HELENA — Within the first month of the 2021 legislative session, transgender Montanans and their supporters are preparing to defend access to critical medical care for minors experiencing gender dysphoria

The issue arises from House Bill 113, sponsored by Rep. John Fuller, R-Whitefish, which awaits a hearing before the House Judiciary Committee. Fuller’s proposal would prohibit medical professionals from providing hormonal treatments or gender-affirming surgery to minors and issue fines ranging from $500 to $50,000 to those who violate the statute. Opponents argue these types of treatments are crucial for addressing gender dysphoria among minors, who may also be experiencing depression and anxiety. 

The bill mirrors proposals introduced in at least six other states. The ACLU of Montana and other groups that advocate for LGBTQ rights have vowed to aggressively fight the measure.

“All Montanans, and especially all Montana youth, deserve to be treated with dignity and respect,” said SJ Howell, executive director of Montana Women Vote, in a written statement. “Given how much HB 113 would harm young people, it is unconscionable that some lawmakers would consider supporting this legislation.”

Health care providers also plan to make their case to the judiciary committee, arguing that the legislation would do “incredible harm” to transgender youth across the state.

“This bill is an extreme rejection of thoughtful and effective medical treatment for a vulnerable group of children,” said Dr. Lauren Wilson, vice president of the Montana chapter of the American Academy of Pediatrics, in a statement she plans to deliver to the committee. “It would enact barriers that would cause Montana families irreversible harm and ultimately cost lives. We urge you to reconsider this intrusion into our exam rooms and this attack on the well-being of Montana youth.”

Describing his motivations for introducing the bill, Fuller said he adamantly opposes the prospect of minors receiving treatments for gender dysphoria that could have a lasting effect on their bodies and their lives. 

“I do believe that it’s morally wrong to subject them to irreversible medical treatment that would, at the very least, end any hope of them being able to reproduce,” Fuller said in an interview with Montana Free Press. “It is insane for treatment to involve the removal of healthy breasts or reproductive organs from minors. That’s insane.”

Fuller, a retired high school teacher who is also introducing a bill to ban trans women from participating in interscholastic sports that align with their gender identity, said he understands his bill will spark criticism.

“I’m not afraid to address controversial issues when the welfare of children and morality is at stake,” he said. “And consequently the pushback will come from people who have an agenda … and a vested interest to put forward the destruction of what I would call, traditional and classical and moral treatment of young people.”

“‘MISGUIDED’ ISN’T A STRONG ENOUGH WORD”

Medical professionals interviewed for this article said Fuller’s bill reflects a fundamental misunderstanding about gender-affirming care for minors, which begins with social transitioning and can eventually involve hormonal suppressants known as “blockers” that can be discontinued at any time. 

“Nobody is doing surgery on young children,” said Wilson, with the American Academy of Pediatrics, in a recent interview. “It’s just not happening.”

“[Blockers] are completely reversible,” said Dr. Juanita Hodax, a pediatric endocrinologist with Seattle Children’s Hospital who also operates a remote clinic in Missoula. “They’re a great way to kind of pause kids’ puberty from happening so they have time to get to an older age where they can make more decisions about medication or surgery.”

For youth with gender dysphoria, puberty “just really increases their level of anxiety and distress. They just start to feel so uncomfortable in their bodies,” Hodax said. “Medically what we can offer is puberty blockers … that alone can really help to alleviate so much of that anxiety and discomfort.”

“As medical providers, our main goal is that kids are healthy and happy. I think for a lot of transgender youth, the medications that this bill is banning are necessary for kids to be healthy and happy. I think the decision to start those medications should really be up to the patient and their family and medical providers.”

Dr. Juanita Hodax, pediatric endocrinologist, Seattle Children’s Hospital

Discussing estrogen or testosterone treatments and possible surgery, Hodax said, comes later in an adolescent’s development. The World Professional Association for Transgender Health recommends that medical providers advise patients interested in surgically altering their genitalia to wait until the age of 18, making those procedures exceedingly rare among minors. A gender-affirming mastectomy, commonly referred to as top surgery, is also an option that patients and their families usually consider in later teenage years, after blockers or hormone treatments. Many transgender people, including adults, do not pursue surgery as part of their transition.

By banning medical providers from treating gender dysphoria with this range of options, Hodax and Wilson said, House Bill 113 would only increase mental health risks for patients.

“Waiting [to offer treatment] until someone’s 18 means they go through irreversible changes of puberty in a gender that they don’t feel comfortable being,” Wilson said, referring to certain physical characteristics. “And those changes are often the trigger that make someone commit suicide or attempt suicide.”

“As medical providers, our main goal is that kids are healthy and happy,” Hodax said. “I think for a lot of transgender youth, the medications that this bill is banning are necessary for kids to be healthy and happy. I think the decision to start those medications should really be up to the patient and their family and medical providers,” she said. 

Many patients and their parents also disagree with Fuller’s characterization of these medical treatments, based on their own experiences. 

Justin Terry, 16, said he was first diagnosed with gender dysphoria when he was 10 years old, but knew he was a boy at a much younger age. As soon as he understood there were hormonal treatments to help him transition, he wanted to take them. 

“I wasn’t really scared about what anyone else had to think or say about it. I just figured, some people would accept it and some people would have a hard time with it,” Terry said. “And no matter what happens, it’s not like I can avoid it my whole life or anything. It’s something that I definitely knew I had to do.”

Despite receiving a diagnosis from multiple therapists, finding a doctor to prescribe medical treatments for gender dysphoria in his hometown of Helena was difficult, said Terry’s mother, Jaime Gabrielli. Eventually, they started seeing a specialist in Missoula who prescribed testosterone treatments that Terry has been taking for just over a year.

“Now that I’m here, I don’t know where I’d be without it,” he said, referring to the medicine. Looking ahead to future treatments, Terry said he’s waiting to find out if his insurance company will cover the cost of top surgery. The thing he’s most looking forward to after that, he said, is eventually feeling comfortable enough to go swimming, an activity he’s avoided for years. 

“I think that it’s important to also realize that this is not a spontaneous or impulsive decision,” Gabrielli said. “It’s an incredibly difficult process and you have to be very determined to see this through, especially with a young person who’s transgender here,” she continued, referring to Montana.

Other parents of transgender children echoed that identifying gender dysphoria and finding proper treatments can already be an exhausting journey. 

Adam and Vickie Edelman lost their 18-year-old child Sam to suicide in February 2016. Sam, who asked that his family refer to him with the pronouns he and him, had recently begun taking hormones to help him transition from male to female after a Bozeman doctor originally denied that treatment because of Sam’s age. Having gone through puberty and living with depression for several years, Sam felt taking hormones was a major step in the right direction, his parents said.

“Certainly the beginning of the hormone therapy, which I think, as really the formal beginning of the transition, was a milestone and positive,” said Adam Edelman. “He was on a trajectory and focusing on that positive. But, you know, he wanted to move that along.”

Sam found camaraderie with other women and trans students at the University of Montana. But ultimately, he expressed frustration about the pace of his transition and a sense of hopelessness that he would ever appear as the woman he knew himself to be. He died during the winter of his freshman year. 

In the years since, the Edelmans have been committed to sharing their story with the hope of reaching other transgender kids and their families who may be struggling. Hearing about House Bill 113, they said, has brought up a slew of complicated feelings. 

“Frankly, it’s heartbreaking. ‘Misguided’ isn’t a strong enough word,” said Adam Edelman. “I mean, these are our children. These are some of the most vulnerable members of our society that we all share a role in protecting and supporting. And something so fundamental for trans kids, to work to prevent them from having access to that. It is, it’s heartbreaking.”

“It’s heartbreaking and frustrating that legislators want to legislate what’s best for a child who’s in need of health care,” added Vickie Edelman.

The bill is sure to face a series of contentious hearings in the Legislature and will likely be challenged in court if it becomes law. As the public debate unfolds, Justin Terry and other advocates want to make sure that transgender kids and their families feel supported. 

“It’s definitely really easy to feel hopeless before you have any access to hormones or surgery or anything,” Terry said. “It’s really easy to feel like you’re kind of not getting anywhere and it’s not ever going to happen. But it does happen and … it all starts to kind of come together,” he continued. “So, I mean, just hang in there.”

If you are transgender or questioning your gender identity and want to talk to a supportive person, the number for the Trans Lifeline is 877-565-8860. The number for the National Suicide Prevention Lifeline is 1-800-273-8255.

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Mara covers Montana’s social welfare, criminal justice and legal systems. She also tracks policy and social issues that affect LGBTQ+ people. Prior to joining Montana Free Press, Mara worked at Slate and WNYC, where she focused on radio and podcasts. She got her start in audio journalism as an intern at Montana Public Radio. Contact Mara at msilvers@montanafreepress.org, 406-465-3386 ext. 3, and follow her on Twitter.