Update: The South Dakota State Senate killed its version of the bill in committee on February 10. A handful of other states are still considering their own versions of bills that would punish medical professionals from offering gender-confirming care for transgender and nonbinary minors.
Getting puberty blockers wasn’t easy for Quinncy Parke. After first coming out to their parents as gay before they came to terms with being nonbinary, Parke—a high school student in Sioux Falls, South Dakota—had to see a specialized psychiatrist in order to be diagnosed with gender dysphoria. It took at least five long visits before Parke received a referral to an endocrinologist.
Parke and their family met with the endocrinologist several times to discuss treatment options for gender dysphoria, including whether puberty blockers were appropriate. Puberty blockers are a medication that delays the onset of puberty until a young transgender or nonbinary person is old enough to make their own decisions about their lived gender. The drug suppresses the flow of hormones that aid in sex development, and it allows more time for transgender youth to consult with doctors and medical experts about who they are, without permanent changes to their bodies.
Parke was certain that puberty blockers were what they wanted, which meant they had to undergo “all these tests” to move forward with the medication. “I think I got blood drawn, like, three times,” Parke recalled. This may seem like a small thing, but for Parke, this was huge. According to their mother Kim, Parke has absolutely hated needles ever since they were very young. “Quinncy used to hide under the chair when we would go to the doctor to get your normal shots,” Kim said.
A mishap with insurance created yet another roadblock, but finally Parke got their medication after six months of constant hoop-jumping. “Every step was drawn out, and every time it seemed like we had to go through somebody else,” Parke said.
A new bill in South Dakota is poised to make that ordeal even more difficult. Introduced in the legislature on January 14, House Bill 1057 would make it illegal for licensed physicians in the state to provide gender-affirming care for transgender youth; this includes including prescribing puberty blockers or performing medically necessary surgeries in consultation with the patient’s parents and in accordance with existing best standards of care. The charge would be classified as a Class 1 misdemeanor — which could result in a maximum sentence of up to one year in prison and a fine of $2,000.
The South Dakota House of Representatives approved the legislation last Thursday, and H.B. 1057 is expected to receive a hearing in front of the Senate Health and Human Services Committee. It could end up being voted on by the full Senate as soon as next week. Should the GOP-controlled Senate approve the bill, it’s headed to the desk of Republican Gov. Kristi Noem, who has not said whether or not she would sign the bill.
The Movement to Restrict Medical Care to Trans and Nonbinary Minors
If H.B. 1057 passes, South Dakota would be the first state to restrict the type of medical care to trans and nonbinary youth. But South Dakota is not an outlier: According to the LGBTQ advocacy group Freedom for All Americans, at least seven other states have introduced legislation that would either criminalize medical providers or subject them to loss of licensure for providing medication or surgery to treat gender dysphoria for minors. These include Colorado, Florida, Illinois, Oklahoma, and South Carolina. Proposed bills in Missouri and New Hampshire go so far as to classify gender-affirming care as “child abuse.”
Supporters of the legislation say these proposals are necessary to ensure that young people do not make decisions that are too big for them to comprehend. Republican Fred Deutsch, the author of South Dakota’s bill, characterized his legislation as protection from “criminal acts against vulnerable children who are too young to understand the impact.” He also compared gender-affirming surgeries on trans kids to Nazi experiments.
“I’m the son of a Holocaust survivor,” he told the anti-LGBTQ advocacy group Family Research Council in a radio interview. “I’ve had family killed in Auschwitz, and I’ve seen the pictures of the bizarre medical experiments. I don’t want that to happen to our kids. And that’s what’s going on right now.”
This Sort of Care Isn't Just Affirming—It Can Be Life-Saving
Deutsch later apologized for the comments, but opponents of the bill say his remarks exemplify the disinformation being spread about medical care for transgender and nonbinary youth. Research shows trans children know their gender from a very young age, typically between 18 months and three years, said Dr. Colt Meier St. Amand, a licensed psychologist and an adjunct assistant professor at the University of Houston. This is why the American Academy of Pediatrics and several other medical groups support gender-affirming care for trans kids as a safe, effective method of treatment.
“This is a very core, early developmental piece of a person,” St. Amand said. “This is not like when people say, ‘Oh, this is a teenager and everything's a phase.’”
While conducting the research for his 2013 dissertation at the University of Houston, St. Amand surveyed more than 100 people between the ages of 16 and 54 who had recently started taking testosterone and asked if they had any regrets related to their transition. Nearly every single respondent told him there wasn’t anything they would have done differently, except for a small handful who expressed some remorse. When St. Amand followed up to ask the outliers why they felt that way, they said they wished they knew that gender-affirming care was an option for them earlier. One called it the “best decision of his life,” St. Amand said.
Parents with trans and nonbinary kids say having access to medical treatments like puberty blockers is critical for their children’s wellbeing. Debi Jackson, a mother in Kansas City, Missouri, said that her 12-year-old daughter, Avery, cried tears of joy the day she was able to begin taking the medication. “I'm so relieved that I don't have to be afraid to look in the mirror every single day to see if I'm growing facial hair,” Jackson remembered her daughter saying. “I don't have to see if my Adam's apple is growing.”
Jackson said the difference in her daughter was like “night and day.” “The emotional trauma she was going through just in anticipation of puberty and what her body might do was so overwhelming that getting the blockers lifted that weight off her,” she recalled. “The release was beautiful to see.”
Avery has since started hormone therapy to go through puberty with her female peers, and Jackson said she has only continued to blossom. “It's just this confidence about her,” Jackson said. “I know a lot of people are afraid. They think kids at this age aren't mature enough to make these decisions for the rest of their lives, but it really did make her a stronger and more proud person.”
In addition to being a lifeline for kids like Avery, medications like puberty blockers have “been used for decades” to treat gender dysphoria with extremely few side effects, said Dr. Jack Turban, a resident physician in psychiatry at the Massachusetts General Hospital. Among the most common is loss of some bone density, which is why he says that doctors usually recommend after a few years that patients begin medically transitioning by taking prescribed estrogen or testosterone “so that the bones can develop further.” If a young person decides that option isn’t right for them, the blockers can be stopped, and the adolescent would continue developing in accordance with the gender they were assigned at birth.
Turban—who studies the mental health of transgender youth—said studies overwhelmingly indicate the benefits of affirming the gender identity of trans adolescents. In a groundbreaking report published in the journal Pediatrics last month, his team surveyed 20,619 people and found that access to treatment options like puberty blockers greatly reduced an individual’s risk of suicidal ideation.
“In medicine, there is broad consensus that affirming transgender youth results in good mental health and trying to force children to be cisgender results in bad mental health,” Turban said. “Unfortunately, this message doesn’t seem to have made it to all of the state legislators in our country.”
The Outcome in South Dakota Could Have a Serious Ripple-Effect
So while Deutsch insists that his bill intends to protect young people from harm, parents and LGBTQ+ advocates worry these bills would have the opposite effect. Susan Williams, executive director of the youth advocacy group Transformation Project, commissioned a survey earlier this year on the rate of suicidal ideation among trans and nonbinary young people in South Dakota. Nationally, around 40 percent of this population say they have attempted to take their own lives, and in South Dakota, it was even higher: 50 percent. “If [Gov. Roem] signs this bill, it’s pretty obvious that rate will go up,” Williams said .
Even if the bill fails in the Senate, Williams said the legislature’s perennial obsession with trans bodies is still damaging. Last year, South Dakota came perilously close to passing a bill to force transgender student-athletes to play on sports teams in accordance with the gender they were assigned at birth, rather than their lived identity. The legislation died by just one vote in the state Senate. In 2016, former Gov. Dennis Daugaard vetoed an anti-trans bathroom bill after it passed both the state House and Senate.
Williams says these close calls weigh heavily on the young people she works with—including her son, who is 13. “I run the support group for these trans youth and their families,” she said. “We see higher depression and anxiety [during the winter legislative session]. Even my own son, I thought he was holding it together OK, and a few days into [the session], he just broke down sobbing and saying, ‘Why? Why does this happen every year?’”
Jackson said the impact of a bill like South Dakota’s in her home state of Missouri would be devastating. She predicted that preventing doctors from treating trans young people is “going to cause a black market and an underground system” for parents desperate to make sure their children get the care they need. Jackson and her husband have already discussed getting an apartment over state lines in Kansas to avoid being labeled “child abusers” under Missouri’s version of the bill. A charge of child abuse or neglect is a class D felony in her state, punishable by up to seven years in prison.
“We’re really worried about depression kicking in again, as she was so relieved to be able to have puberty blockers and to know that she would be able to have hormone therapy,” Jackson said. “Now all of that is in question again and she almost feels powerless to stop it.”
It’s unclear, for now, what will happen next, but it’s telling that Noem, who said she would have signed the bathroom bill that Daugaard vetoed, has expressed “a few concerns” about HB 1057. “When you take public policy and try to fill parenting gaps with more government, you have to be very careful about the precedent you’re setting,” she told the Argus Leader, a Sioux Falls newspaper, on Friday. “That’s really the viewpoint I’m looking at it through.”
Although Parke won’t be directly affected by the fate of South Dakota’s bill because he’s over the age cutoff, they testified last week before lawmakers to help demystify the fear and misinformation surrounding puberty blockers. If there’s one drawback about the medication, aside from the occasional hot flash, it’s that Parke has to continually confront that nagging fear of needles. Because it’s an injection, not a pill, Parke has to go to the doctor every month to get a shot. The first time Parke received the injection, they recalled “full-on [passing] out on the floor,” but it’s gotten better over time.
During the last doctor’s visit, Parke admitted they jumped a little bit when the needle was being injected, though. “It's not as bad once you get used to it,” Parke said. “I knew it was going to be unpleasant because I hate needles so much. It still is unpleasant, but it’s a second of discomfort for a month’s worth of happiness.”
Parke has been taking the medication for just nearly four months but said they’re already feeling “so much better.” Before beginning treatment, Parke could only go an hour, or maybe two, without experiencing the anxiety and stress that commonly accompany gender dysphoria; now Parke can go days at a time without old feelings resurfacing.
“The emotional change has been noticeable—it's hard to describe,” they said. “My body finally feels like my body.”