Bathroom bills, gender-affirming surgery bans pass through subcommittees

By: - February 28, 2023 8:33 pm

Iowa Republicans are advancing so-called "bathroom bills" that restrict the use of school restrooms and locker rooms based on a person's biological sex at birth. (Illustration by Anne-Marie Miller/Getty Images)

Lawmakers moved forward Tuesday with bills banning medical professionals from performing gender-affirming surgeries on minor patients and requiring schools to prohibit people from using restrooms or locker rooms not corresponding with their sex assigned at birth.

The bills follow a larger discussion being driven by majority Republicans this session on what accommodations adults can provide transgender children. Committees have also approved legislation to prevent schools from using a student’s preferred name and pronouns without their parent or guardian’s permission.

The measures discussed Tuesday would prevent schools and health care practitioners from taking steps to affirm a child’s social or medical transition even with knowledge and support from their parent.

“We have a social contagion on our hands,” said Patty Alexander, a teacher speaking in support of the bathroom bills. “We are telling our children they are born in the wrong bodies. … Our youth is seeking the truth, and we need to stand up for the truth. We can’t redefine nature.”

The proposed ban on hormone replacement therapy, puberty blockers and genital or chest surgeries comes after the House Government Oversight Committee heard from doctors who provide minors with gender-affirming medical care. The health care professionals said children with gender dysphoria are not pressured into identifying as transgender or to pursue medical transitions. Minors go through months or years of discussion with a health care team before any form of gender-related medical intervention is taken, the providers said.

Supporters of the bill said they are concerned about the growing transgender minor population and called on lawmakers to do more to encourage children struggling with gender dysphoria to accept their sex assigned at birth.

GOP lawmakers propose gay marriage ban

In addition to various proposals directed at LGBTQ youth, House Republican lawmakers are proposing measures to make gay marriage illegal in Iowa.

Same-sex marriage has been legal in Iowa since 2009 due to the landmark Iowa Supreme Court ruling Varnum v. Brien.

House Joint Resolution 8, sponsored by eight Republican lawmakers, would add an amendment to the state constitution defining marriage as between “one human biological male and one human biological female.”

House File 508 would specify that no Iowa residents be required to recognize same-sex unions or ceremonies as marriages, and that no penalties can be taken for refusal to recognize a same-sex marriage.

Neither measure is scheduled for a subcommittee hearing this week.

Multiple parents said people younger than age 18 are not mature enough to make life-altering or potentially permanent medical decisions. Matt Sharp with Alliance Defending Freedom, a conservative legal advocacy group, said laws like Senate Study Bill 1197 and House Study Bill 214 are needed to protect parents and children from “radical activists and profit-driven gender clinics” pressuring children with gender dysphoria to get medical treatment.

“I think we need to emphasize that states have the authority to protect children from things that society has determined to be harmful to children,” Sharp said. “There’s a reason we don’t let children sign a contract, vote, purchase alcohol, or even get a tattoo, because they don’t have the maturity to consent to experimental and sometimes dangerous things. This is even more true when we’re dealing with irreversible medical procedures.”

But Becky Tayler, executive director of Iowa Safe Schools, said testimony from doctors at the Oversight Committee meeting proved that gender-affirming care in Iowa was being performed safely and responsibly. UnityPoint Health served 46 unique patients between ages 11 to 17, Dr. Dave Williams, the chief medical officer told legislators, which Tayler said is hardly the “epidemic that those on the far right have described.”

She also said providing exceptions for gender-related care for intersex youth and children with hormonal deficiencies places the needs of some children above others. Treating these cisgender children’s conditions is just as important as treating gender dysphoria for transgender children, Tayler said.

“Do those supporting the bill feel that some youth are deserving of critical life-saving care and some are not?” Tayler asked.

Medical professionals and opponents to allowing minors to transition presented conflicting studies of how many transgender youth end up detransitioning – returning to living or identifying as their designated gender at birth. The bill’s supporters said a majority of children with gender dysphoria end up detransitioning, and that medical care could prevent them from having children or cause health issues to occur as adults.

But doctors and LGBTQ advocates said these reports are not true. A study published in the Journal of the American Medical Association found transgender and nonbinary youth who received gender-affirming medical care had 60% lower odds of moderate or severe depression and 73% lower odds of being suicidal. Medical organizations like the American Medical Association, American Psychological Association and pediatric organizations like the American Academy of Pediatrics and American Academy of Child and Adolescent Psychiatry have all released statements in support of keeping gender-affirming care legal for transgender youth.

Multiple doctors spoke against the bill, saying these medical decisions should be left to the doctors, patients and parents. Dr. Kaaren Olesen, an OB-GYN at Broadlawns Medical Center, said medical research shows gender-affirming care for transgender and nonbinary youth improves psychological function and body-image satisfaction, and that clinical studies following up with adults who received puberty suppression or gender-affirming hormones for gender dysphoria in their youth did not regret receiving that care.

Many of the parents speaking in favor of the bill said transgender children’s dysphoria is linked with other psychological problems, pointing to the higher rates of depression, suicide and other mental health issues among trans youth. But Olesen said these issues were not because they are transgender.

“LGBTQ youth are not inherently prone to suicide risk because of their sexual orientation or their gender identity, but rather placed at risk because of how they are treated and stigmatized in society,” Olesen said. “… I do not understand the need to limit health care to a group of people when obviously in doing so they are further harmed, perhaps even to the extreme of death.”

A speaker with the Family Leader, an Iowa-based religious conservative advocacy group, gave lawmakers a letter from Tennessee Dr. Harold Stern, who said minors experiencing gender dysphoria should not receive hormone therapy or surgeries.

Rep. Steve Holt, R-Denison, said the testimonies and studies about people who stop identifying as transgender as they age makes him concerned about these procedures being legal.

“I have a very hard time believing that a young person going through an identity crisis and so many other challenges that young people face today would have the maturity to make what in many cases is such a life-altering decision that cannot be reversed,” Holt said.

Bills restrict school bathrooms

Subcommittees also discussed House Study Bill 208 and Senate File 335 Tuesday, which would prohibit people from using school bathrooms or locker rooms not corresponding with their biological sex. The bills would allow schools to provide accommodations, like single-occupancy restrooms, on request.

Shellie Flockhart said she talked with her sons about what they thought of students “using each other’s locker room or restroom.”

“His answer was simple: It shouldn’t happen because they could end up gender fluid and having sex with each other,” she said.

Proponents of the legislation said the measure is not an attack on transgender people, but a way to protect women from violence and harassment, and to ensure student privacy. But Tayler with Iowa Safe Schools said these measures will not make bathrooms safer, but further isolate and harm transgender Iowans.

“In the state of Iowa, we’ve had equal facility access for transgender individuals for 15 years,” Tayler said. “In this time, not once has there been an accusation of inappropriate conduct.”

Tayler also said the bills conflict with federal laws. Melissa Peterson with the Iowa State Education Association said the legislation would put Iowa schools in conflict with federal Title IX regulations. The United States Court of Appeals for the Fourth Circuit ruled in favor of a transgender student who was barred from using the school restroom corresponding to their preferred gender.

“We make accommodations every single day to meet students where they’re at, to provide the best educational environment for our kids,” Peterson said. “And we would just ask that we not move this legislation forward that would force us to put some children in harm’s way, and frankly, distract from the important learning that needs to take place in our school districts.”

All four of the bills advanced through the subcommittee process, and will next be taken up by the full committees. Policy bills that do not include tax or spending provisions face a deadline this week to receive committee approval and remain eligible for further debate.

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Robin Opsahl
Robin Opsahl

Robin Opsahl is an Iowa Capital Dispatch reporter covering the state Legislature and politics. They have experience covering government, elections and more at media organizations including Roll Call, the Sacramento Bee and the Wausau Daily Herald.