Gender specialist: Bill banning medical treatment for transgender youth unnecessary, potentially dangerous

SIOUX FALLS, S.D. (Dakota News Now) - The South Dakota legislative session continues this week in Pierre.

But a bill that was introduced last week continues to draw pushback from some members of the state’s medical community — including South Dakota’s only certified transgender mental health counselor.

House Bill 1080 aims to prevent children from being able to medically “transition” to the opposite sex, either through medical treatment like puberty blockers, or genital surgery that would give said children the ability to sue providers later in life.

“Unfortunately, this bill is a like someone yelling ‘Fire!’ in a crowded theater when there is no fire, and doing so in order to terrify people,” Dr. Anne Dilenshneider told Dakota News Now on Wednesday.

The “Help Not Harm Bill” co-sponsors claimed medical providers in the state are being “increasingly bold” about the medical treatment for young people seeking a gender transition.

”In the guise of ‘medical treatment,’ children are being mutilated, sterilized, and being turned into permanent medical patients,” said Rep. Bethany Soye (R-Sioux Falls), a co-sponsor of HB 1080, in a press conference in the capital’s rotunda steps last Tuesday.

Rep. Jon Hansen (R-Dell Rapids) then spoke.

“Kids need mental health care, not body mutilation,” Hansen said. ”We have heard stories of children as young as eight in South Dakota being injected with cross-sex hormones right here in our state.”

Dilenschneider said Hansen’s claim is false.

“I don’t know of any healthcare professional who has recommended mutilation or sterilization of prepubescent children or injected prepubescent children with cross-sex hormones,” Dilenshneider said, adding that just because Hansen or others heard something happened doesn’t mean it is true.

“Somehow the legislators forget that, not only do we have multiple sets of evidence-based Standards of Care to follow that explicitly state medical treatment is not recommended for prepubescent children, we also have insurance guidelines that follow those standards.”

Hansen talked about how kids “cannot possibly understand and consent to undergoing the long-term consequences of these procedures.” Dilenshneider agrees, and said there is a state law that already covers this.

“Parents are always involved in any child’s medical care and must give permission for any treatment of minors,” Dilenshneider said.

There has never been a case of a person under age 18 in South Dakota who was administered genital surgery, Dilenschneider said, adding there is not a law needed to prevent that. There have been cases nationally of under-18 genital surgery. However, in that 260-page Standards of Care document that certified people who counsel transgender people like Dilenschneider follows, there are six sets of criteria that have to be met for genital surgery, and one is that the patient has to be on hormone therapy for 12 months — which means the person having surgery is not going to be a “child,” which is defined as a prepubescent person.

Prepubescent children are not allowed hormone therapy, as stated by the Standards of Care set by the World Professional Association of Transgender Health.

“We also have our own professional ethics and practice standards — in counseling, primary care, endocrinology, and surgery — to follow,” Dilenshneider said, adding state law already ensures health care providers, including counselors like her, and treatment and surgery providers work only in the areas of care within their scope of practice (education, training, and experience).

South Dakota Medicaid does not cover any treatment for transgender persons of any age.

The gender specialist said HB 1080 is confusing because it continually uses the word “children,” who, again, are not allowed any transgender medical treatment.

But currently, “adolescents” — not pre-pubescent children — are allowed treatments like puberty blockers and hormone therapy. The “Help Not Harm Bill” would take that treatment away from adolescents. Some as young as 16 are eligible for chest masculinization surgery.

But what most people don’t understand, Dilenschneider said, is just how difficult and multi-layered of a process it already is by WPATH standards for any “adolescent” to actually be referred to medical treatment to help make a transition.

”This isn’t (a process where) somebody just walks in and says, ‘Hi, I’m trans, I’m going on puberty blockers,” Dilenshneider said.

It starts with biological, psychological, and social evaluations of the young patient with a transgender mental health counselor like Dilenshneider. Parents are a part of every step of that process.

“If a child is struggling in any way in their life, there is something we need to understand about them,” Dilenshneider said. “We need to find out what’s going on, and what support they need. It could be related to gender. And it could be related to many other things going on, like undiagnosed learning disorders — which is the case with at least 20% of the U.S. population — neurological-developmental conditions like autism, and other undiagnosed health issues, trauma, etc.”

”It takes months of work. Hours and hours and hours of assessment with the child, with the parent, and teacher input. How is this child in multiple domains of their life — at home, at school, at work, or in groups that they’re part of?”

The specialist does these months of analysis with about 50 to 100 kids a year, with parents sitting in on every meeting. She said in one-third of cases she evaluates, she deems the young patient not to be transgender.

”It often becomes clear — sometimes kids are not trans,” Dilenshneider said. “Not every kid who says ‘I’m transgender’ or non-binary is, but it takes a process to sort that out.”

Dilenschneider — who has worked with transgender patients for 30 years — can, indeed, deem that child to be transgender. It is her call.

And being transgender — officially called “Gender Incongruence” — is a medical condition, as defined by the 194 countries in the World Health Organization that agreed so.

Once a licensed certified transgender counselor determines the adolescent patient to be transgender, a licensed endocrinologist has to approve of the administering of treatment to start making the transition. But only “adolescents” are eligible for treatment. “Adolescent,” Dilenshneider said, is a case-by-case term, decided by medical professionals’ evaluation of each individual’s physical development and other factors.

“Primarily with minors, we start with puberty suppression,” Dilenshneider said. “There are points where maybe it is appropriate to go to hormonal replacement, but that’s a call involved with the endocrinologist, and what’s happening with the child’s development.

”Every step has to be carefully done, and it’s all being vetted by insurance companies.”

In other words, U.S. insurance companies follow the same 260-page Standards of Care that physicians follow, and do not cover procedures outside of those standards.

HB 1080 co-sponsor Soye pointed out that “80 to 90 percent of children who are struggling with their identities will come to accept and thrive as their biological sex. That is why this bill is needed now.”

In response, Dilenshneider referred to a Princeton TransYouth Project study from May 2022, which determined that only six percent of transgender children changed their mind after five years, that 94 percent of the group still identified as transgender five years later.”

Therefore, Dilenshneider finds no need to prevent medical treatment of those responsibly evaluated. She also pointed out that puberty suppression is reversible.

She has seen first-hand how, after exhaustive counseling sessions and analysis, teens who qualified for and received health care to start making a gender transition started to recover psychologically.

“It saves lives,” Dilenshneider said, a reference to the far higher rate of depression, anxiety, and suicide rate among LGBTQ teens — particularly those who identify as transgender or non-binary — compared to the entire teen population.

But Dilenshneider said there will detrimental effects for both patients and physicians if HB 1080 is passed.

”When we cannot do our best work for our patients, we are short-changing them and endangering them,” Dilenshneider said.

She pondered a hypothetical situation in the future: A South Dakota teen may commit suicide because of all the psychological harm their gender incongruence caused them, and because a new state law prohibited them from medical treatment for transition.

Such a law, she feels, is government overreach that will jeopardize lives and also jeopardize the state’s health care system.

“Medical professionals will not want to come here to work if they’re not allowed to do their job by the medical standards of best practice,” Dilenshneider said.

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