The Washington PostDemocracy Dies in Darkness

An Idaho bill would criminalize medical treatments for trans youths. It echoes abortion bans.

The bill would make transporting a child to another state to receive that care a felony

(iStock/The Washington Post)

When Erin Reed first caught news that Idaho’s House of Representatives had passed a bill seeking to ban out-of-state medical treatments for trans youths on Tuesday, she immediately took note.

Reed, 33, has been helping track such legislation for the last two years for the Trans Formations Project’s Step Up For Trans Kids initiative. But what struck her about Idaho’s bill was how similar it seemed to a seemingly unrelated one she had heard about earlier that day: a Missouri proposal that would make seeking out-of-state abortion care illegal.

“If your neighboring state doesn’t have pro-life protections, it minimizes the ability to protect the unborn in your state,” said state Rep. Elizabeth Coleman (R), who introduced the Missouri bill.

Missouri lawmaker seeks to stop residents from obtaining abortions out of state

Idaho’s bill, H.B. 675, is an addendum to an existing ban on female genital mutilation. It proposes that gender-affirming care for transgender youths, including hormone therapy and puberty blockers, be categorized in the same way that castration and hysterectomies are for minors.

The bill, passed on a mostly party-line vote, would make providing gender-affirming care a felony, punishable by up to life in prison. It goes further than other legislation by making transporting a child to another state to receive that care a felony, too.

Any medical intervention that impairs the reproductive organs of a child “for the sole purpose” of affirming the child’s gender is “never necessary,” the bill states.

As the Idaho Press reports, Idaho state Rep. Bruce Skaug (R), who authored the bill, said during debate that his bill would protect “boys and girls who have their genitals mutilated by chemicals or surgery for the purposes of changing their birth sex.”

“The ability to procreate is a fundamental right that must be protected for these children,” Skaug said. (Skaug declined to comment on his remarks.)

Responding to a Democratic colleague’s criticism that the bill was inconsistent with established medical guidance, state Rep. Julianne Young (R) said: “I see this conversation as an extension of the pro-life argument.”

“We are not talking about the life of the child, but we are talking about the potential to give life to another generation,” Young continued. “There is a nexus on this issue.” (Young did not respond to a request for additional comment.) The bill will advance to the state Senate, where leaders say it is unlikely to pass.

In attempting to criminalize the ability to seek gender-affirming care and abortion nationwide, both Idaho and Missouri lawmakers have shown a willingness to wade into unprecedented territory, experts say. The bills also illuminate parallels between the two issues that advocates on either side have increasingly drawn comparisons between.

There is clear overlap among the states proposing more aggressive restrictions on abortion and transgender youths: Alabama, Ohio, Louisiana, Iowa and Mississippi are all considering bills that would limit age-appropriate hormone therapy for minors. They are also among at least 26 states poised to ban abortion if the Supreme Court weakens or overturns Roe v. Wade, according to the Guttmacher Institute, a nonprofit research center that supports abortion rights.

What abortion laws would look like if Roe v. Wade were overturned

Experts say the overlap is because opposition to abortion and transgender people have become litmus tests for the Republican Party.

Last week, Dave Carney, a senior adviser for Texas Gov. Greg Abbott’s (R) reelection campaign, told reporters he considers the politics of the transgender youth issue as a “75, 80 percent winner” for the governor.

The New York Times reports that a coalition of influential conservative think tanks are behind the new group of bills targeting medical care for trans youth. These include the Heritage Foundation, Family Policy Alliance and Alliance Defending Freedom, as well as several Christian organizations, which have also backed abortion restrictions. (The Washington Post contacted several of these organizations, none of whom agreed to be interviewed.)

Gillian Branstetter, press secretary for the National Women’s Law Center, said the similarity in language and strategy between the recent wave of antiabortion bills and bills limiting medical care for trans youths isn’t coincidental — they are both rooted in a strict fidelity to gender norms.

“Abortion and birth control help give women across the country control over their own lives in a way that runs counter to strict gender roles,” Branstetter said. “Gender-affirming care helps trans people pursue our own paths in our own lives. And that is an abject threat to a movement that believes that your path in your life is preordained, be it religiously or biologically.”

On Wednesday, the NWLC released a statement signed by more than 100 women’s rights and reproductive rights organizations in support of transgender youths in Texas, where many parents of trans children are living in fear and uncertainty after Abbott directed the state’s child welfare agency to investigate gender-affirming medical care as “child abuse.” On Friday night, a district court issued a statewide injunction against Abbott’s order, effectively halting all child abuse investigations or prosecutions based solely on providing transgender care to minors.

“It is not the job of the government to dictate to anyone what our bodies should look like, whether we’re able to have children or not, or when and how we do so. These are the most intimate, personal decisions that the state should never forcibly take away,” the NWLC statement read.

Policymakers championing these restrictions argue that they are vital to protecting children, whether that is a fetus or a transgender child. When it comes to transgender youths, conservative lawmakers and pundits have centered concerns on how medical transitions could impact their future ability to have children.

Texas Attorney General Ken Paxton (R), in a legal opinion shared last month that served as the basis for Abbott’s order, argued that gender transition care could “have the effect of sterilization,” and thus should be considered a form of abuse.

Hormone blockers do not cause infertility, according to experts. For transgender teenagers who first take puberty blockers and then take estrogen and testosterone treatments, the Endocrine Society warns that the treatment may compromise fertility later in life. But experts say more research is needed on the subject.

FAQ: What you need to know about transgender children

The American Medical Association has advocated for gender-affirming care for younger patients. When a transgender child has met certain diagnostic criteria and after the child first shows physical changes of puberty, clinicians may recommend puberty-suppressing treatments, which are reversible and intended to give young people more time to decide what to do next. Hormone treatment is not recommended for pre-pubescent children.

This year, a number of proposed bills have highlighted concerns related to future fertility, though they often frame the issue in misleading ways, many physicians and trans advocates say.

Lawmakers in Texas and Idaho have grouped treatments like puberty blockers with castration, vasectomy, hysterectomy, vaginoplasty and mastectomies — procedures that are not performed on people under the age of 18 in the United States.

Far from protecting trans children, laws that curb access to gender-affirming care can add harm, doctors and transgender advocates say. Evidence shows that gender-affirming care considerably improves the mental health of trans youths: One study found that such medical care was associated with a 73 percent reduction in suicidality.

“Before fertility, these youth need to stay alive,” Reed said.

As courts weigh the legality of these bans, the chilling effects — regardless of whether the laws are enacted — have been clear, reproductive and LGBTQ rights activists say.

New reporting shows that Genecis, Texas’s largest clinic providing children with gender-affirming care, closed last year due to political pressure. Last week, Texas Children’s Hospital, the country’s largest pediatric hospital, halted gender-affirming care for trans youths after reviewing the actions of Abbott and Paxton.

“This step was taken to safeguard our healthcare professionals and impacted families from potential legal ramifications,” the hospital said in a statement.

In Texas, the nation’s largest children’s hospital is halting gender-affirming care for trans youths

The Biden administration, meanwhile, has said Texas’s policies run afoul of federal privacy and LGBTQ protections.

Since last year, abortion clinics throughout Texas have also closed, worried they may face lawsuits on account of S.B. 8, which bans abortions at six weeks gestation — before many people know they’re pregnant. The bill, which has been in effect since Sept. 1, also allows private citizens to sue abortion providers or anyone suspected of helping a pregnant person get an abortion, paving the way for the recently proposed Missouri bill.

The shifting landscape is reflected in the Transgender Law Center’s national equality map that help families of trans children identify which states have strong LGBTQ protections. But even in statehouses with Democratic majorities, there are not many laws explicitly supporting trans people, she said.

That could be changing. Just as states like California, Washington and New York have been shoring up protections for abortion, some states are expanding protections for trans and LGTBQ communities.

Lawmakers in Hawaii are considering a bill that would expand the definition of gender-affirming care to include procedures that have been deemed “cosmetic,” such as facial feminization surgery. Several states, such as Maryland, have also made it easier for trans people to change the names and gender on their birth certificate in recent years.

The result is a U.S. landscape that is rapidly becoming polarized on the issues of LGBTQ rights and abortion access.

For trans families, the stakes have never been higher, said Branstetter, who called them “political exiles within their own country”: “Trans kids don’t choose where they’re born, and most families can’t relocate their entire life with every election — nor should they have to.”