Bill Approved to Limit Treatment for Transgender Youth

[J.Adderton]

South Dakota’s House of Representatives approved a bill, on February 29th, that would criminalize physicians who treat transgender children with hormones and sex reassignment surgeries. The Vulnerable Child Protection Act will now be sent to the state’s Senate for a committee hearing. Rep. Fred Deutsch, the bill’s primary sponsor, explains the legislation will protect vulnerable children who “are being chemically castrated, sterilized and surgical mutilated.

South Dakota’s House of Representatives is the first state to pass a bill to restrict medical treatment for trangender teens. However, more than half a dozen state houses are considering similar bills.

House Bill 1057

Under the bill, it would be a Class 1 misdemeanor for a physician to prescribe hormone replacement therapy or perform sex reassignment surgery to youth under the age of 16. This includes:

Performing a mastectomy

• Gender affirming surgery (vasectomy, penectomy, vaginoplasty and others)
• Prescribing, dispensing or administering puberty blocking medication, supraphysiologic doses of testosterone to females and supraphysiologic doses of estrogen to males
• Removing any healthy or non-diseased body part or tissue.

The penalty would be a maximum of 1 year in jail and a fine of $2,000. Nurses would be exempt from prosecution.

The Debate

Republicans and Democrats debate represent a larger culture war with conflicting values, beliefs and practices. The debate is bigger than just the medical issues and extends into parenting and the role of physicians.

Opposition to the Bill

Parents, many members of the medical community and advocates of transgender youths make the following arguments (although there are many more) in opposition to House Bill 1057:

• The bill is a form of discrimination that would withhold life saving treatment
• The bill is unconstitutional and the decision about gender expression should be between the youth, parent and doctor.
• Sex assignment surgeries and are rarely performed on youth
• Puberty blockers, requiring parental consent and extensive counseling, are reversible

Libby Skarin, policy director for the American Civil Liberties Union of South Dakota, issued a statement after the vote, stating “By blocking medical care supported by every major medical association, the legislature is compromising the health of trans youth in dangerous and potentially life-threatening ways.”

A conservative Christian organization, Liberty Counsel, has offered legal counsel to defend bill, at no cost to state taxpayers.

Proponents of the Bill

Lawmakers supporting the bill make debate these points (among others):

• Need to protect youth from making life altering changes until they are old enough to consider all available options
• Too young to understand the potential consequences
• Sex-reassigment surgery and administration in youth are harmful, abusive and criminal acts

The website https://hb1057.com/, promotes Deutsch’s bill and features resources and videos from the Heritage Foundation, the Minnesota Family Council, a Christian organization.

For Thought

In 2018, the American Nurses Association released a position statement, Nursing Advocacy for LGBTQ+ Populations and applied the nursing code of ethics to this population.

Quote

“..nurses must advocate for patient centered treatment, equal access, equal services, and equal resources for all populations that may be adversely affected by bias or prejudice. Nurses have an ethical duty to honor and respect the identities, beliefs, values, and decisions of all patients.”

ANA Position Statement: Nursing Advocacy for LGBTQ+ Populations

How do you think this ethical duty of nursing fits into the debate around limiting transgender healthcare for youth?

Let us hear from you!

[Tweety, BSN, RN]

9 hours ago, KalipsoRed21 said:

I agree that sexuality and gender are solidified in adolescence. I still do not agree, even with the most sure of adolescence, that any healthy pediatric patient should be allowed to under go complex medical procedures for the sake of their appearance. And the excuse that they feel ‘wrong’ in their body and it is ‘more than’ their appearance are still emotional issues more than physiological ones.

Cleft palet, for example, is a deformity that prevents proper nutrition for an infant or child. For the physical health of the child it needs to be fixed. Otherwise I would say that it shouldn’t be fixed until the kid is 18 and can make that decision as an adult. Anything that doesn’t need to be done for the physical health of a child should not be allowed until they are 18.

Well agree to disagree and I respect your opinion. Transgenderism to me isn't an "emotional issue" and I'll leave it at that.

[Tweety, BSN, RN]

7 hours ago, Serhilda said:

......it seems unwise to allow a child to make life-altering decisions potentially based on stereotypes.

It is very unwise. A child, or an adult for that matter, just can't say "I'm in the wrong body, and I want surgery" and then get it. They must undergo months and even years of extensive testing and psychological counseling before any type of therapy is started, never mind surgery. Someone that is just a tom boy female or a feminine boy would not pass the test.

[hppygr8ful, ASN, RN, EMT-I]

1 hour ago, Tweety said:

It is very unwise. A child, or an adult for that matter, just can't say "I'm in the wrong body, and I want surgery" and then get it. They must undergo months and even years of extensive testing and psychological counseling before any type of therapy is started, never mind surgery. Someone that is just a tom boy female or a feminine boy would not pass the test.

I believe this is the concern where young people are concerned - The only person I have ever known personally to have gender affirming surgery went through 4 years of counseling and emotional preparation prior to having the surgery. The teen window is very narrow 13-17 years (4 years) . In my work with adolescents I have seen young people being scheduled for these surgeries with parental consent at 15, far to young to have undergone the counseling we speak of. Now I have met young people who are on hormone suppression to slow expression of secondary sex characteristics(puberty). The idea here being limiting emotional distress while the decision is being made. Still as long as no public funds go to paying for this I feel it's a decision for parents and their teens.

[Jeckrn1, ADN, BSN]

We say someone is not mature enough to buy alcohol, tobacco, firearms until they are 21. Why are they now mature enough to make a decision like this? Don’t get me wrong I am not saying someone should not get this surgery if they feel they really need it but they should have the mental maturity to say yes. What happens when the 17 year old has the surgery then they are 25 and the feel it was a mistake.

[HandsOffMySteth]

On 2/18/2020 at 9:16 AM, Jeckrn1 said:

We say someone is not mature enough to buy alcohol, tobacco, firearms until they are 21. Why are they now mature enough to make a decision like this? Don’t get me wrong I am not saying someone should not get this surgery if they feel they really need it but they should have the mental maturity to say yes. What happens when the 17 year old has the surgery then they are 25 and the feel it was a mistake.

The brain is still developing until around age 21 or so. It is also a well known fact that children have poor decision making skills. Not to mention the hormone therapy that many have attached to the procedure will make schooling very difficult. The odds are against these children having better quality of life and I feel it is often the parents pushing these changes on their children. There is no reason they can't wait for such a procedure. They should be focused on school at that age.

[KalipsoRed21, BSN, RN]

On 2/18/2020 at 8:10 AM, hppygr8ful said:

I believe this is the concern where young people are concerned - The only person I have ever known personally to have gender affirming surgery went through 4 years of counseling and emotional preparation prior to having the surgery. The teen window is very narrow 13-17 years (4 years) . In my work with adolescents I have seen young people being scheduled for these surgeries with parental consent at 15, far to young to have undergone the counseling we speak of. Now I have met young people who are on hormone suppression to slow expression of secondary sex characteristics(puberty). The idea here being limiting emotional distress while the decision is being made. Still as long as no public funds go to paying for this I feel it's a decision for parents and their teens.

I agree with you. If people want to under go this procedure then let the 4-5 years of counseling be done so that on their 18th-19th birthday they can make the decision. No public funds should be used for any of this other than the counseling. I don’t even think that the hormones should be allowed in a healthy kid until they are 18.
I really don’t observe how this issue is any different than a grossly obese teen wanting gastric bypass or sleeve surgery. I am all for counseling for that kid, a nutritionist educator helping with diet, a personal trainer maybe. But it should be hell of illegal for a doctor to preform a bypass surgery on a healthy teen. And really I would say that a grossly obese kid has more physiological health risks to warrant surgical intervention than a kid wishing to change gender. The idea that a transgender teen has more psychological distress due to their body than other teens is just utter nonsense to me. A teen with anorexia is an example of just how dysmorphic other teens can see themselves in relation to their body. Look we would all like it if teens ....and humans in general, were more inclusive and supportive of each other instead of bullying those that are different. But when in all of history has that ever been the case? There is A LOT of healing that goes on learning to accept the parts of you that you hate. Counseling and support groups are great for this, reduce things like teen suicide because these kids have support and comradeship. I am 100% for public funding for such efforts. And when a healthy teen becomes a legal adult, then I am all for them raising money or getting a job to meet their hormone and surgical goals. But I don’t think any medical personnel should be burdened with the ethics of if they should give medicine or preform surgery on a physically healthy kid.

[Tweety, BSN, RN]

2 hours ago, KalipsoRed21 said:

.....a kid wishing to change gender.

I respect you opinion and right to have it, and it seems to be the general consensus of nurses that children need to grow up first before they have any reconstructive surgery or hormone treatment.

However, this kind of makes is sound like it's a choice, that the kid wakes up one day and wants to change gender. This isn't true.

I don't think bringing up a separate issue that affects teens such as anorexia (which by the way is often covered by medicare and insurance plans) is a fair one that's relevant.

[KalipsoRed21, BSN, RN]

22 hours ago, Tweety said:

I respect you opinion and right to have it, and it seems to be the general consensus of nurses that children need to grow up first before they have any reconstructive surgery or hormone treatment.

However, this kind of makes is sound like it's a choice, that the kid wakes up one day and wants to change gender. This isn't true.

I don't think bringing up a separate issue that affects teens such as anorexia (which by the way is often covered by medicare and insurance plans) is a fair one that's relevant.

I don’t believe a kid wakes up one day and wants to change gender. I do believe that this is something they know in their teens or earlier. My uncle, who died in 1989 of AIDS, knew at a young age that he was homosexual. There is no way he would have suffered the crap his parents, and society put him through if he had a choice. I do agree with you that someone who is transgender knows this young. What I don’t agree with is that a young person can fully comprehend the consequences of choosing to have corrective surgery and long term effects of hormone therapy. The future financial ramifications along with the unknown health risks.

”Persons with transsexualism, after sex reassignment, have considerably higher risks for mortality, suicidal behaviour, and psychiatric morbidity than the general population. Our findings suggest that sex reassignment, although alleviating gender dysphoria, may not suffice as treatment for transsexualism, and should inspire improved psychiatric and somatic care after sex reassignment for this patient group.” Long term follow up of Transexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden by Cecilia Dehejne et all.

The conclusion quoted above of this study also tells me the other thing I already knew about sexual reassignment surgery. It doesn’t fix all the issues associated with transgenderisim. Coping, and learning to cope with the conflicts of life are a much more necessary skill to learn in teen years than changing ones body to the correct gender. There is always going to be someone who is intolerant to someone else. The reliance on surgery to fix this lack of inner confidence in who these children see themselves as is a band aid at best. To me it is like saying “Well I can be happy when...”. The point is to make sure they can be “I am satisfied with myself now, I like who I am as I am and can work toward this goal of changing my body to match my sex.” The counseling required to get to this point is far more important than the surgery. But I do agree that eventually it should be covered by insurance. But hell, all of my fertility treatments weren’t covered either. And I wanted a baby probably just as much as someone who wants to change sex probably wishes to have this surgery. Life isn’t fair.

And finally, once more, blurring the lines of ethics by allowing physicians to operate and medicate perfectly healthy, young, and growing bodies is a perversion of medical ethics that endangers a vulnerable group: children.

[Megan1977, MSN, EdD, RN]

On 2/11/2020 at 6:16 PM, ClaraRedheart said:

As a white, I concur. Except whites have been over-represented in healthcare studies as a percentage of the population. 

As a white woman, I concur. Except white MALES have been over-represented in healthcare studies as a percentage of the population.  Women, of any color, have been shamefully absent in many research and pharmaceutical trials.

[Guest856929]

1 hour ago, Megan1977 said:

As a white woman, I concur. Except white MALES have been over-represented in healthcare studies as a percentage of the population.  Women, of any color, have been shamefully absent in many research and pharmaceutical trials.

Women, especially of color, have been shamefully underrepresented in many medical and pharmaceutical studies.

[Tweety, BSN, RN]

On 2/22/2020 at 7:53 AM, KalipsoRed21 said:

I don’t believe a kid wakes up one day and wants to change gender. I do believe that this is something they know in their teens or earlier. My uncle, who died in 1989 of AIDS, knew at a young age that he was homosexual. There is no way he would have suffered the crap his parents, and society put him through if he had a choice. I do agree with you that someone who is transgender knows this young. What I don’t agree with is that a young person can fully comprehend the consequences of choosing to have corrective surgery and long term effects of hormone therapy. The future financial ramifications along with the unknown health risks.

”Persons with transsexualism, after sex reassignment, have considerably higher risks for mortality, suicidal behaviour, and psychiatric morbidity than the general population. Our findings suggest that sex reassignment, although alleviating gender dysphoria, may not suffice as treatment for transsexualism, and should inspire improved psychiatric and somatic care after sex reassignment for this patient group.” Long term follow up of Transexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden by Cecilia Dehejne et all.

The conclusion quoted above of this study also tells me the other thing I already knew about sexual reassignment surgery. It doesn’t fix all the issues associated with transgenderisim. Coping, and learning to cope with the conflicts of life are a much more necessary skill to learn in teen years than changing ones body to the correct gender. There is always going to be someone who is intolerant to someone else. The reliance on surgery to fix this lack of inner confidence in who these children see themselves as is a band aid at best. To me it is like saying “Well I can be happy when...”. The point is to make sure they can be “I am satisfied with myself now, I like who I am as I am and can work toward this goal of changing my body to match my sex.” The counseling required to get to this point is far more important than the surgery. But I do agree that eventually it should be covered by insurance. But hell, all of my fertility treatments weren’t covered either. And I wanted a baby probably just as much as someone who wants to change sex probably wishes to have this surgery. Life isn’t fair.

And finally, once more, blurring the lines of ethics by allowing physicians to operate and medicate perfectly healthy, young, and growing bodies is a perversion of medical ethics that endangers a vulnerable group: children.

Fair enough, and evidenced based, especially if the study you referenced involved the population we are talking about...youth and not adults who transitioned.

Studies also show that affirming and supporting transgendered youth is associated with better outcomes and perhaps the grim statistics in the study you quote might be lessened.

Anyway, we'll just agree to disagree and leave it at that. Thanks!

[KalipsoRed21, BSN, RN]

27 minutes ago, Tweety said:

Fair enough, and evidenced based, especially if the study you referenced involved the population we are talking about...youth and not adults who transitioned.

Studies also show that affirming and supporting transgendered youth is associated with better outcomes and perhaps the grim statistics in the study you quote might be lessened.

Anyway, we'll just agree to disagree and leave it at that. Thanks!

Totally supportive of laws that require public schools and such to be more inclusive of transgendered youth. People should feel validated in who they feel they are as much as possible.

Thank you