U.S. Supreme Court agrees to hear case challenging laws like Kentucky's that ban gender-affirming health care for minors

Photo illustration by Shutterstock Creative

By Mark Sherman

Associated Press

The U.S. Supreme Court on Monday jumped into the fight over transgender rights, agreeing to hear an appeal from the Biden administration seeking to block bans on gender-affirming care like the one in Kentucky.

The justices’ action comes as Republican-led states have enacted a variety of restrictions on health care for transgender people, school sports participation, bathroom usage and drag shows. The administration and Democratic-led states have extended protections for transgender people, including a new federal regulation that seeks to protect transgender students.

The case involves a Tennessee law that restricts puberty blockers and hormone therapy for transgender minors. The federal appeals court in Cincinnati allowed the law and a similar one in Kentucky to take effect after lower courts had blocked them. The high court took only the Tennessee case, but a ruling in it will control the Kentucky case, lawyers for the Kentucky plaintriffs told Alex Acquisto of the Lexington Herald-Leader.

In their appeal, lawyers for the transgender teens in Tennessee told the justices, “Without this Court’s prompt intervention, transgender youth and their families will remain in limbo, uncertain of whether and where they can access needed medical care.” Arguments will take place in the fall.

Last month, South Carolina became the 25th state to adopt a law restricting or banning gender-affirming medical care for transgender minors, even though such treatments have been available in the United States for more than a decade and are endorsed by major medical associations.

Most of the state bans face lawsuits. The justices had previously allowed Idaho to generally enforce its restrictions, after they had been blocked by lower courts.

Kentucky and at least 23 other states ban transgender women and girls from competing in certain female sports competitions. At least 11 states have adopted laws barring transgender girls and women from girls’ and women’s bathrooms at public schools, and in some cases other government facilities.

The nation’s highest court has only rarely taken up transgender issues. In 2020, the justices ruled that a landmark civil-rights law protects gay, lesbian and transgender people from discrimination in employment.

Gender-affirming care includes a range of medical and mental health services to support a person’s gender identity, including when it’s different from the sex they were assigned at birth.

The services are offered to treat gender dysphoria, the unease a person may have because their assigned gender and gender identity don’t match. The condition has been linked to depression and suicidal thoughts.

Gender-affirming care has counseling and treatment with medications that block puberty, and hormone therapy to produce physical changes. Those for transgender men stop periods, increase facial and body hair and deepen voices, among other things. The hormones used by transgender women can slow growth of body and facial hair and increase breast growth.

Gender-affirming care can also include surgery, including operations to transform genitals and chests. These surgeries are rarely offered to minors.

Every major U.S. medical group, including the American Academy of Pediatrics and the American Medical Association, has opposed the bans and said that gender-affirming treatments can be medically necessary and are supported by evidence.

But around the world, medical experts and government health officials are not in lockstep. Some European countries in recent years have warned about overdiagnosis of gender dysphoria. England’s health service stopped prescribing puberty blockers to children with gender dysphoria outside of a research setting.

Contributing: Geoff Mulvihill and Carla K. Johnson, AP.

Beshear defends pandemic work as Cameron cites learning loss, makes false claim about founder of Planned Parenthood

Candidates' supporters at KET Monday night (Kentucky Lantern photo by Matthew Mueller)

By Al Cross
Kentucky Health News

In their next-to-last debate before the Nov. 7 election, Gov. Andy Beshear defended his response to the Covid-19 pandemic against criticism from Republican Attorney General Daniel Cameron. Appearing for an hour on KET, the candidates also debated each other's positions on abortion, and Cameron made  a false claim about the founder of Planned Parenthood.

Moderator Renee Shaw opened the "Kentucky Tonight" forum by asking Cameron how he would have handled the pandemic that hit the state in March 2020. He said he would have "done like other red-state governors" and tried to get businesses "open as quickly as possible."

Asked if he would have shut down schools at any point, he did not say, but said "I wouldn't have infringed on your constitutional rights." That was a reference to court decisions, some successfully sought by Cameron, that said a few of Beshear's state-of-emergency restrictions went too far.

Beshear was asked if he had any misgivings about the strength and duration of his restrictions, specifically the application on Easter Sunday of his ban on mass indoor gatherings.

He did not address that specific point, but said, "This is about leadership. I showed people during the pandemic I was willing to make the hard decisions, even if it cost me. I put politics out the window, and I made the best decisions I could to save as many lives as possible.”

Asked if he would do it all over again the same way, Beshear didn't answer directly, but said "I believe we made the best decision we did with the information we had," and said he was the first governor to prioiritized teachers for immunizations when vaccines for Covid-19 became available.

Cameron claimed that Beshear "said he had no regrets," and said he would not admit regret "because of pride."

Noting repeatedly that Beshear closed schools, Cameron said "Your kids are behind because of this short-sighted decision," and noted his "catch-up plan" to help them.

Beshear, asked if he has a strategy for that, said he does, but tried to spread blame to the Republican-controlled legislature: "This is something that was happening before the pandemic, primarly because of not enough educators," due to low pay causing teacher shortages.

He also shifted blame when asked if he would take responsibility for the huge backlog in unemployment claims during the pandemic. He noted the downsizing of the agency under his GOP predecessor and said "If we'd had the resources that were there in the last administraton we could have done much better."

Abortion

Cameron has said that if the legislature sent him a bill to put rape and incest exceptions into the state's abortion ban, he would sign it. Asked to say "yes or no" if he personally favors such exceptions, he repeatedly declined to answer, and made a false claim about the founder of Planned Parenthood.

Cameron, an African American, noted the organization's strong support of Beshear, and said its founder, Margaret Sanger, favored the extermination of his race. This claim has been made and debunked several times, but Cameron said Sanger "said I didn't deserve to live." UPDATE, Oct. 25: In a debate Tuesday night, Cameron put it another way: "Margaret Sanger wanted to destroy the Black community," and said 79% of abortion clinics are in Black neighborhoods. 

Sanger believed in eugenics, which taught white superiority and discouraged reproduction of races and ethnicities it deemed inferior. In 1939 she started a project to expand birth-control services for African Americans in the South. In a letter, she told a director of the program that it should hire African American doctors and ministers to gain trust in Black communities because “We do not want word to go out that we want to exterminate the Negro population ...”

That was “inartfully written” but was “frequently taken out of context to suggest Sanger was seeking to exterminate blacks,” The Washington Post reported in 2015. The Reuters news service said in a fact check last year, "Sanger’s concern was to avoid a suspicion that the program’s objective was to stop Black people having babies, which having white people in charge could create."

Sanger's full quote was, “We do not want word to go out that we want to exterminate the Negro population, and the minister is the man who can straighten out that idea if it ever occurs to any of their more rebellious members.”

During the debate on abortion, Shaw noted that Cameron and 18 other attorneys general signed a letter in June opposing a proposed federal privacy rule that would keep state officials from getting information on any reproductive health-care services that in-state residents obtained outside the state, and asked if he wants to criminalize women seeking abortions.

"Absolutely not," Cameron replied, returning to the attack: "Andy Beshear is trying to gaslight you tonight. . . . He wants no limits on abortion." Not so, Beshear said.

Asked if a woman be allowed to terminate a pregnancy at any point, Beshear said his long-held position is that "I am in favor of reasonable restrictions on abortion, especially late-term abortions. . . . He signed a letter saying that he should be able to come after your medical record if you go out of state for care."

On another hot-button social issue, Beshear was asked about an early campaign commercial in which he said that transgender surgeries are not performed on minors in Kentucky. A letter from UK HealthCare, written in March but not released by state Rep. James Tipton, R-Taylorsville, until August, said UK had “a small number of non-genital gender reassignment surgeries on minors, such as mastectomies for older adolescents.”

Shaw asked Beshear if he knew that when he made the ad. He said, "No, I didn't know."

Numerous pro-Cameron commercials have used the ad and the letter to argue that Beshear was lying. Immediately after Beshear answered, Cameron claimed, "The governor just told you a lie," because Beshear vetoed this year's Senate Bill 150, which banned transition surgeries for minors after the legislature overrode the veto.

Beshear said the bill "had a lot more in it" than the ban, but "Our parents should be able to make complicated medical decisions, rather than the government . . . This was all passed just for political points."

The candidates' final debate is scheduled for 7 p.m. ET Tuesday on Lexington's WKYT-TV and on sister Gray Television stations in Evansville, Ind., and Bowling Green.

Appeals court rules law banning gender-affirming care for minors can stay in effect as lawsuit against it moves through lower court

By Melissa Patrick
Kentucky Health News

A panel of the 6th Circuit U.S. Court of Appeals ruled 2-1 Thursday that Kentucky's ban on gender-affirming care for transgender minors will stay in place while a lawsuit against it moves through a lower court.

The ruling was in response to an injunction request against parts of 2023 Senate Bill 150, filed by the National Center for Lesbian Rights and the American Civil Liberties Union of Kentucky on behalf of seven Kentucky minors and their parents seeking medically necessary care for transgender youth in Kentucky.

The Republican-controlled legislature enacted SB 150 earlier this year over Democratic Gov. Andy Beshear's veto. Among other things, the bill bans health-care providers in Kentucky from performing gender-related surgeries on minors. It also bans providers from prescribing drugs that delay, stop or alter puberty.

In the same ruling, the appeals-court panel also upheld a similar law in Tennessee. The panel heard oral arguments in the cases Sept. 1.

 
In the majority opinion, Chief Judge Jeffrey Sutton wrote: “No one in these consolidated cases debates the existence of gender dysphoria or the distress caused by it. And no one doubts the value of providing psychological and related care to children facing it.

"The question is whether certain additional treatments — puberty blockers, hormone treatments, and surgeries — should be added to the mix of treatments available to those age 17 and under. . . . This is a relatively new diagnosis with ever-shifting approaches to care over the last decade or two. Under these circumstances, it is difficult for anyone to be sure about predicting the long-term consequences of abandoning age limits of any sort for these treatments."

In her dissenting opinion, Judge Helene White said, "The statutes we consider today discriminate based on sex and gender conformity and intrude on the well-established province of parents to make medical decisions for their minor children.”

She concluded, "Tennessee’s and Kentucky’s laws tell minors and their parents that the minors cannot undergo medical care because of the accidents of their births and their failure to conform to how society believes boys and girls should look and live. The laws further deprive the parents—those whom we otherwise recognize as best suited to further their minor children’s interests—of their right to make medical decisions affecting their children in conjunction with their children and medical practitioners."

Attorney General Daniel Cameron claimed victory in what he called "his fight to protect Kentucky children from experimental sex-change treatments."

“These gender interventions, billed as medical care, cause permanent harm to vulnerable children and their health,” Cameron said in a press release. “Despite full-throated denials by Gov. Beshear and his far-left activists, our children would still be under attack without SB 150. Andy Beshear won’t protect our kids, but I will, and I am proud to carry the mantle for this important law.”

The ACLU called the ruling a "temporary setback."

Corey Shapiro, legal director for the ACLU of Kentucky, said in a statement, "The majority ignored the extensive evidence from the actual medical experts and the trial court who all agreed that this care is medically necessary, effective, and appropriate."

An ACLU spokesperson told Sarah Ladd of the Kentucky Lantern that the group will review the opinion and look at whether to seek relief from the entire 6th Circuit U.S. Court of Appeals or the U.S. Supreme Court.

Three U.S. appeals court judges hear arguments on new law restricting health care for transgender minors in Kentucky

By Sarah Ladd
Kentucky Lantern

A three-judge federal panel on Friday heard opposing arguments over Kentucky’s ban on gender-affirming medical care for transgender minors, after first hearing arguments in a similar case in Tennessee.

Stephanie Schuster presented arguments for the American Civil Liberties Union of Kentucky and the National Center for Lesbian Rights, which are suing on behalf of seven anonymous transgender minors and their parents seeking to restore access to hormone treatments and puberty blockers for transgender minors in Kentucky.

Attorney General Daniel Cameron’s office is fighting to keep the ban imposed by Senate Bill 150, which the Republican-controlled legislature enacted earlier this year over Democratic Gov. Andy Beshear’s veto.

Schuster argued that SB 150 is inherently discriminatory on the basis of sex because a patient’s biological sex – what was assigned at birth – would need to be known for treatment to be legal or illegal.

Solicitor General Matthew Kuhn argued for Cameron that the law deals with “regulating the practice of medicine” and is not sex-based discrimination. He said the state “has chosen a particular condition and has chosen particular treatments for that condition and restricted that. That is not a a sex-discrimination issue.”

Judges Jeffrey Sutton, Amul Thapar and Helene White heard
arguments at the Cincinnati court. (L.A. Blade photo illustration)

The arguments before a three-judge panel of the 6th Circuit U.S. Court of Appeals in Cincinnati came after the same panel rejected on a 2-1 vote an August request from the ACLU of Kentucky to let transgender minors get certain medical care, such as puberty blockers.

SB 150 also bans gender-related surgeries like phalloplasty, vaginoplasty or hysterectomies and vasectomies on minors. But neither the ACLU nor Kentucky LGBTQ+ organizations are challenging the ban on such surgeries.

Schuster argued, “The evidence in this record shows that withholding treatment – even up until the age of 18 – and allowing puberty to occur consistent with the sex identified at birth is extraordinarily harmful to these children.

“And what this regulates is not just procedures that they can’t get until the age of 18. It’s many aspects of these children’s lives while they’re in school and able to get treatment that is medically indicated and medically necessary for them to live and develop into functioning and happy adults.”

Friday’s arguments — streamed to the press and public with audio only — were heard by Chief Judge Jeffrey Sutton and judges Amul Thapar and Helene White.

One of the judges said “I feel like there’s compassion (in) both directions.”

He continued: “It’s not crazy to say that there’s a compassion component to the other side of this, that maybe this is the kind of thing some people might regret if they do it at age 14, 15.”

Kuhn argued that the law is indeed “a compassion measure.”

“The plaintiffs think that Senate Bill 150 is going to cause harm to children,” Kuhn said in rebuttal. “And the Kentucky General Assembly thinks it’s going to prohibit harm for children.”

2-1 appeals court ruling will interrupt gender-affirming care for Ky. transgender youth as the new law against it moves through courts

Judges Jeffrey Sutton, Amul Thapar and Helene White are pictured in front of the Potter Stewart Courthouse in Cincinnati, where their Sixth Circuit U.S. Court of Appeals sits. (L.A. Blade illustration)

By Melissa Patrick
Kentucky Health News

A federal appeals court panel voted 2-1 last Monday to allow Kentucky to enforce a recently enacted ban on gender-affirming care for transgender youth while the law that imposed the ban works its way through the courts. The ruling will have a health impact on transgender youth undergoing treatment.

The provisions in 2023 Senate Bill 150 under legal challenge are the ones that ban gender-affirming medical care for minors diagnosed with gender dysphoria, such as hormone therapy and puberty blockers.  

The American Civil Liberties Union of Kentucky has filed a motion asking that the entire Sixth Circuit Court of Appeals review the ruling, which would involve all 16 judges instead of the three-judge panel.

ACLU Communications Director Angela Cooper said the motion was filed because the ruling risks "irreparable harm" to some transgender youth.

"Youth who are already receiving puberty blockers and hormone therapy are being forced to taper off that service or seek it out of state," Cooper said. "We don't advise clients on what to do about their medical choices, but they are being forced to make very serious decisions about their health that go against the advice of their physician and the prevailing standard of care." 

She added that the medications are "prescribed by their doctor, in accordance with the prevailing standard of care. It's the same as any other medication and it should not be denied." 

Gender-affirming care is considered the accepted standard of care and is recommended by a broad range of medical associations, including the American Medical Association and the American Academy of Pediatrics. 

In early August, the AAP reaffirmed its policy to support gender-affirming medical care for transgender youth, while also taking steps to commission a systematic review of medical research and treatments. The group said it opposed "any laws or regulations that discriminate against transgender and gender-diverse individuals, or that interfere in the doctor-patient relationship." 

The AMA has strongly opposed laws that ban gender-affirming care for transgender youth, while voicing concerns about the increased risk of mental-health conditions, including depression, anxiety and suicidality, that transgender youth often experience – especially when they lack appropriate supports.

"It is important to note that this higher suicide risk is not unavoidably associated with transgender or nonbinary status, but instead is the result of stigma, discrimination and mistreatment," Dr. Jack Resneck, immediate past president of the AMA, wrote last August. "A large body of medical literature demonstrates that with support at home, school and in the community – and with access to gender-affirming care – transgender youth do as well on mental-health measures as their non-transgender peers." 

Kentucky's ban was set to take effect in late June, but on June 28 U.S. District Judge David Hale placed a temporary block on the section of the law that dealt with gender-affirming care. After the same Sixth Circuit panel issued a similar ruling in a Tennessee case, Hale lifted his injunction. Four days later, on July 18, the ACLU filed for emergency relief that would allow gender-affirming care while the lawsuit worked its way through litigation. On July 31, the request was rejected. 

Attorney General Daniel Cameron, the Republican nominee for governor against Democratic Gov. Andy Beshear, applauded the appeals court ruling, which allows SB 150 to be enforced in full. "Last night’s ruling was a win for Kentuckians and a win for our values," he said in an Aug. 1 news release.

The ruling was not unexpected, given the Tennessee ruling. It was written by Chief Judge Jeffrey Sutton, an appointee of George W. Bush, and Judge Amul Thapar, an appointee of Donald Trump.  

They said the issues involved – irreparable harm, the balance of harms, the public interest and the ACLU's likelihood of success on the merits – are best left to the legislature rather than judges: “The people of Kentucky enacted the ban through their legislature. That body, not the officials who disagree with the ban, sets the Commonwealth’s policies.”

Judge Helene White, who was first nominated by former President Bill Clinton and later nominated by Bush, dissented.

She wrote that the need for an injunction to block the ban in Kentucky was greater than in Tennessee because "Kentucky's law provides no grace period during which patients receiving care may continue treatment. Instead, health-care providers must immediately cease treatment or "institute a period during which the minor's use of the drug or hormone is systematically reduced."

Tennessee's law allows minors that are receiving treatment to keep getting it until March 31, according to the appeals court's decision. 

The decision ruling is preliminary. An expedited final ruling on the lower court's ban is expected by Sept. 30. 

"At least 20 states have now enacted laws restricting or banning gender-affirming medical care for transgender minors. Most of those states face lawsuits. A federal judge struck down Arkansas’ ban as unconstitutional. In other states, judges have issued disparate rulings on whether the laws can be enforced while the cases are being litigated," The Associated Press reports.   

If you’re looking for transgender peer support, you can reach Trans Kentucky at 859-448-5428 or online at transkentucky.com. You can also contact the Trevor Project, which provides free, confidential counselors who specialize in helping LGBTQ youth.

Judge reverses his ruling that blocked law on gender-affirming care, citing 2-1 ruling of appeals court handling similar cases

By Sarah Ladd
Kentucky Lantern

A federal judge on Friday stayed a temporary block on part of a new Kentucky law that banned gender-affirming medical care for transgender minors.

That means Kentucky’s transgender children are now banned from receiving hormone treatments, a move celebrated by Attorney General Daniel Cameron, who requested the reversal.

Corey Shapiro, legal director for the American Civil Liberties Union of Kentucky, gave the other side: “While we strongly disagree with this opinion, it is only in effect while our appeal is pending in front of the Sixth Circuit. It is not the final word, and we remain optimistic that with a full briefing we will achieve a positive result.”

District Judge David Hale

In late June, U.S. District Judge David Hale sided with the ACLU of Kentucky in temporarily blocking the part of Senate Bill 150 that banned certain health-care options, such as puberty blockers, for transgender minors.

Last week a panel of the 6th Circuit Court of Appeals, in a 2-1 decision, overturned a similar district court ruling in Tennessee, allowing that state’s ban on gender-affirming medical care for minors to take effect.

Hale, an appointee of Barack Obama, based his latest decision on the appeals court ruling in the Tennessee case.

Cameron, who is running for governor, said in a statement that the ruling was a “win for parents and children.” He also criticized the “influences of leftist activists.” 

“Moving forward, my office will continue to defend Senate Bill 150 and stand up for the right of children to be children,” Cameron said.

State Sen. Max Wise, who sponsored SB 150, also celebrated the court’s decision.

“I’m pleased to know the holistic well-being of Kentucky’s transgender children, at least for now, will be fully considered,” said Wise, a Republican from Campbellsville.

Rebecca Blankenship, executive director of Ban Conversion Therapy Kentucky, and Michael Frazier, its government-affairs director, said in a joint statement that the decision marks “an extremely difficult moment” for the state’s trans children.

The decision, they said, “was a lost battle, but not the end of the war in this case or the broader fight to protect Kentucky’s kids.”

Federal judge blocks part of Senate Bill 150 that would block gender-affirming health care for transgender minors in Kentucky

By Sarah Ladd
Kentucky Lantern

A federal judge has blocked, at least temporarily, part of a recently passed state law banning gender-affirming health care for transgender minors.

U.S. District Judge David J. Hale ruled on Senate Bill 150, which the General Assembly passed in April. “The treatments barred by SB 150 are medically appropriate and necessary for some transgender children under the evidence-based standard of care accepted by all major medical organizations in the United States,” he wrote.

The American Civil Liberties Union of Kentucky filed to block SB 150 in May, asking for a preliminary injunction to block part of the bill while the larger legal challenge plays out. The legislation was to take effect Thursday.

The ACLU specifically took issue with the portion of the bill that prohibits health-care providers from prescribing puberty blockers or hormones, performing surgeries like phalloplasty and vaginoplasty or hysterectomies and vasectomies on minors. 

Judge David J. Hale

Hale wrote, “These drugs have a long history of safe use in minors for various conditions. It is undisputed that puberty blockers and hormones are not given to pre-pubertal children with gender dysphoria.”

Hale was appointed by Barack Obama in 2014. In Tennessee, a federal judge appointed by Donald Trump ruled likewise in a similar case on the same day Hale ruled. Earlier, there were such rulings from an Obama-appointed judge in Arkansas and one in Florida named by Bill Clinton.

Judge Eli Richardson of Tennessee wrote, "To the court’s knowledge, every court to consider preliminarily enjoining a ban on gender-affirming care for minors has found that such a ban is likely unconstitutional."

Transgender advocates have said such surgeries on minors are not happening in Kentucky. The state's first openly trans elected official, Berea school board member Rebecca Blankenship, said on a recent KET appearance that “every LGBT organization in the commonwealth said that we were absolutely fine with banning those sorts of surgeries for minors. . . . We might as well ban unicorn attacks; it makes no difference.”

Attorney General Daniel Cameron called the ruling “misguided.” Cameron, the Republican nominee for governor, said in a press release that SB 150 is a “commonsense law that protects Kentucky children.”

“There is nothing ‘affirming’ about this dangerous approach to mental health,” hesaid. “My office will continue to do everything in our power to defend this law passed by our elected representatives.”

Cameron’s opponent, Democratic Gov. Andy Beshear, vetoed SB 150, but Republican-controlled legislature easily overrode him.

Blankenship, executive director of Ban Conversion Therapy Kentucky, said in a joint statement with Michael Frazier, a lobbyist for the group, that “puberty blockers and hormone therapy save lives.”

National Center for Lesbian Rights Legal Director Shannon Minter called the decision a “a huge relief for the families targeted by this unnecessary and harmful law. She said the law “prevents doctors from doing their jobs and parents from making medical decisions for their own children.”

Backers of laws on transgender care often have misconceptions and misinformation that make details of care hard to understand

Movement Advancement Project chart, adapted by KHN; click to enlarge; notes and details are here.

By Helen Santoro
KFF Health News

Legislators in states that have limited gender-affirming treatment for minors say their intent is to protect children and families from pressure “to receive harmful, experimental puberty blockers and cross-sex hormones and to undergo irreversible, life-altering surgical procedures,” as a new Montana law puts it.

“Gender transitions involving major surgeries not only result in sterility, but other irreversible negative biological effects,” said Montana state Sen. John Fuller, the Republican who introduced the bill.

Such laws and policies — and statements such as Fuller’s that are used to justify them — can reflect misconceptions and misinformation that conflate and confuse different treatments.

Gender-affirming care is a broad term for many distinct treatments provided to children, teens, and adults. Puberty blockers, for example, are medications that inhibit puberty by suppressing the body’s production of sex hormones, while hormone therapy is the administration of testosterone or estrogen to alter secondary sex characteristics.

One common misbelief heard when legislation is discussed is that gender-affirming medical interventions are provided immediately to any trans or nonbinary child who walks into a gender clinic.

The reality is that the process informing these treatments is long and intensive. Before any medical or surgical interventions, kids must first be diagnosed with gender dysphoria, which, for pre-pubescent youth, involves experiencing significant distress for at least six months from at least six of a set of causes, including a strong desire to be of the other gender, and a strong dislike of one’s sexual anatomy. Youth who have gone through puberty must meet two of the criteria for a diagnosis.

Standards of care set by the World Professional Association for Transgender Health encourage health care professionals to perform a comprehensive assessment of a child’s or teen’s “strengths, vulnerabilities, diagnostic profile, and unique needs” before providing any medical or surgical interventions. Without this assessment, other mental health issues “that need to be prioritized and treated may not be detected.”

The time it takes to perform this assessment varies from patient to patient, said Jack Turban, an assistant professor of child and adolescent psychiatry at the University of California-San Francisco. Turban may see someone who is 12 years old and asking for puberty blockers. This hypothetical patient has known they are trans since they were 5, and has already adopted a new name and pronouns that match their gender identity.

“That’s going to be a much shorter assessment to know that they are ready for treatment when compared to somebody who has only understood their trans identity for six months” and has other complex mental health conditions like schizophrenia, Turban said.

To receive puberty blockers, kids must also have experienced the onset of puberty, or Stage 2 on the Tanner Scale of developmental change. This is marked by physical changes like the development of breast buds or testicle growth, and tends to happen between the ages of 9 and 14 in children with testes and 8 and 13 in those with ovaries. By pausing puberty, these drugs buy children more time to explore their gender identity before undergoing permanent and potentially unwanted pubertal changes.

The age at which trans minors receive gender-affirming hormone therapy depends on the patient’s ability to provide informed consent for the treatment, which can happen when they’re as young as 12 or 13 years old. The Endocrine Society says most adolescents have “sufficient mental capacity” to consent by the time they’re 16.

“We offer hormones to patients who are experiencing gender incongruence when patients and families are ready. This may be at an earlier age so that patients can go through puberty alongside their cisgender peers, or later, if they choose to,” said Mandy Coles, co-director of the Child and Adolescent Transgender Center for Health at Boston Medical Center. “If someone says, ‘I’m interested in estrogen,’ I say, ‘Great. What are the things that you are hoping to get out of that?’ Because it’s incredibly important to speak to patients and families about what medications can do, and what they can’t do.”

Coles said she also makes sure to talk continuously about consent with both the child and parents throughout the treatment process and lets her patients know they can stop taking hormones at any time.

Some physical changes brought about by gender-affirming hormone therapy are reversible. For example, decreased muscle strength and body-fat redistribution caused by estrogen can reverse once a person stops taking the hormone, though these changes become more fixed the longer someone uses it — but breast growth from estrogen or a deepening of the voice caused by testosterone are not reversible.

If a trans person decides to receive gender-affirming surgery, clinics require that the individual receive letters from one or more providers stating they have persistent and well-documented gender dysphoria, any significant mental health concerns they have are sufficiently controlled, and they can consent to the surgery. For genital, or “bottom,” surgery, the letter may also need to state that the individual has been living full time in their “identified gender” for at least 12 months.

Most medical centers require individuals to be at least 18 years old for bottom surgery and chest, or “top,” surgery, though some do perform top surgery on younger teens if the patient, their parents, and health care providers agree the procedure is appropriate.

Much of the confusion is over puberty blockers, drugs that have been used for decades for children who enter puberty too early. A common assertion that anti-trans groups and legislators make is that puberty blockers are dangerous and lead to infertility. This is not the case, said Coles. “Puberty blockers are fully reversible medications. They work like a pause button on puberty.”

Fertility may be impaired, however, in those who go straight from puberty blockers to hormone therapy, which is why the current medical guidelines require fertility counseling prior to any gender-affirming medical care, said Turban.

The Food and Drug Administration has not approved the use of puberty blockers for gender-affirming care. However, 10 to 20% of prescriptions across all medications are for “off-label,” or unapproved, use — and the rate is even higher for prescriptions to children.

“We know that taking away the decision to use blockers from parents and providers leads to poor health outcomes for patients,” said Coles.

A study by Turban and colleagues found that trans adults who received puberty blockers during adolescence were less likely to have suicidal thoughts than those who wanted puberty blockers but did not receive them. The same benefits have been found with gender-affirming hormone therapy.

In a study of data from nearly 28,000 trans adults who responded to the 2015 U.S. Transgender Survey, Turban and fellow researchers found that people who received gender-affirming hormone therapy during adolescence had more favorable mental health outcomes than those who didn’t take hormones until they were adults.

Additionally, a study of 104 young trans and nonbinary patients at the Gender Clinic of Seattle Children’s Hospital found those who had started on puberty blockers or hormone therapy had 60% lower odds of depression and 73% lower odds of self-harm or suicidal thoughts than peers who hadn’t received those treatments.

There is much misinformation claiming that providers of gender-affirming care are permanently harming vulnerable children, said Coles. “Denying access to care harms transgender and gender-diverse kids,” she said. “Gender-affirming care is not new. It’s the attacks on care that are new.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at the Kaiser Family Foundation, an independent source of health policy research, polling, and journalism. Learn more about KFF.

OPINION: Criminologists say baseless anti-transgender claims fuel adoption of harmful laws in Kentucky and other states

By Henry Fradell and Alexis Rowland
Republished from The Conversation

It has been seven years since North Carolina made headlines for enacting a “bathroom bill” — legislation intended to prevent transgender people from using restrooms that align with their gender identity. After boycotts threatened to cost the state more than $3.7 billion, legislators repealed the law in 2017. Since then, however, religious and political conservatives have successfully spread an anti-trans moral panic, or irrational fear, across the United States.

As far back as 2001, Republican lawmakers proposed the first of what are now nearly 900 anti-LGBTQ+ bills. More than 500 of these were introduced in 49 state legislatures and the U.S. Congress during the first five months of 2023. To date, at least 79 have passed.

Many of these laws have been  written and financed by a group of far-right interest groups, including the Alliance Defending Freedom, the Family Research Council, the American Principles Project and Liberty Counsel.

These groups claim the laws protect cisgender women and girls – whose gender identity matches the sex they were assigned at birth – from violent trans people who are often depicted in movies and other media.

But as criminologists, we know these claims are without merit. No reliable data supports the argument that transgender people commit violent crimes at higher rates than cisgender men and women. In fact, transgender people are more than four times as likely to be the victim of a crime as cisgender people.

In the last year, at least 18 states including Kentucky have enacted laws that limit medically age-appropriate gender-affirming health care for trans minors, with similar bills pending in 14 more states. And Florida’s barrage of anti-LGBTQ+ regulations even prohibits the mere discussion of sexuality and gender identity in schools through the 12th grade. Journalist Adam Rhodes called these efforts a “centrally coordinated attack on transgender existence.”

We believe these laws and bills illustrate the increasingly hostile legislative landscape for LGBTQ+ people despite polls showing that most people in the United States want trans people to be protected from discrimination in public spaces on the basis of their gender.

What the data show

A variety of myths, false narratives, bad science, misconceptions and outright misrepresentations undergird anti-trans laws. The reality, however, is that trans-exclusionary laws do not protect cisgender women and girls from harassment or violence. Rather, they result in dramatic increases in violent victimization for transgender and gender-nonconforming adults and children.

When laws permit transgender people to access sex-segregated spaces in accordance with their gender identities, crime rates do not increase. There is no association between trans-inclusive policies and more crime. As one of us wrote in a recent paper, this is likely because, just like cisgender folks, “transgender people use locker rooms and restrooms to change clothes and go to the bathroom,” not for sexual gratification or predatory reasons.

Conversely, when trans people are forced by law to use sex-segregated spaces that align with the sex assigned to them at birth instead of their gender identity, two important facts should be noted.

First, no studies show that violent crime rates against cisgender women and girls in such spaces decrease. In other words, cisgender women and girls are no safer than they would be in the absence of anti-trans laws. Certainly, the possibility exists that a cisgender man might pose as a woman to go into certain spaces under false pretenses. But that same possibility remains regardless of whether transgender people are lawfully permitted in those spaces.

Second, trans people are significantly more likely to be victimized in sex-segregated spaces than are cisgender people. For instance, while incarcerated in facilities designated for men, trans women are nine to 13 times as likely to be sexually assaulted as the men with whom they are boarded.

In women’s prisons, correctional staff are responsible for 41% of women’s sexual victimization, with cisgender women committing the balance of nearly all prisoner-on-prisoner violence. Similarly, trans boys and girls who are barred from using the washrooms and locker rooms that align with their gender identity are respectively between 26% to 149% more likely to be sexually victimized in the locations they are forced to use than cisgender youths.

In society at large, between 84% and 90% of all crimes of sexual violence are perpetrated by someone the victim knows, not a stranger lurking in the shadows – or the showers or restroom stalls. But trans and nonbinary people feel very unsafe in bathrooms and locker rooms, though others experience relative safety there. In fact, the largest study of its kind found that upward of 75% of trans men and 64% of trans women reported that they routinely avoid public restrooms to minimize their chances of being harassed or assaulted.

Lies drive harm

Because criminological data does not support trans-exclusionary laws or policies, advocates of anti-trans laws often resort to lies, flawed anecdotal evidence, or what fact-checkers have called “extreme cherry-picking” to support their position.

For instance, one of us documented how isolated news stories, often from notoriously transphobic tabloids, conflate the actions of sexual predators with the “dangerousness” of trans women. Although there are undeniably examples of actual transgender people committing crimes, even deeply troubling ones, they are not evidence of any behavioral trends among the broader class of trans people. No such data exist.

We believe the spate of anti-trans proposals represents a textbook example of crime-control theater – an unnecessary, ineffective and harmful legislative response to unfounded fearmongering.

Anti-trans laws are not just baseless. They’re hurtful and damaging, especially to LGBTQ+ teenagers. Recent polls indicate that more than 60% of these people experience deteriorating mental health — including depression, anxiety and suicidal thoughts – as a result of laws and policies aimed at restricting their personhood.

The criminological research is clear that anti-trans laws do not help the people they are claimed to protect. In fact, these laws inflict harm on people who are even more vulnerable.

Henry Fradella is a professor in the School of Criminology and Criminal Justice at Arizona State University, where he also holds a law-school appointment . He is the author, co-author, or editor of 13 books, including LGBTQ+ Issues in Criminology and Criminal Justice. Alexis Rowland is a Ph.D. student in criminology, law and society at the University of California, Irvine.

Mostly along partisan lines, legislature overrides governor's veto of bill that would ban gender-affirming care to minors in Kentucky

Nineteen protesters opposing Senate Bill 150 in the gallery were arrested as the House voted to override the veto of a bill to ban gender-affirming care for Kentucky's youth. (Photo by Melissa Patrick)

By Melissa Patrick
Kentucky Health News

Republicans in the Kentucky House and Senate voted Wednesday to override Democratic Gov. Andy Beshear's veto of Senate Bill 150, which bans gender-affirming care for trans youth and sets rules around how issues of sexuality should be addressed in schools. 

The Senate voted 29-8 to override the veto, with one Republican voting against the override and one Democrat changing her vote. Soon after, the House voted 76-23 for the override, with four Republicans voting against the measure and one Democrat voting for it. 

Protesters were chanting loudly from the halls while the Senate overrode the veto. In the House,  protesters in the gallery yelled, "Henry, Zachee -- they should be with us today." 

This chant was in reference to Sen. Karen Berg's 24-year-old transgender son, Henry, who died by suicide in December and the shooting death of a Louisville transgender woman, Zachee Imanitwitaho. 

Kentucky State Police arrested 19 of the protesters, according to the Lexington Herald-Leader. 

"KSP gave each individual the option to leave without any enforcement action or be placed under arrest,” Capt. Paul Blanton, a KSP spokesperson, told the Herald-Leader in a prepared statement.

Earlier that morning, hundreds of LGBTQ+ youth and their supporters rallied to ask the lawmakers to not override Beshear's veto. 

Before being removed, the protesters in the House were so loud that it was difficult to hear the lawmakers explaining their "no" votes during the veto override, even with their efforts to be heard. 

Senate Bill 150, sponsored by Sen. Max Wise, R-Campbellsville, would ban gender-affirming treatment for Kentuckians under 18, including surgeries and puberty-blocking hormones, even if parents want the treatment for their children.

It would bar schools from requiring teachers to use a transgender student's preferred pronouns, keep trans students from using bathrooms that fit their gender identity, and bans instruction that explores "gender identity, gender expression or sexual orientation," among other sex-education requirements.

Wise focused his comments on the school-related requirements, with little said about the bans on gender-affirming care for trans youth. 

"The goal is to strengthen parental engagement and communication in children's education while protecting the safety of our children," he said while explaining the bill on the Senate floor. 

“I’ve had countless number of people coming up to me from both sides of the aisle to say, ‘Thank you for standing up for common sense. Thank you for standing up and being willing to stand in that gap, to be willing to take whatever it is thrown our way,’’ Wise said on the Senate floor while explaining the bill. “If it’s hit jobs from newspaper activists, if it is for standing up for parents, for those that do not show up here in committee meetings to testify because they’re working and because they are also dependent upon us in a representative democracy, that we can make common sense decisions here that protect our children.”

Berg opened her remarks by reading the words her son, Henry Berg-Brousseau, wrote for the Human Rights Campaign that was published the day before he took his life.  

"To say this is a bill protecting children is completely disingenuous. And to call this a parent rights bill is an absolute despicable affront to me personally," she said. "We are denying families their physicians and their therapists the right to make medically informed decisions for their families. Not a single reputable society, National Medical Society in this country, supports what we are doing today. The data at this point is unequivocal.  The misinformation is appalling. Appalling that you allow this information to stand." 

Sen. Danny Carroll of Benton was the only Republican to vote against the measure. He said it was an "uncomfortable place to be" to go against his entire caucus, but he was convinced it was the right thing to do, later adding that if having access to puberty-blocking hormones saved just one child's life, they should be available to them. 

"My fear and my no vote is for those kids that are being left you Those kids that may be contemplating suicide, that may need to delay puberty, that that could have a huge impact on them. We're taking away an option that a family that a doctor would have -- we're not doctors, with the exception of a couple of us, we're not doctors, I trust them to make the right decisions when they are dealing with those kids in those specific instances." 

Sen. Robin Webb, D-Grayson,  initially voted in favor of the bill but said after further "reflection and evaluation" she voted against voting to override Beshear's veto of SB 150. Over and again, she called the bill a "bad product." She said there were parts of the bill that she could support and that the amendment offered by Carroll that was not called up for a vote was " a rational solution and a much better product." Further, she said the bill had "legitimate constitutional issues" and contradictions. 

"This discussion is not over," she said. "We will get to revisit this I'm sure once it gets through the courts. And I'm going to serve with the senator from McCracken in making sure that we achieve what the intention of this legislation is and to better perfect the provisions of it that I personally support." 

While explaining his "yes" vote, Sen. Chris McDaniel, R- Ryland Heights, said, "The bill is intended to balance the needs and desires of families with children who are following a conventional path of human sexuality, while making reasonable accommodations for those who have a different path." Later adding that the bill strives for a balance for all citizens "while protecting the rights of the minority, while respecting the will of the majority." 

It is unclear what majority McDaniel is referring to. A Mason-Dixon poll by the Fairness Campaign, a pro-LGBTQ+ rights advocacy group that paid for the poll question, showed 71 percent of respondents oppose laws letting state leaders overrule parents' wishes for gender-affirming care for their child.

In the House, 16  of the 20 Democrats stood to passionately explain their "no" votes, as there was no discussion allowed on the measure before the vote because of the protesters. No one stood to explain their yes vote. 

"This is dangerous policy, passed by poor process, supported by junk science," said Josie Raymond, D-Louisville, "We should not override this veto." 

Minority Leader Derrick Graham of Frankfort said, "Over my 21 years, this is the worst bill I've had to vote for on this floor. . . .  For over 40 years, you want limited government, you want local control, you believe in individual responsibilities, and government intervention is not the real answer to solving our problems. Well, all of those four things that I just went off and talked about, you've done. You've invaded on the rights of the parents, you've invaded on the rights of the individuals who were here today." 

The four House Republicans who voted against the veto override were Reps. Killian Timoney, Kim Moser, Kim Banta and Stephanie Dietz. Rep. Ashley Tackett Laferty was the only Democrat to support the measure.

The bill is expected to face a legal challenge. 

"To all the trans youth who may be affected by this legislation: we stand by you, and we will not stop fighting. You are cherished. You are loved. You belong," the American Civil Liberties Union of Kentucky said in a statement. "To the commonwealth: we will see you in court."

The ACLU has called this bill the most extreme anti-trans bill in the United States.

The Family Foundation of Kentucky praised the override. 

"SB 150 will protect the lives of Kentucky children by setting policy in alignment with the truth that every child is created as a male or female and deserves to be loved, treated with dignity, and accepted for who they really are," Family Foundation executive director David Walls said in a statement.

Beshear vetoes bill that would ban gender-affirming care for Kentuckians under 18; Republicans are expected to override it

Gov. Andy Beshear (State photos)

By Melissa Patrick
Kentucky Health News

Gov. Andy Beshear has vetoed a far-reaching bill that would ban transgender minors' access to gender-affirming care and sets strict rules for teaching in Kentucky's schools about sexuality. 

Senate Bill 150 would ban gender-affirming treatment for Kentuckians under 18, including surgeries and puberty-blocking hormones, even if parents want the treatment for their children.

It would bar schools from requiring teachers to use a transgender student's preferred pronouns, keep trans students from using bathrooms that fit their gender identity, and bans instruction that explores "gender identity, gender expression or sexual orientation," among other sex-education requirements. 

State Sen. Max Wise

The veto came as no surprise. Beshear, a Democrat running for re-election, has been consistent in his disapproval of the bill, sponsored by Sen. Max Wise, R-Campbellsville, who is running for lieutenant governor on a slate headed by Kelly Craft of Lexington.

"I think I've been clear on how I feel about it," Beshear said the day before he vetoed the bill. "I believe Senate Bill 150 tears away the freedom of parents to make important and difficult medical decisions for their kids. It tears away the freedom of parents to do what those parents believe is best for their kids, and instead has big government making those decisions for everyone -- even if the parents disagree."

Beshear's veto message says SB 150 "allows too much government interference in personal healthcare issues and rips away the freedom of parents to make personal family decisions." He wrote that it turns educators and administrators into investigators who must report to parents about how students behave and/or refer to themselves or others. 

He also wrote, "My faith teaches me that all children are children of God and Senate Bill 150 will endanger the children of Kentucky," citing data to support his concerns.

"In a 2022 National Survey on LGBTQ youth mental health, 45% of LGBTQ youth seriously considered suicide in the past year and nearly one in five transgender youth attempted suicide," he wrote. "The American Medical Association reports that receipt of care dramatically reduces the rates of suicide attempts, decreases feelings of depression and anxiety, and reduces substance abuse. Improving access to gender-affirming care is an important means of improving health outcomes for the transgender population. Senate Bill 150 will cause an increase in suicide among Kentucky's youth." 

Lawmakers will reconvene March 29 and 30, when the majorities of Republicans in the House and Senate are expected to easily override the veto. Republicans were quick to criticize it. 

Wise's statement said Beshear "puts party over Kentuckians' wish to eliminate woke ideologies in our children's schools." He said the goal of the bill "is to strengthen parental engagement and communication in their children’s education."

He added, "Parents should look at this veto as a slap in the face. . . . I look forward to the legislature overriding this veto, and protecting children from the irreparable harm of gender-transition surgeries by making SB 150 law.”

Wise also issued a joint statement with Craft, saying “Time and time again, Gov. Beshear has proven he is out of step with what Kentuckians are talking about at their kitchen tables: communication and engagement with their children’s schools. A Craft-Wise administration will ensure our children are protected, make sure parents are heard, and empower teachers to focus on providing a world-class education that teaches our children how to think, not what to think.”

Republican Party of Kentucky spokesman Sean Southard also criticized the veto and looked ahead to the election.

“Is Andy Beshear the governor of Kentucky or California?” Southard asked. “Kentucky voters will have an opportunity this fall to rid our state of this far-left governor and replace him with a Republican who will work to protect children. Once this campaign is over, today may very well be remembered as the day Andy Beshear lost his bid for re-election.”

Attorney General Daniel Cameron, the apparent front-runner in the May 16 Republican primary, criticized news-media coverage of the bill and said “chemical castration and genital mutilation . . . is the exact opposite of how we should support children experiencing gender dysphoria or mental-health struggles. My administration will protect our youth from dangerous ideologies and defend Kentucky’s values.”

Others issued statements praising the veto. 

"By vetoing this hateful legislation, Gov. Beshear has demonstrated his commitments to protect Kentucky parents’ rights to raise their children as they see fit, and to keep medical decisions where they belong: between providers and patients," said Angela Cooper, communications director for American Civil Liberties Union of Kentucky.   

Chris Hartman, executive director of the Fairness Campaign, said "SB 150 will only lead to disaster and despair for transgender Kentucky kids and their families. . . . We urge state lawmakers to read the governor's veto message, listen to medical professionals and sustain Gov. Beshear's veto." 

Kentucky Voices For Health said in its newsletter that it joined more than 500 organizations, providers and individuals in signing a letter of opposition to SB 150, and urged citizens to call their legislators' offices at 502-564-8100.

Opinion: Gender dysphoria may have a basis in human biology

By Kimberly Kennedy

Most of us witnessed with horror the passage of anti-transgender bill SB150 by legislators who ignored overwhelming opposition. Since Gov. Andy Beshear is expected to veto it, our only recourse is to convince legislators not to override that veto.

If you’re dubious, hear me out: We’ve left critical information out of the conversation, namely the growing evidence that gender dysphoria (GD) has a basis in biology. Skeptical that would work? Well, research shows that when people understand this, their support for trans people increases.

Kimberly Kennedy

Many in the trans community bristle at the idea of discussing GD as if it were a defect. But I believe we can be sensitive; and I take inspiration from researcher Dr. J. Graham Theisen of Augusta University, who describes it as a “variant,” like blue eyes or brown hair, that doesn’t cause disease but makes us individuals.

Plus, we must meet the opposition where they are, if we hope to bridge the gap. I’ve heard awful comments about trans people; but I look for common threads, like the belief it’s a choice or lifestyle, or that it ignores what God intended. Evidence of a biological basis discounts these arguments and might persuade more legislators to push the pause button on anti-trans legislation.

So here’s a sample: First, research has confirmed that male and female brains are different. Second, during fetal development, hormones influence the gender of the external and internal sex organs during the first trimester; hormones program gender development in the brain, where gender identity is experienced, later in the pregnancy.

Research in the Netherlands from 2014 found that in some cases, physical development in utero was subject to a hormonal mismatch from brain development, “so that the body was masculinized and the brain was feminized, or the other way around.” This corresponds with transgender people’s reported experience of their gender identity, which occurs before age seven for three-fourths of the population.

In 2018, an Australian study comparing transgender women and cisgender men (both born male) found statistically different variations in four genes. In 2020, a U.S. and a U.K. meta-analysis (compilation of multiple studies) found that “people with gender dysphoria have a brain structure more comparable to the gender to which they identify” rather than to the sex assigned at birth. Yet a 2020 German study found that the brain structure of trans women was different from both cisgender males and females. In view of this, researchers suggest that we view gender as a “spectrum” rather than a binary construct.

Theisen clarifies that “once someone has a male or female brain, they have it and you are not going to change it. The goal of treatments like hormone therapy and surgery is to help their body more closely match where their brain already is.”

Proof of transgender biology indicates that SB 150 will invite a civil-rights lawsuit. Thus Kentucky taxpayers will pay to defend legislation that 71% of Kentuckians don’t want — potentially costing hundreds of thousands or even millions of dollars; just ask Floridians about the price tag for defending controversial legislation.

Contact all legislators who voted "yes" in the House and Senate. Write to your own representative or senator, or call the Legislative Research Commission comment line at 1-800-372-7181. We have until Tuesday, March 28, to make a difference for our families and friends.

Kimberly Kennedy of Villa Hills is a freelance writer, former educator and parenting-magazine editor, and parent of an LGBTQ+ young adult. Her degrees are a BFA in art education and a BA in art history from the University of Cincinnati. This article was originally published in Forward Kentucky.

Bill to ban transgender health or mental-health care of minors in Kentucky has a head of steam in the state House

By Melissa Patrick
Kentucky Health News

A far-reaching anti-transgender bill filed Tuesday, Feb. 21, was assigned to a legislative committee the same day it was filed, has received the first of three required readings and already has 20 co-sponsors.

Rep. Jennifer Decker

House Bill 470, sponsored by Rep. Jennifer Decker, R-Waddy (Shelby County), says "The provision of gender transition services to a person under the age of 18 years by a health-care provider or mental-health care provider is unethical and unprofessional conduct that establishes the provider is unfit to perform the duties and discharge the responsibilities of his or her position or occupation."

The bill defines gender transition as "the process in which a person goes from identifying with and living as a gender that corresponds to his or her sex to identifying with and living as a different gender and may involve social, legal, or physical changes." 

Among other things, the bill includes provisions to :  

• Require health care providers and mental health care providers to be investigated if there is any report that a provider has provided gender transition of provision of gender transition services to a person under the age of 18 years; 
• If confirmed, the provider's license is to be revoked and their public funding terminated; 
• Require that providers be jointly and severally liable for all damages and costs sustained for providing gender transition services or aiding and assisting a person under the age of 18 years to consider or to obtain gender transition services; 
• Provide defense to providers refusing to provide services; 
• Makes failure to report a gender transition service to the Vital Statistics Branch within 30 days of providing the service a crime; 
• Provides provisions for when a person's parents or guardian can bring an action because of personal injury before the person turns 18 and by the person within 30 years of the person turning 18, with exceptions under which the time may be longer;
• Includes conditions for actions and damages;
• Prohibits the use of public funds, including Medicaid, for gender transition services; 
• Prohibits a provider employed by a public agency to provide  and include gender transition procedures; 
• Allows the Attorney General to bring action to enforce provisions;
• Prohibits a public health care or mental health care  provider from intervening in a legal proceeding in defense of the provision of gender transition services; 
• Requires a school to notify each parent or guardian if a student under the age of 18 significantly changes his or her gender expression, expresses an inconsistency between his or her sex and his or her perceived gender or perceived sex; or expresses a desire to be referred to by a name, pronoun or other identifier inconsistent with his or her sex, with some exceptions related to parental abuse. 
• Includes updates to a host of laws to comply with the bill's provisions, including ones that will prohibit a court from changing a person under the age of 18's name if it is to assist them with a gender transition and another to prohibit the Department of Juvenile Justice from classifying a detainee by a sex that is inconsistent with his or her sex as defined in the bill. 

The bill, dubbed the "Do No Harm Act," has been assigned to the Judiciary Committee, of which Decker is a vice-chair. The committee meets at noon on Wednesdays; this bill has not yet been placed on the agenda. If passed and signed into law, it would become effective Jan. 1, 2024. 

This is just one of several bills targeting the LGBTQ+ community, Olivia Krauth reports for the Louisville Courier  Journal: "Several 'parents’ rights' bills include provisions either restricting gender transition services, outing students to their parents or allowing teachers to ignore a student’s preferred pronouns or name. One such measure, Senate Bill 150, already cleared the Senate and now waits in the House for consideration," she writes. "Other proposals include forcing students to use the school bathroom tied to their biological sex, even if they don’t identify with it. HB 120 also would prohibit gender transition procedures for youths."