Montana not the only state targeting transgender health care

Lawmakers say they don't want children making decisions they'll regret, but many of the procedures being banned are considered reversible.
Rep. Zooey Zephyr, right, looks on as members of the Montana House of Representatives recite The Pledge of Allegiance.
Posted at 1:57 PM, Apr 27, 2023

In March, Montana joined a list of states that ban gender-affirming care to transgender youth. The legislation prompted a Montana lawmaker to tell supporters of the bill, “I hope the next time there's an invocation when you bow your heads in prayer, you see the blood on your hands.”

Montana State Rep. Zooey Zephyr, a transgender Democrat, was ultimately censured for the comments on Wednesday. Zephyr is no longer able to enter House chambers and is forced to vote remotely. 

Republican lawmakers claimed Zephyr violated the chamber’s rule on decorum. 

What is gender-affirming care?

An American Medical Associationletter sent to state governors says, “Accepted medically necessary services that affirm gender or treat gender dysphoria may include mental health counseling, non-medical social transition, gender-affirming hormone therapy, and/or gender-affirming surgeries.”

In a 2020 amicus brief filed in a federal court case by various medical organizations, it says surgery is “appropriate and medically necessary” for some patients. 

“These procedures could include chest reconstruction surgery for transgender men, breast augmentation for transgender women, or genital surgeries, including removal of the testicles, the primary source of testosterone production, in women who are transgender,” the brief said. 

Rep. Zooey Zephyr, D-Missoula, walks out of the Montana House of Representatives

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Although surgeries and hormone therapy are one facet of gender-affirming care, some patients do not require these interventions as part of their treatment. 

“There is strong consensus among the most prominent medical organizations worldwide that evidence-based, gender-affirming care for transgender children and adolescents is medically necessary and appropriate. It can even be lifesaving,” wrote Moira Szilagyi, 2022 president of the American Academy of Pediatrics. “The decision of whether and when to start gender-affirming treatment, which does not necessarily lead to hormone therapy or surgery, is personal and involves careful consideration by each patient and their family.”

The Office of Population Affairs within the Department of Health and Human Services lists four different aspects of gender-affirming care:

Social affirmation

Adopting gender-affirming hairstyles, clothing, name, gender pronouns, and restrooms and other facilities can be done at any age and is reversible. 

Puberty blockers

Using certain types of hormones to pause pubertal development can be done during puberty and can be reversible.

Hormone therapy

Testosterone hormones for those who were assigned female at birth and estrogen hormones for those who were assigned male at birth. Treatment is done early in adolescence or onward and is partially reversible. 

Gender-affirming surgeries

Typically done for adults, but can be done for adolescents on a case-by-case basis. This kind of care is considered non-reversible. 

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What does Montana's law do?

Senate Bill 99 bans minors from having access to three of the four above categories of treatment. The bill prohibits minors access to puberty blockers, hormone therapies and gender-affirming surgeries. 

It also would prohibit public resources from being used to assist with youth transitioning.

According to the Human Rights Campaign,17 states had previously passed bans on gender-affirming care: Alabama, Arizona, Arkansas, Florida, Georgia, Idaho, Indiana, Iowa, Kentucky, Mississippi, Missouri, North Dakota, South Dakota, Tennessee, Texas, Utah and West Virginia. 

On Thursday, Kansas became the latest state to ban gender-affirming care as the Republican-led legislature performed an override on Democratic Gov. Laura Kelly’s veto.

The laws are among many anti-trans bills being considered throughout the U.S., especially in Republican-led states. Many states have banned or are in the process of banning transgender participation in youth and high school sports. There are also a number of states that have passed laws requiring transgender people to only use the restroom of the gender listed on their birth certificate. 

What bill proponents argue

Those who support restrictions to gender-affirming care say minors shouldn’t be deciding on treatments that could alter the rest of their lives. It should be noted, however, that with the exception of gender-affirming surgeries, puberty blockers and hormone therapies are generally reversible. 

“It's important to remember that this bill is about permanent, life-altering medical procedures, and it's also important to remember we're not talking about adults, we're talking about children,” Rep. Kerri Seekins-Crowe, R-Billings, told Scripps News Billings.

“Let's be clear, we're not saying don't transition; we're simply saying wait until you're 18,” Rep. Terry Moore, R-Billings, also told Scripps News Billings.

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What the medical community says

Most major medical organizations, including American Medical Association and the American Academy of Pediatrics,have been strongly opposed to these types of bans. 

“In some states, efforts are underway to restrict access to gender-affirming care and criminalize the pediatricians who provide it. This has already had a chilling effect on access to care in these communities, and other efforts across the country are focused on doing the same,” Szilagyi wrote. “The people who suffer the most from this discrimination are of course the children and teens just trying to live their lives as their true selves. Pediatricians will not stay silent as these lies are waged against our patients and our peers.”

It was a point echoed by Zephyr. 

“It is important to understand that the underpinning to all of this is that when trans people are allowed to transition, we truly become ourselves,” she told Scripps News. “When it comes to youth, these decisions are being made with parents according to every approved medical guideline.”

Most transgender adults satisfied with their transition

While lawmakers say they don’t want young people to make decisions they’ll regret later in life, most transgender adults say they are happier after transitioning. 

In a survey releasedlast month by the Kaiser Family Foundation and the Washington Post, more than 3 out of 4 transgender adults in the U.S. say they are more satisfied than before transitioning. 

The poll also indicated that most transgender adults realized they were trans as children. About a third said they realized they were trans by age 10. Another 34% of transgender adults said they understood they were trans from ages 11-17. Less than a third said they realized they were trans as adults.