The Washington PostDemocracy Dies in Darkness

South Dakota bill restricting medical treatment for transgender youth passes first major vote

Daniel Goldman of Arlington holds the transgender flag outside the Supreme Court in Washington on Oct. 8. (Michael S. Williamson/The Washington Post)

A proposal to ban doctors from prescribing hormones or performing sex-reassignment surgery for transgender youth in South Dakota cleared a committee vote on Wednesday, the first state to take action on a wave of bills that restrict medical interventions affecting young people’s gender expression.

The bill makes it a misdemeanor for doctors to provide puberty blockers or other treatments affecting gender expression to children under the age of 16, carrying a maximum penalty of one year in jail and a fine of up to $2,000. The nearly four-hour hearing ended with an 8-to-5 vote of the House State Affairs Committee, with three Republicans breaking with their party to oppose the bill.

Lawmakers in several other states are hoping to follow suit with bills that punish doctors, and in some cases parents, who provide treatments for transgender or non-binary youth, with legislation pending in South Carolina, Colorado, Florida, Oklahoma and Missouri. Some of the bills equate providing the medical treatments to child abuse, allowing parents to be reported to child welfare agencies and doctors’ licenses to be suspended or revoked.

State lawmakers in Kentucky, Georgia and Texas also have announced plans to file bills that limit transgender youths’ medical options.

The debate mirrored the nation’s culture wars, with Republican and Democratic lawmakers disputing not just medical facts, but also morality, parenting and the role of doctors in American life.

South Dakota Rep. Fred Deutsch (R), who sponsored the bill in that state, said that hormone treatment and sex-reassignment surgery aren’t health care and should be considered “criminal acts” that are “deeply harmful” for children. Deutsch and other supporters of the bill argued that teenagers are too young to make potentially permanent decisions about their gender, while opponents say transgender treatments help ease emotional distress for teens dealing with gender dysphoria and rarely involve permanent changes.

South Dakota is seen as a testing ground for such issues because Republicans hold a supermajority in the legislature. It also was one of the first states to pass a law restricting transgender students’ bathroom use. That 2016 law was ultimately vetoed by the governor, but it helped build momentum for a flurry of “bathroom bills” across the country.

Roger Tellinghuisen, former attorney general of South Dakota, argued that treatments for transgender youth are a private matter for doctors, parents and transgender youth and that the debate would distract from important issues in the state.

“I know this particular issue will be decided in the courts,” he said during Wednesday’s hearing. “I implore you not to make South Dakota the test case, again.”

Deutsch said he began considering the bill last spring, after he met people on Twitter who said they formerly identified as transgender and were “hurting and suffering” as a result of the treatments.

He said he Googled “transgender medicine in South Dakota” and found a number of doctors advertising services, which concerned him.

He has framed the bill as “homegrown” but said he consulted with groups such as the Liberty Council and the Kelsey Coalition as he was drafting it. In October, Deutsch attended the “Summit on Protecting Children from Sexualization” conference in Washington, which was hosted by the conservative Heritage Foundation and featured discussion of similar efforts criminalizing transgender care in other states, he said.

Deutsch’s bill shares language with several other states’ proposed legislation. The day it was introduced, a website promoting Deutsch’s bill went online with videos from the Heritage Foundation and a “Parent Resource Guide” from the Minnesota Family Council, a Christian organization aligned with the Family Research Council. The website also includes quotes from people who say they regret their gender transitions.

Wednesday’s bill passed with amendments that moved the minimum age for medical interventions from 18 to 16 and made violations Class 1 misdemeanors instead of Class 4 felonies. The final bill only applies to medical practitioners who can prescribe hormones or perform surgery, omitting nurses and medical assistants.

Rep. Kent Peterson (R), who voted against the bill, said he wasn’t clear on how it would be enforced, questioning how the state would access confidential medical information and track prescriptions for hormone treatments.

Majority Whip Rep. Michael G. Diedrich (R) also voted against the bill after hearing testimony from parents and transgender teenagers who credited puberty blockers with saving the child’s emotional health and preventing young people from committing suicide.

He said he also was persuaded by expert testimony that the effects of the puberty blockers aren’t permanent. He attempted to remove puberty blockers from the bill, but his amendment was voted down.

Both sides brought in doctors and pediatricians, who provided contradictory testimony about whether the affects of the hormones are reversible or did damage to teens’ bodies.

During the debate, Deutsch’s voice became extremely shaky as he said, “Come on, can you wait till you’re 16? Think about what you knew when you were that age.”

It’s lawmakers’ “role to interject. We need to be the adult in the room,” he said.

House Minority Leader Jamie Smith (D) retorted that doctors and parents were already involved in decisions about gender transitioning, saying, “Is it possible there are other adults in the room?”

At the hearing, about 24 people in white lab coats wore pins that read, “Every child counts,” and said they were opposed to the bill. Representatives from the South Dakota State Medical Association and Sanford Health testified that the bill goes against “best practices.”

After listening to a string of doctors who opposed the bill, Smith said he couldn’t believe that he and lawmakers who supported the bill “were in the same room, listening to the same evidence.”

“We are assuming as a legislature that we know better, again, than medical providers,” he said. “I, for one, do not believe that I know better. I’m a wresting coach, all right?”

Some advocates and physicians framed the bill as a solution looking for a problem. Fewer than four physicians in South Dakota offer puberty blockers and hormone therapies, and it is unclear if any perform sex-reassignment surgeries for transgender patients, advocates and doctors say.

Sioux Falls family physician Glenn Ridder supported the bill, saying it is “medically impossible” to change a person’s gender.

“Instead, they’re being chemically castrated and sterilized surgically, mutilated by surgeons, according to only ideology — no science — which in any other situation would be considered criminal,” he said.

Kara Dansky, an attorney with the radical feminist group Women’s Liberation Front, or WoLF, testified in support of the bill, saying gender identity treatment is “a multibillion-dollar industry, not a civil rights movement.” The group has become increasingly vocal in opposition of transgender rights.

Randi Pimentel, a 39-year-old mother of three, watched parts of the hearing from her home just outside Rapid City, S.D.

Her transgender son, Matthew, came out about a year and a half ago, when he was 11. He decided against using puberty blockers after reading about possible side effects that would cause bone damage with long-term use. But in the past year, as his body has changed, his dysphoria has become worse.

“Sometimes it’s hard to take a shower. It’s hard to even go to the bathroom sometimes,” said Matthew, now 13. “It’s hard to even sleep, because my dysphoria is extremely bad at night.”

He’s now reconsidering looking into puberty blockers but worries he wouldn’t be able to if the bill were to pass.

“One of my biggest fears is not being able to grow up as a boy,” he said.

Pimentel said she is troubled by the “anger and hate” coming from some supporters of the bill.

“The comments are horrible, calling parents of these kids child abusers,” she said. “It’s just designed to create more divide.”