Officials with South Dakota’s largest healthcare agencies, Sanford Health and Avera Health, are not willing to talk about the state of what gender affirming health care looks like in the state.
The Argus Leader had requested interviews with doctors in both hospital systems to speak about transgender health care and support services, including what a typical timeline, course or plan of treatment for trans patients under 18 can look like in South Dakota at a time when such treatments are facing scrutiny during this year’s legislative session.
The questions were sparked by the Jan. 17 introduction of House Bill 1080, which would prohibit health care professionals from providing several forms of gender-affirming care for patients under 18. The bill has been referred to the House Health and Human Services committee, and is awaiting its first debate.
A conversation about what the treatment or care plan is for minors could dispel myths, rumors and misinformation in the public conversation about being trans, the Argus Leader argued in emails to the hospital systems.
More:South Dakota Republicans introduce legislation prohibiting gender-affirming care for trans children
Cale Feller, director of media relations and corporate communications for Avera Health, said the hospital system didn’t have anyone to speak about the issue.
Jon Berg, lead media relations specialist at Sanford Health, said the hospital system isn’t doing interviews about the topic, but sent a statement from Dr. Jeremy Cauwels, chief physician at Sanford Health.
“We are committed to providing exceptional, evidence-based care for all of our patients, including children,” Cauwels said. “All patients consult with their medical provider, as well as their families and caregivers, on the best treatment plan for their individual health care needs.”
Spokespeople with both Sanford and Avera would not answer questions about why they wouldn’t make doctors available to discuss the issue.
The Argus Leader also tried to find out information about the state of gender-affirming care during a recent summit held in Sioux Falls, but media was not allowed to attend. A small gathering of people in protest against the purpose of summit was also held at the time.
Current transgender healthcare standards
The bill prohibits several forms of bottom surgery, prohibits the potential for top surgery for those assigned female at birth and prohibits hormone therapy and puberty blockers.
However, the top transgender medical association doesn’t even recommend those for children, and has some limitations on each of those things for adolescents.
More:‘You aren’t the only trans kid in South Dakota’: Transgender youths discuss challenges, acceptance
Standards of care outlined by the World Professional Association for Transgender Health for adolescents, or minors from the start of puberty until age 18, require the following before gender-affirming medical and surgical treatment are administered:
- The adolescent must have reached a certain stage of puberty, marked by development of breast buds for those assigned female at birth, and marked by certain testicular volume increases for those assigned male at birth.
- The adolescent must meet the diagnostic criteria of gender incongruence, and their experience of it must be marked and sustained over time.
- To consent to treatment, the adolescent must demonstrate emotional and cognitive maturity required to provide informed consent, any mental health concerns that could interfere with their diagnostic clarity, capacity to consent and gender-affirming medical treatments have been addressed, and they must have been informed of the reproductive effects, including the potential loss of fertility and options to preserve it.
- The adolescent has had at least 12 months of gender-affirming hormone therapy or longer, if required, to achieve the desired surgical result for gender-affirming procedures, including breast augmentation, orchiectomy, vaginoplasty, hysterectomy, phalloplasty, metoidioplasty, and facial surgery as part of gender-affirming treatment unless hormone therapy is either not desired or is medically contraindicated.
The WPATH organization also recommends parents and guardians be involved in the assessment and treatment process for transgender and gender-diverse adolescents, unless their involvement is determined to be harmful to the adolescent, or not feasible.
Health care professionals can also provide adolescents menstrual suppression agents, as well as health education on chest binding and genital tucking, including a review of benefits and risks.
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Recommendations from WPATH for health care professionals working with gender diverse children who haven’t hit the that Tanner Stage 2 of puberty include consultation, psychotherapy, supporting the child’s social transition and advising them about gender-affirming medical interventions and their effects on future fertility, as well as options for fertility preservation.
However, those recommendations for children don’t include any language on hormone treatment or surgeries for this age group as they do for adolescents.
WPATH also acknowledges childhood gender diversity is an expected aspect of general human development, isn’t a pathology or mental health disorder and that diverse gender expressions in children can’t always be assumed to reflect a transgender identity or a gender incongruence.
A recent study in the New England Journal of Medicine found treating 315 trans and nonbinary youth ages 12-20 with gender-affirming hormone treatment improved patients’ appearance congruence, positive affect and life satisfaction, and decreased symptoms of anxiety and depression.
Local counselor, lawmaker react to legislation
Anne Dilenschneider, a WPATH-certified gender specialist and mentor at New Idea Counseling in Sioux Falls, reached out to the Argus Leader to provide her own expertise on the subject of trans youth health care options in the state.
She said the representatives who introduced HB 1080 are “totally inaccurate” about what is happening, and what is best practice according to WPATH.
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“No sterilization or mutilation or experimental procedures are being done with children. It’s great that they want to follow that section of the Standards of Care, although it’s clear that’s not their intent with this bill,” she said. “There are many, many checks and balances. This is just misinformation and political grandstanding.”
Rep. Erin Healy, a Sioux Falls Democrat, said on Twitter that HB 1080 sends a “clear message to our trans youth that their healthcare needs don’t need to be met.”
Meanwhile, the bill’s sponsors Rep. Bethany Soye and Rep. Jon Hansen argued at a press conference introducing their bill. Soye said “children are being mutilated, sterilized and turned into permanent medical patients,” while Hansen said children were facing “permanent body mutilation.”
Gov. Kristi Noem supports this legislation and will be watching as the legislature works through the process, spokesman Ian Fury said.
Similar bills were filed and failed in past legislative sessions, including HB 1205 in 2019, HB 1057, SB 93 and SB 109 in 2020, and HB 1247 in 2021.
If you’d like to speak with the Argus Leader about your experience as a healthcare provider working with transgender patients, or as a transgender patient seeking care in South Dakota, please reach out to[email protected] to share your story.