Iowa ban on gender-affirming care for trans kids awaits Kim Reynold’s signature. The impact:
Trans #Trans
Transgender children in Iowa will lose access to gender-affirming medical care in a bill passed Wednesday by the Iowa Legislature and now on its way to Gov. Kim Reynolds.
Senate File 538 would prohibit Iowa doctors from providing puberty blockers, hormone therapy or gender-affirming surgeries to a transgender person younger than 18.
The Senate passed the bill along party lines late Tuesday night. Most House Republicans voted to advance the bill Wednesday, just hours after hundreds of protestors at the Capitol sang and chanted and pledged to keep fighting for LGBTQ rights.
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The American Medical Association, American Psychological Association and the American Academy of Pediatrics all recommend providing transgender kids with gender-affirming care. Medical professionals told lawmakers last month that these treatments can be life-saving for transgender children.
But Republican leaders on the legislation say they need to protect transgender kids and their parents from making irreversible changes they may regret. Sen. Jeff Edler, R-State Center, repeatedly called the treatments “experimental” and said banning gender-affirming care for minors was a public health imperative.
“Children should not be pushed to receive experimental medical treatments that can leave them permanently sterile and physically marred for life,” Edler said. “Iowa has a duty to protect its citizens, especially our children.”
Rep. Steve Holt, R-Denison, expressed similar skepticism about the safety and efficacy of gender-affirming treatments. He said medical groups “don’t always get it right,” pointing to a time in history when lobotomies were recommended.
The Senate also passed a bill Tuesday to prohibit transgender kids from using school bathrooms that don’t align with their biological sex.
The House passed a bill Wednesday to prohibit teaching about gender identity or sexual orientation in kindergarten through sixth grade.
More:Which Iowa lawmakers voted for bills targeting LGBTQ kids? These maps tell the story
Bill’s passage comes after several significant protests in central Iowa
The ban on gender-affirming care was introduced in the House and Senate just one week ago, spurring large protests in central Iowa.
About 200 people gathered in the Capitol Wednesday, waving pride flags and speaking about the importance of respecting and protecting LGBTQ Iowans. The Des Moines Gay Men’s Choir led the crowd in a song: “Start at home, change what you can, never again alone. Start at home, change what you can, never again be silent.”
“We want to let (lawmakers) know that even when our state government fails to stand up for us, we will be there to support each other,” said Katy Crowley, an organizer with the Iowa Queer Student Alliance.
Hundreds of Iowa students staged a walkout last week to oppose the ban on gender-affirming care and a slew of other bills to restrict transgender accommodations and LGBTQ-inclusive lessons in schools.
Over the weekend, hundreds more Iowans rallied on the Capitol steps to protest the legislation.
LGBTQ advocacy groups mourned the bill’s passage on Wednesday evening and expressed their fury toward the Iowa GOP.
“The extreme wing of the Iowa Republican Party cannot seem to go a day without harming LGBTQ kids,” said One Iowa Action Executive Director Courtney Reyes. “For all their bluster about parents’ rights, these legislators have shown us what their true priorities are.
What does a ban on gender-affirming care mean for transgender kids?
Under passed legislation, health care professionals in Iowa would be forbidden from prescribing transgender minors medication to delay the onset of puberty or any cross-sex hormones, like estrogen or testosterone.
That means transgender youth would go through biological puberty with no medical intervention to delay or change the process.
Doctors would also be forbidden from performing surgeries on minors that sterilize or reconstruct genitalia to differ from the individual’s sex at birth. Surgeries to remove “any healthy or nondiseased body part or tissue” would be prohibited, if the surgeries are meant to affirm a transgender child’s gender that differs from their sex.
More:Iowa GOP’s plan to ban gender-affirming care for transgender kids explained in 60 seconds
Medical procedures on children’s genitalia that are unrelated to transgender care would still be legal, including circumcisions.
Iowa doctors told lawmakers that they do not perform genital surgery on transgender minors, and they remove breast tissue only in rare cases.
The University of Iowa LGBTQ Clinic told the Des Moines Register they have served 211 transgender children in the last 12 months.
The clinic prescribed puberty blockers to 43 kids and cross-sex hormones to 90 children. They performed five mastectomies on minors.
What would happen to kids who are already transitioning?
Transgender kids who are already on puberty blockers or hormones would be required to stop taking them under the legislation.
Health care providers would have 180 days — about six months — after the passage of the law to cease gender-affirming care for their patients.
“This would allow an essential off-ramp to let their bodies back off of the toxic drugs that they’re on,” said Edler.
Unlike an earlier draft of the bill, the passed legislation does not explicitly prevent doctors from referring their patients to out-of-state providers who offer transition-related care.
Any Iowa doctor who violates the law could lose their license or face a lawsuit from any Iowan, regardless of whether they were directly affected. The attorney general may also take legal action to enforce the law, if it passes.
Dr. Katie Imborek, co-founder of the University of Iowa LGBTQ Clinic, worried that the legislation could be “devastating” for young patients to halt their transition.
If Iowa passes a law to ban gender-affirming care, Imborek said she would “provide (patients) with as much support and care that we could” but ultimately follow the law.
Over hours of debate on Tuesday and Wednesday, Democrats and Republicans battled over the reality of transgender health care, and whether a ban on gender-affirming care for minors would be harmful or helpful to transgender kids.
Democrats argued that transgender kids who can access gender-affirming care are less likely to attempt suicide, citing studies and personal letters from transgender Iowans and their parents.
“Kids are going to kill themselves because of this law,” said Sen. Zach Wahls, D-Coralville. “Iowa children will die if this becomes law.”
Edler responded that most studies on gender-affirming care were insufficient, and he cited different studies that show long-term negative mental health and physical implications for individuals who transition. Holt acknowledged that there was “data on both sides” but argued there was not enough research on the issue.
“The available data, most particularly the few studies available that truly have longitudinal depth, convinced me that the medical efficacy of these procedures on young children is far from proven,” Holt said.
In response, Rep. Megan Srinivas, an infectious disease physician, spoke about the rigorous, detail-oriented process to create medical guidelines on an issue — a process that allows experts to evaluate the data and decide best practices. She reminded House lawmakers that major medical associations in America support gender-affirming care for minors.
“Why are we choosing to trample on the opinions of people that know best? On the experts that have dedicated their life to taking care of those in our community?” asked Srinivas, D-Des Moines.
In his closing comments, Holt asserted that most transgender kids would grow out of their gender identity if they go through puberty.
“I believe the data overwhelmingly shows that performing these treatments on children puts them on a path of lifelong struggle, with their chance of suicide far higher than average,” Holt said.
Some House Republicans vote against gender-affirming care ban
All 33 present Senate Republicans voted in favor of the bill Tuesday night. But five House Republicans broke ranks and opposed the legislation.
Rep. Megan Jones, R-Sioux Rapids, proposed an amendment that would keep the care legal but explicitly require parental consent before a child receives it. The legislation was voted down by her own party.
Rep. Chad Ingels gave an emotional speech opposing the bill. He recalled his experience raising his children who have disabilities and said their life experience and perspectives of themselves fundamentally differs from his own.
“I don’t know what my children feel, think, how they see the rest of the world. I know the rest of the world sees them differently,” Ingels said. “The people that we’re talking about today, they see themselves differently than the way they want to be.”
Ingels, Jones, Rep. Brian Lohse of Bondurant, Rep. Hans Wilz of Ottumwa and Rep. Shannon Latham of Sheffield voted against the bill. The other 58 Republicans present in the House voted in favor, sending it to the governor.
Similar bills in other states have faced legal challenges.
Arkansas was the first state to ban adolescent puberty blockers or hormone therapy. The American Civil Liberties Union brought a lawsuit against the state on behalf of four transgender teenagers and a doctor. A district court judge has temporarily blocked the law.
A law in Alabama has also been partially blocked by the courts.
However, the recent spate of laws banning gender-affirming care for minors has yet to be fully adjudicated by state and federal courts. Many states enacted restrictions in 2022, and several more have passed laws in recent weeks.
Iowa’s bill specifies that complying with or enforcing the ban would not violate Iowa’s Civil Rights Act, which prevents discrimination based on gender identity, race, creed, color, sex, sexual orientation, national origin, religion, ancestry and disability.
Wahls asked Edler why the bill, which specifically prohibits medical care based on gender identity, would not count as discrimination.
“This bill restricts — only for this group of people — access to this care,” Wahls said.
Edler responded that the bill is “a prohibition under the public health chapter, not the civil rights chapter.” He said the language in the bill simply clarifies that the bill is meant to address public health.
Katie Akin is a politics reporter for the Register. Reach her at kakin@registermedia.com or at 410-340-3440. Follow her on Twitter at @katie_akin.
This article originally appeared on Des Moines Register: Iowa ban on gender-affirming care for trans kids awaits Kim Reynold’s signature. The impact: