HB 2007: What Gender-Affirming Health Care Means For Minors

Last week, the House of Delegates approved HB 2007.

The bill would limit gender-affirming medical care for anyone under 18. During two committee hearings on the bill, lawmakers called no expert witnesses.

To get that missing perspective, Curtis Tate spoke with Dr. Kacie Kidd of the WVU School of Medicine about what gender-affirming care for minors is and is not.

Tate: What should people understand about gender affirming care for minors?

Kidd: I think it’s important to recognize that adolescent gender affirming care has many things. It is family support, its assistance, navigating school and relationships. It’s help with individual and family therapy, mental health therapy. And after puberty has begun, there is also consideration for medication therapy. And I think a lot of the conversation regarding this bill was about surgeries, it’s really important to note that no surgical interventions happen for gender for my purposes, for minors in West Virginia. And to my knowledge, there is no plan to begin offering those surgeries. And so that’s one piece that was inaccurate in a lot of the conversation that was happening.

One of the medication interventions that is considered only after puberty begins is something called a puberty blocker. And there’s a longer medical name for that medication. It’s gonadotropin-releasing hormone agonists, but we call them puberty blockers, because that’s much simpler. But those medications are fully reversible. And so there is no long term harm from use of those medications. And they really just act as a pause button on puberty, that allows young people and their families to work together to determine the best route forward. And that could include stopping the medication and resuming their body’s puberty. Or they could start hormonal therapy in the future. And there are some aspects of hormonal therapy that are harder to reverse. But those are things, really careful considerations and discussions and plans between parents and their young people and their doctors.

Tate: Can puberty blockers and hormone treatments cause infertility?

Kidd: It’s an important consideration too. And we know that there’s a whole lot of folks who have been on these medications for many years, and go on to have biological children. But just with many other medical interventions, there is a potential risk. And it’s hard to promise or predict with certainty how anybody’s fertility journey was going to go in the future. And so we talk about fertility preservation as an additional component to this just as we would with any other medication that has that potential side effect.

Tate: What is “detransitioning”? How common is it?

Kidd: The research on this suggests that it is very rare, estimated to be around 2% or less of folks who pursue medical or surgical transition care or gender affirming care. And the important bit here is that when you ask us why they pursued detransition or retransition, 98% of people shared that it was due to an external factor like discrimination, the kind of discrimination that is perpetuated by legislation like this.

Tate: What are the reasons someone would detransition?

Kidd: When researchers asked folks who are in that 2% category who have detransitioned or retransitioned why, you know, the reasons for that decision? The vast majority, 98% of folks, say that it is for reasons like discrimination, that it is very challenging to exist in a world that doesn’t see you or think that you should be there that you are worthy. And all of those things are certainly very harmful to people.

Tate: Some of the supporters of HB 2007 referred to gender confirmation surgery as “mutilation.” Is there anything accurate about that?

Kidd: Absolutely not. As I said, there are no surgical procedures offered for gender affirming purposes to minors in West Virginia. And so certainly, I would disagree with the word being used in this context.

Tate: What’s the most likely impact you can foresee if this bill becomes law?

Kidd: I’m very concerned that the loss of access to this care or even the potential loss of access to this care will worsen the mental health inequities faced by this population. And we know that gender affirming care, specifically puberty blockers and hormone therapy, the exact interventions that this potential law would ban are associated with a 73% lower odds of suicidality among transgender adolescents. And so removing that access to care has real potential for harm here in West Virginia.

Tate: What happens if you can’t start gender affirming treatment until a young person turns 18?

Kidd: A big concern here is the significant mental health inequity that transgender adolescents face compared to their cisgender peers. And we worry that lack of access to care could result in worsening mental health inequity, including increased depression, suicidality and suicide attempt. And so for some young people, care at 18 may come too late.

Tate: What will happen to families who need gender affirming care if the bill becomes law?

Kidd: They would have to leave our state, unfortunately, and I’ve had families tell me, you know, if this kind of legislation passes, they will be leaving our state because parents and families of these young people recognize how important it is for them to be able to access this care. And I think we will lose many, many young families as a result.

Tate: Providers of gender affirming care in other states have been harassed and received threats. Is that happening in West Virginia? Where is it coming from?

Kidd: Yes. So I think nearly all of us at this point actually have received some level of threat targeting or harassment from various, various directions including social media calls to clinics, things of that nature. And that has been frightening. It seems that there are a lot of folks online that kind of gather and disseminate information about folks providing evidence based gender affirming care, and (that) has made us targets.