West Virginia House OKs bill doctors say would eliminate care for most at-risk transgender youth

West Virginia’s Republican-controlled House of Delegates has approved a bill that doctors treating transgender youth in the state say would prevent the prescription of certain medical interventions like hormone therapy to patients at risk for self-harm or suicide

Gender Affirming-West Virginia (Copyright 2023 The Associated Press. All rights reserved)

West Virginia's Republican-controlled House of Delegates passed a bill on Wednesday that doctors treating transgender youth in the state say would prevent the prescription of certain medical interventions like hormone therapy to patients at risk for self-harm or suicide.

The proposal, which now heads to the Senate, was greenlit after more than 500 medical professionals and students signed a letter opposing it, expressing concern it would cause young patients preventable harm and put their lives at risk.

House Republicans said such fears are overblown and that the bill is less restrictive than current law. But the state's only LGBTQ+ advocacy organization and doctors treating transgender youth in West Virginia said that's not true.

“If this bill becomes law, it will take away the only treatment that has been shown to help a small, but very vulnerable group of children,” said Dr. Kate Waldeck, a pediatric critical care physician at Hoops Family Children’s Hospital in the state’s second-largest city of Huntington. Waldeck runs a monthly clinic for transgender youth — one of only a few existing care options in the state.

She said the law as it stands enables transgender adolescents to get the medical and psychiatric evaluations they need while still allowing doctors “to provide what is truly life-saving medical care.”

“That’s what it comes down to — gender-affirming care keeps these children out of my PICU. It saves lives,” she said. "And the new bill would strip parents of the right to obtain this potentially life-saving care for their children.”

On the House floor, Lead Sponsor Republican Del. Geoff Foster said he doesn't believe treatments like puberty blockers help reduce suicide rates, despite research showing otherwise.

He said the bill is “pointing doctors in the direction of actually treating the issue of the suicidality problem and the depression rather than moving to a solution that’s not working.”

Republicans in the House of Delegates — who occupy 89 out of 100 seats — voted last year to eliminate transgender minors' access to hormone therapy and puberty blockers. The bill was altered in the Senate by Majority Leader Tom Takubo, a physician who expressed concern about the high suicide rate for transgender youth.

The 2023 law allows the prescription of medical interventions but requires parental consent and a diagnosis of severe gender dysphoria from two medical professionals, both of whom must provide written testimony that medical interventions are necessary to prevent or limit possible or actual self-harm.

It says any use of the medication must be the lowest possible necessary "to treat the psychiatric condition and not for purposes of gender transition.”

Takubo, a physician, cited more than a dozen peer-reviewed studies showing a decrease in rates of suicide ideation and attempts among youth with severe gender dysphoria who had access to medication therapy. Gender dysphoria is defined by medical professionals as severe psychological distress experienced by those whose gender identity differs from their sex assigned at birth.

The law also prohibits kids from accessing gender-affirming surgery, which physicians said wasn’t happening in West Virginia anyway.

House Health and Human Resources Chair Amy Summers, a Republican and registered nurse, said this year's bill wouldn't prevent adolescents from getting hormone therapy treatment for psychiatric conditions like gender dysphoria as long as the dose was not supraphysiologic, or high enough that it “actually assisted that child in transitioning."

“What has been expressed to me by physicians is that they are receiving lower doses of a hormone, and that tends to help with their anxiety and depression,” she said. "But it’s not doses that transition that individual.”

Republican Del. JB Akers said he's received emails from “people who I think simply attacked this body for going after kids and going after doctors," and that people upset about the bill don't fully understand it. Current law already prevents prescribing medication to assist minors with a gender transition, he said: ”Whether you like it or not — that’s what the law is."

“We have affirmation that this medication can still be provided for psychiatric treatment, which is my main concern. And that’s not changed," he said. “And no one in this body is against the physicians or health care providers who provide this care.”

But Waldeck, the doctor who treats transgender kids in West Virginia, said in a phone interview Wednesday that it doesn’t feel that way to her.

“If you’re saying you can’t do it for gender transition, well, what is the normal physiologic level, then?” she said. “In terms of what doctors are legally going to be able to do, in reality, there’s not going to be a normal quote unquote physiologic level for a biological female who is getting testosterone for their gender dysphoria and suicidality.”

She said if signed into law, the proposal would restrict her ability to help her most at-risk patients: "In reality, it is still an effective treatment ban."

Before voting for the bill, lawmakers rejected two amendments from Democratic Del. Mike Pushkin. One would have allowed kids already receiving treatment to continue care. The other would have allowed treatment if an attending physician provides a written opinion that it's "medically necessary to treat the minor’s psychiatric symptoms that makes the minor a danger to commit suicide without such treatment.”

Every major medical organization, including the American Medical Association, the American Academy of Pediatrics and the American Psychiatric Association, supports gender-affirming care for youths.

Lawmakers in West Virginia and other states advancing bans on transgender health care for youth and young adults often characterize gender-affirming treatments as medically unproven, potentially dangerous and a symptom of “woke” culture.

Andrew Schneider, Executive Director of Fairness West Virginia, said delegates are sending a message to parents with transgender teens who are at serious risk of self-harm or suicide that they can’t get their kid the help that doctors say they need in West Virginia.

“I don’t understand how anyone could look at these families and tell them their child’s life doesn’t matter, but that’s what they did today with this vote,” he said.