conservatives’ larger culture war against trans people. Conservative media and politicians have been fanning the flames for this fight for years in hopes of rallying the base over a nonexistent threat — a threat that only puts trans lives, like Greyson’s, in danger.

What spurred the latest trend in anti-trans laws

The recent conservative push for an outright ban on transition care for minors grew directly from the social media disinformation campaign surrounding Luna Younger, a 7-year-old trans girl from Dallas caught in the middle of a bitter custody battle between parents who disagree over her gender identity. A Texas judge overruled a jury decision to award full custody of Luna to her mother, Anne Georgulas, in late September. That means Luna’s father, Jeffrey Younger, who insists on dressing his child as a boy and forced her to cut her hair, has an equal say in future medical decisions for Luna.

Driving the conversation about the case were primarily conservative media outlets. In the week following the initial jury decision, 23 conservative news sites published 55 stories about Younger, and all opposed the child’s transition. According to data from Media Matters, those 55 stories earned 3.5 million Facebook interactions.

People were so riled up online that some sent threats to Georgulas; she was “viciously attacked and threatened by complete strangers,” her attorneys told the Daily Caller. Several prominent Texas officials even added to the fray: Republican Gov. Greg Abbott promised to order the Texas Department of Family and Protective Services to investigate Georgulas. State Rep. Steve Toth said he would propose legislation to “add ‘transitioning of a minor’ as child abuse.” A version of the bill is expected on the Texas docket when the legislature reconvenes next year.

It didn’t take but a few months for this groundswell of conservative opposition to spur the introduction of legislation seeking to ban the medical transitioning of minors altogether.

While South Dakota’s bill would threaten doctors with prison time, states like Missouri are taking a different tack. That state’s bill would automatically report any parent who affirms their child’s trans identity with medical care to Child Protective Services for child abuse, and any doctors found to be dispensing blockers or hormones to minors would have their medical licenses revoked.

Kentucky’s bill, which was introduced on Tuesday, goes well beyond those of Missouri and South Dakota: It would allow either parent to override consent for transition care, a right which the state cannot overrule; it would require all government agents to disclose to parents whether a child expresses gender dysphoria or gender-variant behavior; and it would protect the right of any government employee, including teachers, to express their views on gender identity, including misgendering or harassing transgender students. Additionally, any adult (or minor with parent or guardian permission) who had previously been given transition care would be allowed to sue doctors for damages for the next 20 years.

Because the bills don’t stop at banning puberty blockers, a second South Dakota bill introduced Tuesday would require any teacher, school psychologist, or social worker to out any students they suspect may be suffering from gender dysphoria to the student’s parents. And let’s not forget the bills targeting trans school sports participation.

The anti-trans fight has moved from bathroom access to legislating over children’s bodies. With so many bills in process, LGBTQ advocates worry that the passage of one could trigger passage of the rest, casting the progress of trans children back at least half a century.

There is an abundance of misinformation on how trans children are medically treated in adolescence

Confusion and misinformation are rampant in the debate over treating transgender adolescents. While many conservatives falsely claim that doctors are performing genital surgeries on children, a more nuanced conversation is actually taking place between young teens, doctors, and parents.

“Children often have a clear sense of their gender identity as young as three or four years old. However, no medical intervention occurs for younger children, and the best practice is to provide psychological and social affirmation until very early puberty,” Dr. Alex Keuroghlian, director of the National LGBT Health Education Center at the Fenway Institute and director of the Massachusetts General Hospital Psychiatry Gender Identity Program, told Vox. “Once a child reaches the cusp of puberty, whether they desire and access pubertal suppression or not, psychosocial gender affirmation by family and peers through adolescence and adulthood remains critical for good mental health outcomes.”

Once adolescents reach ages 9 to 14, puberty blockers can be a tool to prevent permanent changes from natal puberty from taking place so that can become more mentally mature before deciding the course of their permanent treatment.

“Blockers put puberty on hold so that adolescents have more time to decide what to do next. Without them, the adolescent will have physical changes that are difficult if not impossible to reverse. Often, it requires surgery to undo these changes down the line,” Dr. Jack Turban, resident physician in psychiatry at the Massachusetts General Hospital, where he researches the mental health of transgender youth, told Vox.

However, ultraconservatives and trans-exclusionary radical feminists, along with some extreme sexologists, have other ideas for those children’s futures, lobbying to ban puberty blockers and cross-sex hormones for all minors. While the proposed bills are new, the ideology behind them is old. Bill proponents appeal to the fallacy that natal puberty is natural and therefore necessary for all kids.

But this approach would force trans girls into male puberty and trans boys into female puberty without their consent, and brings along its own permanent changes, which could partially be reversed only with painful and expensive medical treatments in adulthood. Trans women forced through male puberty would have to undergo electrolysis to remove facial hair and may be left with a body frame (shoulder and hip width) that would be unchangeable surgically. Trans men would have to have surgery to remove their breasts and, like trans women, be forced to live in an unwanted body frame for their entire lives.

Those permanent changes were discussed between Rodriguez, her son, and her son’s doctor before he started testosterone, the hormone taken by transmasculine people as part of their medical transition. “‘If we start this, the changes are permanent,’” Rodriguez recalled the doctor saying. “‘Once you have a beard, you have a beard. Once you have a mustache, mustache. Once your voice drops, your voice drops. There’s no going back to it.’ And everything he said, Grey was like, ‘Yes, let’s do it.’”

So many conservative arguments against trans rights deploy the specter of “big, scary” trans women’s bodies in female spaces — which was the crux of the bathroom bills and the latest push against trans athletes. Trans girls who receive early support through puberty blockers and eventual cross-sex hormones end up with normal female body and bone development, making their bodies much less easily marked for social exclusion and poking a hole in conservative scaremongering against trans rights.

With their legislation, conservative lawmakers are removing parents’ and kids’ choices altogether, forcing their own political ideology on the medical choices of private citizens.

The South Dakota bill has even received out-of-state help. It’s being pushed by a small coalition of conservative special interest groups, with activists and doctors from as far away as Seattle and California testifying mostly via video. The bill’s original sponsor, Rep. Fred Deutsch, also attended an anti-trans conference hosted by the conservative Heritage Foundation titled “Summit on Protecting Children From Sexualization” in October, according to the Washington Post. (When Vox contact the Heritage Foundation about its involvement in the legislation, the foundation sent a link to an article co-written by a Heritage research fellow in defense of prohibiting the “physical interventions on the bodies of children to ‘affirm’ their ‘gender identity.’” Deutsch has not returned Vox’s request for comment.)

Meanwhile, local South Dakota doctors and medical experts have been testifying against the bill. Public health researcher Michaela Seiber pointed out that much of the research Deutsch presented actually supports affirming care for gender-diverse youth.

“I was curious about what studies he was actually using to support all of this stuff, but when I started diving into them, they were actually from publications that I think he should have realized were very anti what he’s trying to promote,” Seiber told Vox.

According to Seiber, Deutsch cherry-picked rare potential side effects of puberty blockers from safety studies and presented them as if every youth who goes on blockers will experience them. “He made mistakes that undergrads might not even do anymore, just picking out little pieces out of context and using as his support.”

These laws could mean a matter of life or death for trans kids

The political fight has worried young trans people across the country who depend on their medication to keep their gender dysphoria at bay. According to data from the Trevor Project, 76 percent of LGBTQ youth felt that the recent political climate impacted their mental health or sense of self. Over the past year, the Trevor Project has supported more than 150 LGBTQ youth in crisis in South Dakota.

“They’re using transgender youth as political pawns to advance a particular agenda,” said Alexis Chavez, medical director at the Trevor Project, referring to conservative politicians. “They’re advancing it under the guise that they’re doing what’s best for the youth, but they’re not basing it on any evidence. They’re not basing it on clinical best practices. They’re not using providers who are working day to day with these youth to make these laws. It’s really unfortunate because they’re targeting some of the most vulnerable population.”

Compiled by the Trevor Project in a research brief, study after study has shown that affirming trans and gender-diverse kids in their self-exploration improves mental health and lowers suicide risk. The affirming model, which allows children to explore their gender identities at their own pace and can include puberty blockers, has been recommended by nearly every major American medical association, including the American Academy of Pediatrics, the American Medical Association, the American Psychological Association, the Endocrine Society, the World Professional Association for Transgender Health, and the American College of Obstetricians and Gynecologists.

“What is most important is for a parent to listen, respect, and support their child’s self-expressed identity. This encourages open conversations that may be difficult but [are] key to the child’s mental health and the family’s resilience and well-being,” wrote Jason Rafferty, a pediatrician and child psychiatrist at Hasbro Children’s Hospital in Providence, Rhode Island, and a professor at Brown University, in a key American Academy of Pediatrics policy statement in 2018.

The effects of supporting a trans child can also be lifesaving. Late last week, new analysis from a group of researchers who specialize in studying trans youth found that access to puberty blockers significantly lowers lifetime suicidality in trans people.

That’s the biggest concern for mothers like Rodriguez. “He’d kill himself,” she replied when asked how her son would react if the state took his hormones away. “He’s already flat-out said that.”

Conservatives in Texas have prioritized anti-trans legislation in each of the last three sessions, including trying and failing to pass a statewide bathroom bill in 2018. Should the legislature enact a ban on hormone blockers and other medical treatment for gender dysphoria, Rodriguez says she’d have no choice but to pick up and move out of state.

“I will have to sell my house; I will have to quit the job at the nonprofit that I love,” she said. “But we’re going to have to go to a more affirming state. I can’t expect my child to thrive and continue to live if [they] pass this.”

While some families with trans kids may be able to afford to leave the state, others may be forced to find medical solutions across state lines, and still others will have no choice but to abruptly stop their medical transitions entirely.

According to Branstetter, conservatives pushing these bans need to be prepared for the worst possible outcome. “Is Rep. Deutsch ready to host in his office the first family that is forced to bury their 12-year-old because he wanted to be a hero in right-wing media?”

The state now threatens to insert itself into the most basic decisions of body and identity, all to drive a handful of votes from the conservative base to win in an election year. Lost in the conservative rush to tamp down the trans rights movement are the very real lives of trans kids who simply want to transition and move on to adulthood.