A polarizing debate is happening around the nation as lawmakers in eight states have introduced bills in recent weeks seeking to restrict transition-related treatment for transgender youth.

Proponents say the measures protect minors from medical changes they may regret as adults, while opponents say the bills prevent doctors from following health care guidelines approved by organizations such as the American Medical Association. 

The South Dakota House passed its version of the bill last week, which would impose a one-year jail sentence and a maximum fine of $2,000 on doctors who provide hormone replacement therapy, puberty blockers and gender confirmation surgery to children younger than 16 years old.

Chase Strangio, ACLU Deputy Director for Transgender Justice, said transgender rights advocates are geared up for a fight against HB 1057 and similar measures in Colorado, Oklahoma, Missouri, Illinois, Kentucky, West Virginia, South Carolina and Florida. 

"There have been policy meetings among groups like the Alliance Defending Freedom and The Heritage Foundation, who have long had a mission of pushing anti-LGBTQ policies, to push two types of bills this year," Strangio said. "One being the medical care bans and the other being bans on trans athletes participating in sports. So it's a coordinated effort that's coming from national groups." 

Rep. Fred Deutsch, sponsor of the South Dakota's HB 1057, said he introduced the bill Jan. 14 to prevent doctors from pushing children to change their bodies.  

“Every child in South Dakota should be protected from dangerous drugs and procedures,” Deutsch said in an emailed statement. “The solution for children’s identification with the opposite sex isn’t to poison their bodies with mega-doses of the wrong hormones, to chemically or surgically castrate and sterilize them, or to remove healthy breasts and reproductive organs."

Guidelines from the Endocrine Society currently recommend transgender youth wait until age 18 to get genital surgery. The society also suggests starting gender-affirming hormones at about 16, and beginning puberty blockers after girls and boys show physical changes, typically around 10 or 11.

The same Tuesday Deutsch introduced his bill, lawmakers in South Carolina and Florida read their own versions on the floor. Colorado legislators heard a similar one the next day and an Oklahoma lawmaker introduced another the day after. Kentucky and West Virginia followed suit over the next two weeks.  

Missouri was the first this year to introduce the bill on Jan. 8, but an Illinois lawmaker made a similar proposal last year, before a court case brought attention to transition-related care for children. 

A high-profile custody battle over a transgender child in Texas may have spurred the proposals, said Currey Cook, Lambda Legal's Director of the Youth in Out-of-Home Care Project. Sen. Ted Cruz and Gov. Greg Abbott helped elevate the case in October, with Cruz calling the child a "pawn in the left-wing political agenda." 

The parents in the case, Jeffrey Younger and Anne Georgulas, disagreed on whether their child is transgender and whether to support the child's identity. Misinformation about medical treatment for the 7-year-old circulated the internet, prompting state legislators in Texas and Georgia to propose banning transition-related care for minors, Cook said. 

"I think some of the politicians are just kind of trying to capitalize on fear, misinformation, prejudice around a particular population," Cook said. "It's really fundamentally troubling that you're going to decide to take on kids and families that are doing their best to support their young people who already face so much stigma in the world."

How would the bills affect transgender youth? 

The nine bills would ban transition-related treatment for transgender minors. Many reference gender dysphoria, discomfort or distress caused by a discrepancy between a person’s gender identity and sex assigned at birth.

Medical treatment for dysphoria can include puberty blockers, which a Centers for Disease Control and Prevention study found reduces risks for mental health problems and suicide, which 35% of transgender youth attempt. Prepubescent minors may decide to socially transition before requesting treatment, experts said, by seeing how changing their style and name makes them feel. 

Lawmakers in Kentucky and Florida have proposed making providing such care a felony. If passed, bills in Illinois, Oklahoma and South Carolina would require doctors who treat transgender youth face professional discipline, such as the suspension or revocation of their medical license. Colorado's version of the bill proposes classifying the medical treatments as both a felony and malpractice. 

Rep. Anthony Sabatini, who sponsored one of the bills in Florida, said he introduced the Vulnerable Children Protection Act in response to an "explosion of interest" in gender reassignment surgery across the nation. 

“It’s the wild west ... there are no real guidelines, laws, no valid, serious diagnoses given to a child before they go down the path of changing their gender and their sexual identity,” Sabatini said during a subcommittee meeting Monday. “It's important that we make sure that everyone who is going forward with this process is informed and knows how to give consent for such a procedure. This bill makes sure that a young person waits until they are 18 years old before they make an irrevocable decision to change into the opposite sex.”

If passed, the West Virginia measure would also require residents be at least age 18 to be eligible for hormone replacement therapy or the surgeries. Under the Missouri proposal, doctors or parents who help minors get gender-affirming care would be charged with child abuse or neglect, despite studies showing how parents supporting their child's gender identity improves their mental health. 

Similar language appears in the state bills, Cook said, including bans on treatments "affirming the minor’s perception of the minor’s sex." 

"The government is basically telling you, 'Nope, you're wrong about your own identity, and we're telling you how you're going to be,'" Cook said. "Some of the proponents of these bills are the very people who decry government intrusion into people's private lives, so it's just a complete 180 from their usual proposition." 

How are they similar to the bathroom bills? 

The health care bills rely on misinformation and fear, Cook said, following a similar strategy to the bathroom bills. In 2017, the year North Carolina rolled back HB2, 16 states considered restricting people to restrooms that matched their sex assigned at birth, according to the National Conference of State Legislatures. 

Proponents claimed the laws would protect women from being assaulted by transgender people in public restrooms, despite studies showing transgender people are more likely to be attacked, Cook said.

Likewise, these sponsors argue the bills will protect children from being forced to medically transition by doctors, despite how transgender minors undergo many consultations with therapists, family and doctors before getting any prescriptions. Doctors also assess whether youth want to continue treatment throughout the process and explain risks and side effects, according to the Transgender Care Navigation Program at the University of California, San Francisco. 

How do they compare to federal policies? 

In the past year, the Trump administration has implemented rules restricting the service of transgender troops, proposed allowing homeless shelters to discriminate on the basis of gender identity, told the Supreme Court employers can fire transgender workers because of who they are and announced plans to rollback protections for transgender patients included in the Affordable Care Act.

"There's definitely a lot of anti-trans policies coming out of the White House, but there's nothing that would go so far as to criminalize the provision of medical care," Strangio said. "The federal government is trying to make it easier to discriminate and has pushed forward proposed interpretations of federal law that would limit nondiscrimination protections. These state bills are sort of criminal bans on health care or mandatory discrimination."