Why some fear South Dakota's transgender bill will hurt kids

South Dakota lawmakers sent a bill to the House floor Wednesday morning that would criminalize treating transgender youth under the age of 16 with puberty blockers, hormones and gender confirmation surgery.

But both medical experts and LGBTQ advocates say that surgeries and hormone treatments are already rarely recommended at the ages noted in the bill.

Lawmakers and supporters of HB 1057 called the procedures and therapies listed in the bill "medical experiments." Opponents, including about two dozen doctors, said the bill would "criminalize" the doctor-patient relationship.

Among the main concerns of bill opponents, though, is the bill's prohibition of puberty blockers, which are used to treat teens who meet criteria for gender dysphoria by suppressing the signs of puberty.

Why the bill has some people worried

If puberty blockers were banned in South Dakota, children would be at risk, said Anne Dilenschneider, a licensed professional mental health counselor who works in Sioux Falls and specializes in gender health.

They are fully reversible, Dilenschneider said, which makes them distinct from the testosterone or estrogen treatments that may be used as part of a transition.

"It buys us time," she said, who added the treatments helped get adolescents to "neutral" in what can be an extremely stressful time in their lives, citing a Harvard study that showed higher rates of depression, anxiety, suicide attempts and self-harm in transgender youth compared with cisgender youth.

"Why would we put kids at risk," she said, "if we can lower the risk and sort things out?"

Mike Diedrich, R-Rapid City, proposed an amendment removing the puberty blockers prohibition from the bill, which was defeated.

What is the bill trying to prohibit? 

The bill, filed by Rep. Fred Deutsch, R-Florence, and co-sponsored by more than 40 other South Dakota lawmakers, would make it a Class 1 misdemeanor for medical professionals to conduct the following treatments on children under 16:

• Surgeries including castration, vasectomy, hysterectomy and vaginoplasty;
• Mastectomies
• Prescribing, dispensing or administering medications that block normal puberty, give testosterone to females, give estrogen to males;
• Remove a healthy or non-diseased body part or tissue.

While Deutsch said the bill was specifically aimed at criminalizing the act of following the gender dysphoria treatment guidelines of The Endocrine Society, their guidelines state that all treatments should be performed in concert with a multidisciplinary team.

"None of this is done in isolation," said Dilenschneider.

What is the usual standard of care for transgender kids?

The standards say that sex hormone treatments with testosterone or estrogen are recommended to wait until a patient is 16 in most cases, and that genital gender-affirming surgery should be pursued only after the patient is 18, has completed a year of hormone treatment and is supported in the decision by the members of their treatment team.

Corey Brown, vice president of government relations at Sanford Health, said the hospital system is also in opposition to the bill.

"Regardless of the topic," he said, "we believe a relationship between patients and doctors shouldn't be intruded upon by the government."

Brown also noted the Endocrine Society's guidelines, saying that "The part that talks about irreversible surgeries, that is just not standard practice or done typically on minors."

How common is this type of treatment? 

Sanford treated over 1 million unique patients last year, Brown said, and fewer than 20 of them would have fallen under the prohibitions listed in the bill.

"If you look at this, this is 0.00002% of our patients," Brown said. "But I don't want to de-emphasize that regardless of that small number, if someone comes in with a diagnosable medical condition, we would like to be able to try to help those kids."

Susan Williams, executive director of The Transformation Project and mother of a transgender child, said of Deutsch that "rather than listening to people on the internet who are not from South Dakota and may or may not be telling the truth, he needs to listen to trans youth and their families in South Dakota who are begging to be heard because of how much this bill will harm them."

Medical associations in the state also pushed back against the bill, with a lobbyist from the South Dakota Medical Association calling it "very risky" and a pediatrician with Sanford Health saying the "far reaching" bill would force doctors to choose between treating patients and jail.

Kim Parke, a Sioux Falls mother of a non-binary 17-year-old told legislators "You are telling me you know what's best for my child. You do not."

Dilenschneider says she sees this bill, alongside bills addressing which bathrooms transgender people could use and what sports teams they could play on, as an educational opportunity for the state and a way to create more understanding about the transgender community — but she's blunt about what she believes the bills would lead to.

"This is hampering medical professionals from saving the lives of adolescents.”