BOISE, Idaho — In January, medication and surgery to treat children with gender dysphoria will be illegal in Idaho.
Transition-related surgeries on minors are rare, but the consequences of banning medications, like puberty blockers and hormonal therapy, could prompt Idaho families to move to another state. It also could mean transgender children without access to medication will be more likely to harm themselves, medical experts told the Idaho Statesman.
But the exact effects of the new restrictions are unclear, because bans on gender-affirming care are new. The first statewide prohibition on gender-affirming care was enacted just two years ago.
“These bans came so swift and fast,” said Dr. Meredithe McNamara, an assistant professor of pediatrics at Yale University’s School of Medicine who specializes in adolescent health care. “We’re going to have to follow these young people closely after they’re forced to cease care.”
Idaho joins national trend
The Idaho Legislature this year passed House Bill 71 with majority GOP support, and Republican Gov. Brad Little signed the bill into law.
Supporters of the bill argued that childhood is too early for medical intervention to treat gender dysphoria, the feeling of discomfort or distress associated with having a gender identity different from one’s birth sex. Instead, transgender children should rely on mental health therapy, they argued.
“Children are too young to be making the decision to sterilize themselves,” Rep. Bruce Skaug, R-Nampa, who sponsored the bill, told the Statesman by email. “Children who struggle with gender dysphoria need real help, not pharmaceutical and surgical interventions that cause irreversible harm.”
Physicians told Idaho lawmakers this year that doctors here don’t offer surgeries to minors. But other treatments are sometimes prescribed after parents consult with medical and psychiatric doctors.
Major medical associations in the United States and Idaho have endorsed medical — including puberty blockers and hormone treatment — and therapeutic gender-affirming care for minors. That includes the American Medical Association, American Academy of Pediatrics, American Psychiatric Association and the Idaho Medical Association.
The standard of care for treating gender dysphoria includes puberty blockers and hormonal therapy, said Dr. Neil Ragan, a family doctor from Pocatello who provides gender-affirming services and opposed House Bill 71. Physicians will continue to consider data on gender-affirming care, and standards may evolve if scientific evidence calls for it, Ragan said by phone.
“What we don’t need is the Legislature, some of whom, honest to God, crawled out from under a rock last week, making medical decisions about things that they know absolutely nothing about,” Ragan said. “They don’t know a vagina from a hole in the wall, and they’re legislating decisions about the most personal, intimate, and sometimes painful decisions that an individual and family can make. They are patently disqualified to do so.”
Recent surveys have shown that gender-affirming care is unpopular among Americans. The majority of respondents to a recent Washington Post-KFF poll from this month said they oppose giving transgender youth access to gender-affirming medication, like puberty blockers and hormonal treatments.
Pew Research Center last year found that most Americans believe one’s gender is determined by their birth sex. Policies related to transgender issues are sharply divided along partisan lines. Strong majorities of Republican-leaning Americans support policies restricting access to sports and medical care for transgender youth.
Arkansas in 2021 became the first state to ban gender-affirming care for minors. Today, 18 states have similar restrictions and 13 other states have considered them, according to the Human Rights Campaign, an LGBTQ+ advocacy group. Last month, the group tracked more than 110 new bills that would limit access to gender-affirming care.
The new Idaho law, which is set to take effect Jan. 1, is among the strictest. Utah this year also banned gender-affirming care for minors, but the law provides an exception for some patients who had been previously diagnosed for treatment.
The Idaho law makes it a felony for a physician to treat a transgender minor with puberty blockers, hormone therapy or transition-related surgeries. A conviction carries up to 10 years in prison.
What puberty blockers, hormone treatments do
Puberty blockers suppress bodily changes that occur during puberty, such as body hair growth and voice-deepening in males and breast development and menstruation in females. Hormone therapy, on the other hand, activates bodily changes; for example, helping those seeking transition to grow breasts or deepen their voice.
Research has shown that puberty blockers can have negative effects on fertility and bone development. Ragan conceded that the medications aren’t without risk. But he added that treatment is about reducing overall harm that can come with gender dysphoria.
“We’re trying to help this kid survive through puberty and give them the room that they need to figure things out,” Ragan said. “Our position on that is informed by the fact that depression, anxiety, self-harm, suicide is such a problem in this community.”
Studies have shown that stress associated with discrimination and lack of access to medical care contribute to higher rates of suicidal thoughts among transgender people. Several transgender adolescents and their parents testified against House Bill 71 for that reason, saying gender-affirming medical care has positive effects on mental health.
“I’ve been able to get myself off a cliff that I wasn’t sure if I would ever find myself off of,” Eve Devitt, a 17-year-old transgender girl from Boise, told a House committee in February. “I feel so much better and more complete with myself.”
A 2020 study found that 82% of transgender people have considered killing themselves and 40% have attempted suicide. The researchers from the University of Toronto and Barry University in Florida found that among transgender youth, 56% reported a previous suicide attempt and 86% reported suicidal thoughts or intent.
While the effects of puberty blockers are reversible, hormone therapy, to a certain extent, causes permanent changes. That’s part of the reason hormone medication is sought after, McNamara said. Early treatment can spare someone “painful and difficult” gender-affirming surgery later in life, she said.
“That has huge implications for the individual, and it also cuts down on health care costs,” McNamara said by phone.
What will be the impact of Idaho’s ban?
An estimated 1,000 transgender teens live in Idaho, less than 1% of the state’s adolescent population, according to the Williams Institute, a policy research group at the University of California, Los Angeles.
Ragan guessed the number of transgender youth in Idaho who are receiving gender-affirming services is in the dozens. The American Civil Liberties Union of Idaho has promised to sue the state over House Bill 71, which could delay the Jan. 1 effective date.
“They feel as if the rug has been pulled out from under them,” said Ragan, who has treated LGBTQ+ patients for decades, including during his U.S. Navy service. “What the consequences will be, we don’t know yet.”
But one can “infer various types of harm” caused by a ban on gender-affirming care, McNamara said. Transgender youth who no longer have access to medication will experience changes in their appearance that don’t align with their gender identity, which can lead to “poor social functioning” in friendships, relationships and school, she said.
“Things that you want healthy young adults to experience are much harder for youth who want care and can’t access it,” McNamara said.
Additionally, a lack of access could lead to higher risk of suicide, the physicians said. Families with transgender children may choose to leave the state as a result, or they could turn to medications that can be purchased on the internet, which is “very unsafe,” Ragan said.
Skaug said he hopes parents don’t move for the purpose of obtaining medications or surgeries that will be banned in Idaho. Skaug pointed to data showing that, in most cases, gender dysphoria diagnosed in prepubescent children isn’t sustained in adolescence.
“My prayer is that parents choose best for their kids by getting them the traditional mental health treatment they need,” he said.
Physicians told the Statesman that mental health care alone isn’t enough for transgender minors who want medical care.
“These bans are creating a vacuum,” McNamara said. “We don’t have anything evidence-based to replace it with.”
