Debate gets personal, as Idaho House passes trans youth medical care bill

Two Idaho legislators on Tuesday described how they felt upon learning that a family member was transgender. Their surprise and confusion gave way to acceptance and empathy, they said, as they came to understand what it meant for their loved one to identify as a gender that differed from the sex they were assigned at birth.

But when it came time to vote on a bill to make medical care for gender dysphoria in youth a felony, they came down on opposite sides — with one legislator voting with the House Republican majority to ban trans care for Idaho minors, including hormone therapy, “puberty blocker” medications and surgeries.

The bill passed on a party-line vote — all 11 House Democrats opposed and 58 House Republicans in support. Mountain Home Rep. Matthew Bundy was the only Republican to vote against the bill. It now heads to the Idaho Senate for consideration.

Rep. Bruce Skaug, R-Nampa, is the bill’s sponsor. Similar legislation from Skaug passed the House last year but failed in the Senate.

On the House floor Tuesday, he said House Bill 71 is “not a religious crusade” but was “following the science.”

Skaug likened gender-affirming care for trans youth to eugenics, the pharmaceutical opioid crisis and “other things that were popular in medical circles … that now we know were evil, outright evil,” he said.

Rep. Colin Nash, a Democrat from Boise, spoke against the bill.

He described learning that a sibling was transgender. The feeling of being born into the wrong physical body was “foreign” to him, he said.

A member of his wife’s family also died by suicide “over issues related to their transgender status,” he said.

“And although I may not understand it, I believe them, that they feel differently and they want the world to see them differently,” he said.

But the legislation didn’t seem to reflect what he saw with his own family, he said.

“The surgeries that are (described in the bill) are not something that I saw in the standard of care for my own sibling — and, largely, that care is helping a child feel understood, accepted and helping them to a place where they can safely make these decisions on their own,” Nash said.

Legislation is ‘reaching too far,’ said House Republican

Rep. Lori McCann, R-Mountain Home, seemed at first to oppose the bill as she spoke of “standing alone as a Republican” during the floor debate.

“I’ve lost a lot of sleep over this bill, I’ve wrestled with it, I’ve talked with professionals, I’ve talked with medical folks, parents, I’ve talked with actual transgender people, and I want them to know that I care, I feel for them,” she said. “And (gender dysphoria) is real. It is something that is real, that we all need to try to understand.”

When she learned that an adult family member came out as transgender, she said, “my first reaction was, ‘Oh, you’ve got to be kidding me, this can’t be happening. How does one get married, and then want to become a man? … I had a hard time wrapping my head around this.”

Now, she said she would “do anything I can to make life easier for them, to get through day-to-day.”

McCann also described a recent meeting with a transgender teen girl and parents of trans youth, she said. They agreed that surgeries should wait until a person is 18, she said.

“However, there was tears, there was very uncertain futures that they also shared with me — that if they were not allowed to have the medications necessary to help them on their journey, that it would be devastating for them,” McCann said.

McCann said she would support the bill if it stopped at making surgeries a felony. But it reaches beyond that to include medications and hormone treatments that can be, but aren’t always, prescribed for minors with gender dysphoria. And that made her conflicted, she said.

She imagined what she would do if one of her children or grandchildren was struggling with gender dysphoria as a child.

“Well, I would fight like all-get-out to get them the treatment, whatever that is that they need,” she said, adding that she fears Idaho parents will use “alternative means” to obtain medications for their kids.

She said the Legislature is “jumping the gun and … reaching too far” into the realm of parents’ authority.

In the end, though, McCann said the surgery component of the bill was important enough that she would support it.

Trans-youth medical care bill now heads to Senate

Democrats in the House, and McCann, raised concerns about whether the bill is based in part on misinformation or misunderstanding about the health care provided to Idaho youth with gender dysphoria.

“I would like to talk a little bit about what gender-affirming care is, because I think it’s unfamiliar for most of us,” said Rep. Lauren Necochea, D-Boise.

Necochea said that sex-reassignment or gender-confirmation surgeries are not currently performed in Idaho — or considered to be “standard of care” for children and teens.

Very few surgeons in the U.S. specialize in the procedures to create facsimiles of female or male body parts and facial features. None of those surgeons are based in Idaho, according to provider directories.

“For young kids, gender affirming care is therapy, psychological assessments, social transition,” such as supporting a child to wear different clothes or hair styles, Necochea said.

“It might not be until years later when puberty is starting to happen that they start to consider puberty blockers,” she said.

“There are no studies showing clinically significant changes to bone density or brain development or any of the other things asserted in this statute, and it is concerning that we have factual inaccuracies — that are contrary to mainstream medical consensus — being proposed, proposing we are going to write this into statute,” Necochea said.

Hormone therapies are introduced later. Medical providers say those medications may affect fertility and do cause irreversible changes — a deepened voice from taking testosterone, for example.

Some observational studies and medical experts say that pressing pause on puberty could have long-term effects on physical development. But the effects can be reversed or mitigated by stopping the medication.

Puberty blockers are not supposed to be prescribed to minors on a whim; the patient must have “a long-lasting and intense pattern of gender nonconformity or gender dysphoria,” the Mayo Clinic says.

The gender clinic at Oregon Health Sciences University describes some of the effects in its patient handout on puberty blockers — noting that they are meant to be used for a limited time and monitored by health care providers to lessen the risks.

“Researchers have not finished studying how safe puberty blockers are in the long term. So, there might be some risks that doctors do not yet know about,” the handout says.

This story was originally published Feb. 14, 2023 by the Idaho Capital Sun.