Ban on gender-affirming care for transgender minors heads to Reynolds’ desk

By: - March 8, 2023 5:33 pm

Democrats said the ban on gender-affirming care for minors in Iowa will put transgender youth at higher risk of suicide as the legislation heads to the Gov. Kim Reynolds’ desk March 8, 2023. (Photo via Canva)

Republicans sent a ban on gender-affirming care for minors to Gov. Kim Reynolds’ desk Wednesday, less than two weeks after the measure was first brought up as a possibility.

Two other LGBTQ-related measures on what materials are available in school libraries and classrooms also passed the House.

The bill on transgender health care, Senate File 538 cleared the House on a 57-39 vote after passing the Senate Tuesday night. If signed by the governor, the measure will prohibit transgender minors from obtaining gender-related medical care such as puberty blockers, hormone replacement therapy or any surgical interventions. 

Youth seeking the gender-related treatments outlined by the bill for purposes outside of transitioning would still be able to receive the care.

Democrats said if signed into law, this bill will be responsible for the death of transgender children in Iowa who are at a high risk of suicide. But the bill’s floor manager, Rep. Steve Holt, R-Denison, said transgender people still face higher rates of suicide after receiving care, and that this bill will stop children from receiving treatment that could have permanent health effects.

“Despite all medical and surgical efforts and suicide rate among transgender individuals documented in numerous studies to be much higher than those who embrace their chromosomal sex, the only outcome that actually results in decreased suicidality is desistance, or return to gender identity consistent with biological reality,” Holt said.

Republicans cited studies from Sweden, which restricted hormone treatment therapy for minors in 2022 as doctors call for more research into the long-term effects of beginning gender-related care at an early age. These studies show substantially higher rates of suicidal thoughts and attempts as well as psychiatric hospitalization among transgender people after undergoing gender-affirming surgery than a healthy control population.

Rep. Monica Kurth, D-Davenport, brought up the study referenced, which said transgender patients do not stop facing higher mental health risks after getting gender-affirming surgeries. Medical treatment, both psychiatric and physical care like hormone therapy, are typically ongoing needs for transgender patients.

The study also found transgender people saw better outcomes when societal attitudes became more accepting of people with different ways of expressing their gender, she said.

“What this study is saying is that persons who are in this situation need increased psychiatric care, increased somatic care … And it also points out the need for continued education of the general population,” she said. “What we need to be looking at is how we can reduce the stigma.”

The Trevor Project, a LGBTQ suicide prevention organization, condemned the proposed medical care ban as well as the “more than 20” other bills targeting LGBTQ identities and topics. In the Trevor Project’s 2022 U.S. National Survey on LGBTQ Youth Mental Health by State, more than half of Iowa transgender and nonbinary youth reported seriously considering suicide, and 22% attempted suicide.

The Trevor Project also found in a study that transgender youth who reported experiencing discrimination based on their gender identity were much more likely to report attempting suicide than those who did not. In 2022, 71% of transgender and nonbinary youth reported experiencing discrimination for their identity.

“The extreme wing of the Iowa Republican Party cannot seem to go a day without harming LGBTQ kids,” One Iowa Action Executive Director Courtney Reyes said in a news release. “For all their bluster about parents’ rights, these legislators have shown us what their true priorities are. They are willing to take away the fundamental parental rights of any parents they disagree with. Shame on them. Shame. Make no mistake: this legislation will kill transgender youth.”

Intra-party dissent

While the Senate passed the measure along party lines, five House Republicans voted against the measure. Rep. Chad Ingels, R-Randalia, said, as the parent of children with disabilities, he has empathy for parents of transgender children. Transgender children are not disabled, he said, but he understands the parental experience of seeing a disconnect between your child and how the world sees them.

Ingels said he would be in support of the bill if it was narrowly focused on surgeries. But banning all “gender-affirming” health care is too broad a category, he said, and prevents Iowa parents from choosing the best path for making sure their child lives a happy, fulfilling life.

“I think choosing to focus on one extremely small population of people with this legislation we’re talking about right now — with legislation that we’re going to be talking about in a little while — is sad for me,” he said. “I think it’s sad for a lot of Iowans.”

Rep. Brian Lohse, R-Bondurant, said the bill puts “religious and personal and political views kind of at odds with what I probably will vote for.” Republicans said they wanted to increase parental rights through bills, like the governor’s private school scholarship program, but Lohse said this bill strips Iowa parents’ freedom to make the best medical choices for their children.

Rep. Megan Jones, R-Sioux Rapids, introduced an amendment to the House version of the bill to specify these procedures are only prohibited “without the consent of the minor’s parent.” The amendment was ruled not germane to the bill, and the motion to suspend the rules for consideration of the measure failed.

By voting down Jones’ measure, the Legislature is limiting how Iowans parent, Lohse said.

“They should be free to make that decision for their kid,” Lohse said. “I may disagree with that decision, I have never been faced with that decision. But I don’t know how, why we were asked, but it’s not my job as a legislator — certainly not my job as a human — to judge them in the rightness or wrongness of that decision.”

Republican Reps. Shannon Latham of Sheffield and Hans Wilz, R-Ottumwa, also voted against the bill.

LGBTQ activists say anti-trans bills driving people out of Iowa

Protesters gathered in the Capitol rotunda Wednesday to support transgender Iowans. In the past week, thousands of Iowans have protested the legislation advancing across the state: a crowd of 2,000 Iowans gathered on the steps of the Capitol Sunday for the “Rally to Resist” and  hundreds of K-12 students walked out of classrooms March 1 in protest of the LGBTQ bills.

Katy Crowley of West Des Moines said she was happy to see how many Iowans were speaking up against these bills. While LGBTQ Iowans and allies hoped the legislation wouldn’t move forward, she expects “it’s going to get worse before it gets better.” But questions of how much worse things will get for LGBTQ Iowans and how long until things get better are having many people asking whether they want to stay in Iowa.

“Everyone in the queer community is questioning on whether they want to stay or whether they want to leave,” Crowley said. “I mean, even myself, and I grew up here, Iowa’s my home. I love it here. I’ve never considered leaving. … But even now, I’m reaching a point where it’s like, I think I just need to get out of here for a little bit.”

Democrats shared testimony from medical providers and parents in the floor debate who also said they were considering leaving Iowa if this bill becomes law. Rep. Megan Srinivas, D-Des Moines, said one of the patients she serves as a physician moved to Iowa because the state legalized same-sex marriage in 2009.

“He’s also one of my slew of patients who recently told me that if we pass this legislation, and any of the other pieces of anti-LGBTQ legislation we have before us, that he will be moving out of the state,” Srinivas said. “That he can no longer live in a place that doesn’t welcome him for who he is in his family for who they are. That is what this legislation represents to so many Iowans.”

Rep. Skyler Wheeler, R-Hull, pulled up 2022 census data about population trends that showed many moving away from large states like Illinois, New York and California, that have gender-affirming care policies in place, and going to live in states like Florida, Texas and Idaho.

If this were a problem, he said, people wouldn’t be moving to states like Florida and Idaho, which both have passed anti-LGBTQ measures in recent legislative sessions. Wheeler did not offer data indicating whether LGBTQ people are moving to those states.

“Iowa, we’re not growing as fast as I would like, but we’re growing,” Wheeler said. “And there are reasons why we’re going to continue to grow and we’re going to grow bigger — for instance, when we get rid of the income tax.”

‘Gender identity’ in Iowa classrooms also up for discussion

Rep. Elizabeth Wilson, D-Marion, said Iowa youth have been targeted by GOP lawmakers both in the Statehouse and on the national stage. In addition to the ban on gender-affirming care, the House was set to debate two education bills Wednesday that prohibit materials containing “sexual identity” and “gender identity” for students in kindergarten through 6th grade, and that ban any material that contains a written or visual depiction of any sex act.

The “age appropriate material” bill, House File 597, was brought up after lawmakers talked with parents who challenged books available in school libraries for explicit material. Many of the books challenged, like “Gender Queer,” “Fun Home” and “Lawn Boy,” focused on LGBTQ identities.

These books could be removed from schools because they have scenes with sexual activity. But some books and materials that do not contain explicit materials may also be taken out of the classroom through House File 348. Materials related to “gender identity” and “sexual orientation” could not be included in instruction, curriculum or other materials available to kindergarten through 6th grade students.

Both bills passed the Iowa House Wednesday. Democrats said the measures will not prevent children from learning about sex, or questioning issues like gender identity and sexual orientation. While legislators who have served as educators said teachers play a crucial role in helping children work through and understand these issues, Wheeler argued that these topics should be left to the parents.

“We’re talking about 5-year-olds, we’re talking about 8-year-olds, 11-year-olds, 12-year-olds,” Wheeler said. “If they have questions and these types of topics come up ,they should be directed to go home and talk to their parents about it. That is the appropriate avenue to have a conversation with these kids at such a young age.”

Rep. Helena Hayes, R-New Sharon, introduced an amendment to expand the bill on gender-related topics to prohibit “sexual orientation” and “gender identity” from appearing in material for all K-12 students. She withdrew the amendment, saying she was looking forward to future conversations on this material in schools.

Rep. Austin Baeth, D-Des Moines, said banning these topics from school classrooms presumes all parents are accepting of or will provide a safe home for LGBTQ children. LGBTQ youth who report having at least one accepting adult in their life report lower rates of attempting suicide, according a Trevor Project study.

“Now in a perfect world, parents serve that role,” Baeth, a physician, said. “We don’t live in a perfect world.”

Wheeler argued against the idea that this bill will inhibit teachers’ ability to provide a respectful and accepting environment for students.

“I have no idea how this bill says any of that, and I promise you it doesn’t,” Wheeler said. “They have every right and they should treat all of their students equally respectfully, regardless of what they can and can’t talk to them about when they’re 8 years old.”

While the transgender medical care bill heads to the governor’s desk for final approval, the education bills still have to clear the Senate.

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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.