Lawmakers Approve Gender-Affirming Health Care Ban, With Exception

The House of Delegates passed an amended version of House Bill 2007 Saturday that restricts gender-affirming medical care for transgender youth, but carves out an exception for some treatment.

Late Saturday, the Senate voted 30-2 to give the bill its final approval.

HB 2007 bans gender-confirmation surgeries for minors, which experts have said are rare or nonexistent in West Virginia and other states. The House last month passed a version with no exceptions for hormone therapies and puberty blockers.

However, the Senate amended the bill Friday night to create a narrow path for minors to receive such treatment, with the endorsement of doctors and parents.

On Saturday, the House approved the amended bill on a vote of 88-10.

Del. Ric Griffith, D-Wayne, spoke in favor of the amendment and the bill.

“And like I said, you know, I think about this, and the votes we take on this will show up next November. But I keep thinking which is more important. These children, or how we’re perceived by our voters, and the lives of these children, are critical for us to protect and this is a very narrow allowance for there to be an exception when the medical profession believes it’s in the best interests of preventing a suicide for these young people, so I urge adoption of the amendment.”

The amendment followed testimony from doctors, parents, counselors and religious leaders who spoke against the bill, followed by a protest Thursday at the Capitol by LGBTQ rights groups.

• HB 2007: What Gender-Affirming Health Care Means For Minors
• Bill To Limit Gender-Affirming Health Care Advances In Senate
• House Passes Bill Limiting Medical Care For Transgender Youth
• Lawmakers Hear From Medical Experts In Public Hearing On Trans Bill

Regardless of medical or parental opinion, HB 2007 has been hotly contested since the early days of the session and has sparked public hearings, rallies and lengthy floor discussions. 

The bill originated with the purpose of banning gender affirming surgery for minors, something that medical experts testified in committee meetings is almost never done, and was later amended to include all forms of hormone therapy for minors as well. 

House Bill 2007 was the last bill taken up on the floor of the Senate Friday night, and was amended to provide an option to healthcare providers and families. One complaint about the bill is that lawmakers didn’t listen to experts in the field when it was drafted, making some doctors on the relevant committees uncomfortable. 

Senate Majority Leader Sen. Tom Takubo, R-Kanawha, who is a doctor, introduced an amendment to allow hormone treatment under certain circumstances when a person has  a sense of unease because of a mismatch between their biological sex and their gender identity, a condition known as gender dysphoria.

“Patients with severe gender dysphoria, which is an extreme psychological illness, these kids struggle, they have incredible difficulties,” Takubo said. “What the section did was gave very strict guardrails so that the rest of the bill was left alone that talked about not being able to use the medicines just to create all these external changes, but instead it says that they can only be used in very specific situations.”

First, two distinct medical professionals, one specializing in mental health, must diagnose an individual with gender dysphoria. Second, the medical professionals must give a written opinion that hormonal therapy is medically necessary. Third, the patient’s parents or guardians, as well as the patient’s primary care provider, must all agree in writing that hormone treatment is the best course of action and finally, only the minimum level of hormones to treat the condition may be used.

Takubo went on to cite 17 peer-reviewed studies to dissuade concerns that hormonal therapy is not supported by the data. He began with a study in the New England Journal of Medicine, which he called, “almost one of the Bibles of medical studies.”

“What they did is they tested early treatment versus trying to wait because that’s the question, ‘What if we just wait till they’re adults to do this?’ When you wait, and the patient is already suffering from severe psychological psychosis, the incidence of depression was markedly higher,” Takubo said. 

He went on to highlight the statistical significance of early treatment for gender dysphoria.

“The p value for the changes of what it did in severe depression, it had a p value of .001. If this was a surgery or cancer treatment, there would be no question,” Takubo said.

Sen. Mike Maroney, R-Marshall, also a doctor and the chair of the Senate Health and Human Resources Committee, stood in favor of the bill and extended Takubo’s comparison to cancer treatment.

“If it was a chemotherapy drug for lung cancer, you change the treatment the next day because it works better. But because it’s something we don’t quite understand, legislators can step in and tell experts across the nation and the world how to treat 30 patients that have a psychiatric condition,” Maroney said. “That is such a bad precedent to set.”

Several Senators, including Sen. Mark Maynard, R-Wayne, and Sen. Eric Tarr, R-Putnam, stood to oppose the amendment. Sen. Mike Azinger, R-Wood, provided the most animated opposition to the amendment. He said the nature of gender was “self-evident” and that giving children hormones to change their sex was “self-evidently” wrong. Azinger quoted a speech by Mississippi Gov. Tate Reeves about “a dangerous movement sweeping across America today.”

“It’s trying to convince our children that they are in the wrong body. This dangerous movement attempts to convince these children that they’re just a surgery away from happiness. It threatens our children’s innocence and it threatens their health,” Azinger read. 

“It’s self-evident that you do not, you do not chop up a child just try to prove that you can change their sex. You do not interrupt the natural course of childhood, growing into a young person by blocking their puberty, the natural course of events,” Azinger concluded.

Woelfel stood in favor of the bill and the amendment, and pointed out the irony that Senators who just minutes before had spoken about protecting children from predators would now go against science proven to protect children’s healthcare. 

“Moments ago by vote of 32 to 1 this body decided that 16 and 17 year old kids with their parents could make a major life altering decision to get married,” Woelfel said. “I just can’t fathom that some legislator would want to get in the middle of that doctor – patient, parent – child relationship.”

Woelfel also pointed out that similar bills in Alabama and Arkansas were found to be either partially or wholly unconstitutional. 

The amendment passed 20 to 12, with two Senators absent.

Sen. Patricia Rucker, R-Jefferson, also proposed an amendment that would establish reporting requirements for the prescription of “gender altering medication.”  The amendment was deemed to not be germane to the bill and was dismissed.

The Senate’s final vote to pass the amended bill was 30 to 2, with two Senators absent. Sen. Mike Caputo, D-Marion, and Sen. Robert Plymale, D-Wayne, were the two votes against the bill.