State legislators across the country proposed a record number of bills targeting LGBTQ rights last year, but less than 1 in 10 have become law, a report published Thursday by the Human Rights Campaign found.
The LGBTQ advocacy group’s 2022 State Equality Index, an annual review of state legislation and policies that affect the rights of lesbian, gay, bisexual, transgender and queer people, found that state legislators introduced 315 bills that the Human Rights Campaign described as “anti-equality.” Just 29 became law.
The majority of the new laws target transgender minors. In the last three years, 18 states have banned trans youths from playing school sports on the teams that align with their gender identities, and four states — Alabama, Arizona, Arkansas and Tennessee — have restricted or prohibited their access to gender-affirming medical care.
Supporters of such measures claim that trans girls have an unfair advantage in sports and that minors are too young to receive gender-affirming medical care. The American Medical Association, the American Academy of Pediatrics and other medical associations oppose efforts to restrict gender-affirming care for minors.
JoDee Winterhof, the senior vice president of policy and political affairs at the Human Rights Campaign, said the 315 bills are part of a coordinated conservative response to LGBTQ rights gained over the last few years.
“We consider this to be part of the backlash from the gains around marriage equality, from the gains in overall equality through the courts or through cities and other states,” Winterhof said.
Some lawmakers, she added, believe the bills will motivate conservatives to head to the polls, although she said the track record of last year’s anti-LGBTQ bills and midterm election polling have led her to believe otherwise.
She pointed to a Human Rights Campaign poll of 1,000 voters, who were surveyed online and by phone the week of the midterm elections, that asked which issues motivated them to head to the polls. The top two were inflation, at 52%, and abortion, at 29% (an NBC News Exit Poll found the same two issues were also top-of-mind for voters). Gender-affirming care for trans youths or trans participation in sports came in last, with less than 5% identifying them as issues that motivated them to vote, the Human Rights Campaign found.
“For many people, the jig is up,” Winterhof said, adding that targeting LGBTQ people would harm conservative lawmakers in future elections. “I know they don’t see that, but these are not winning issues.”
This year’s State Equality Index also found that state legislators introduced 156 “pro-equality” bills, of which 23, or just under 15%, became law.
Twenty states and Washington, D.C., are in the index’s highest of four categories, “Working Toward Innovative Equality,” while 23 states are in the lowest-rated category, “High Priority to Achieve Basic Equality.”
States are scored on whether they have “pro-equality” laws, including those that would prohibit discrimination in public accommodations, housing or adoption, among other areas of life; anti-bullying laws or laws that protect youths from conversion therapy; and measures that bar insurance companies from refusing to cover transgender care. “Anti-equality” laws — such as those that target transgender youths, bar the discussion of LGBTQ topics in schools or allow business owners to refuse to serve LGBTQ people — hurt a state’s score.
An increasing number of states are passing “pro-equality” legislation, according to the Human Rights Campaign. For example, 21 states restrict conversion therapy, which is the discredited practice of trying to change a person’s sexual orientation or gender identity; 25 ban insurance exclusions for transgender medical care; and 38 allow trans people to update their names and gender markers on their driver’s licenses, while 27 allow them to do the same on their birth certificates.
However, many states still have “anti-equality” laws on the books. Nearly half of states (22) don’t protect people from discrimination in public accommodations based on sexual orientation, and 23 don’t provide protections based on gender identity. Seventeen states bar Medicaid from covering certain transgender medical care.
The report warns that, even though 2022 was a record-breaking year for legislation targeting LGBTQ people, 2023 is already expected to outpace it. In just the first few weeks of the year, state legislators have introduced nearly 150 such bills, the majority of them continuing to target LGBTQ youths, according to an NBC News analysis.
Tiffany Najberg, a Louisiana doctor who is transgender, said three insurance companies refused to reimburse her since she legally changed her name nearly two years ago.
The companies have since come to agreements with her and her Shreveport clinic, UrgentEMS, but not until after she started a petition that has garnered nearly 12,000 signatures and received news media attention about her cause, including inquiries from NBC News.
While the three insurers have agreed to update her name in their records and pay back claims, Najberg and her clinic have yet to receive any checks. In the meantime, she has spent her life savings — about $200,000 — to sustain her clinic, where she provides both primary and urgent care, including to more than 100 transgender patients, some of whom come from Alabama and Tennessee, two states that have passed restrictions on gender-affirming medical care for minors.
After Najberg changed her name in April 2021, she said, she updated it with all the necessary government offices and with databases from which most insurance companies pull information about providers.
She said Medicare, Medicaid, Blue Cross Blue Shield and United all updated the information and continued to reimburse her for the care she provided to her patients. But she said Aetna, Cigna and Humana had repeatedly denied her claims and refused to reimburse her.
“They were flagging each claim and rejecting it because of a name incompatibility with their internal database. They did not change my deadname,” she said, referring to the name she used prior to her transition.
She said all three companies told her that they don’t source information from the same database used by the government, Blue Cross and United. When she asked which database they use so that she could go through whatever steps necessary to update it, she said they wouldn’t tell her what it was. Even after her office sent the companies the court order granting her name change and copies of her updated IDs, they still wouldn’t update her name, she said.
Last March, Najberg began posting videos about the reimbursement denials on her TikTok account, where she has more than 150,000 followers. Last month, she also started a petition demanding that the three companies change her name and pay all of the back claims — something she said she did “out of sheer desperation because nothing else worked.”
“I’ve run through every dime I’ve ever had,” Najberg said. “I don’t have three to seven years for a court fight. I’ve got to make a living now. I have hundreds of patients, and most of them are in vulnerable populations. I want to keep taking care of them.”
Najberg said the situation has also had an impact on her mental health, because every time she would reach out to the three companies, their representatives would use her deadname, which at the time was still in their databases.
English Perez, who since 1998 has done medical credentialing — including helping hundreds of medical providers update their credentials following a name change after marriage or divorce, or an error in their name — said she has never encountered a problem like the one Najberg has been facing.
“That’s why I volunteered to help her,” Perez said, adding that she came across Najberg’s story on TikTok. “This needs to stop for her, for the next person that becomes their true self and lives in their authentic self — they should never have to incur this type of embarrassment.”
Perez added that Najberg’s relevant medical identification numbers and tax ID number all reflect her legal name change.
“That’s why I said it’s more about the transition, less about a name change,” Perez speculated.
By mid-January, after Najberg’s petition received more than 10,000 signatures and her story was covered by local news outlets, the three companies reached out, but they did not immediately agree to pay the back claims, she said.
As of Jan. 23, Aetna created a new contract with Najberg and agreed to process all of the back claims. Humana and Cigna had not agreed to anything at that point, she said.
NBC News reached out to all three companies on Jan. 24 for comment regarding Najberg’s reimbursement denials, their processes for updating medical provider names in their systems and Najberg’s allegations that company representatives repeatedly misgendered her. All three responded the following day, though none responded to specific questions regarding Najberg’s allegations.
A spokesperson for Aetna said, “We value our relationship with our providers and strive to resolve any issues they may experience as quickly as possible.”
Cigna’s spokesperson said name changes “have no impact on our payments to doctors or other health care providers; and we are committed to fair and prompt payment for both in- and out-of-network clinicians.”
Humana shared its first on-the-record response Jan. 27, with a spokesperson telling NBC News in an email that, “We are glad to have Dr. Tiffany Najberg as a provider in Humana’s network, and we look forward to continuing to partner with her and her office.”
The day prior, Humana had informed Najberg that the company would pay all of the back claims with interest and would create an immediately effective updated contract that puts her in their network.
On Monday, Jan. 30, Najberg said Cigna tentatively accepted her terms, and that she and her clinic now have agreements with all three insurance companies.
Perez, who noted that two of the three insurance companies did not help Najberg find a solution until they received an inquiry from NBC News, said, “We can’t relax and breathe until those checks start coming in the door.”
There is little available data on how many openly transgender medical providers there are and whether others have had issues similar to Najberg’s. Of 15,794 entering medical students surveyed by the Association of American Medical Colleges last year, 1.4% reported that their gender identity is different from their sex assigned at birth — up from 1.2% in 2021 and 0.8% in 2020.
Najberg said that she hasn’t had to stop seeing any patients as a result of the three companies denying claims for nearly two years now, but her practice has had to postpone plans to expand its telehealth services to Texas, Mississippi, Alabama and Florida, because she cannot afford the malpractice insurance in those states right now. She said she’s had more than 100 requests from residents in those states regarding telehealth care.
She said that she has been living off of Go Fund Me fundraisers for about eight months and that if she doesn’t start receiving reimbursements from the insurance companies soon, she could lose both her business and her home. She has dropped both her dental and health insurance and has eliminated all nonessential medications.
“I am literally in survival mode right now,” she said.
She said her goal isn’t to attack any of the insurance companies — but to draw attention to what has happened so that it doesn’t happen again.
“I’m not asking for anything special,” she said. “I just want to be an equal.”
The percentage of adults in the U.S. who identify as LGBTQ increased slightly year over year, to 7.2% last year, according to a Gallup Poll released Wednesday.
While that’s just a slight increase from 7.1% in 2021, it’s more than double what it was a decade ago, when Gallup found just 3.5% of the U.S. population identified as something other than heterosexual in 2012.
Gallup asked more than 10,000 adults nationwide how they identify in telephone interviews last year.
For the first time, the organization recorded the identities of LGBTQ people who said they are something other than lesbian, gay, bisexual or transgender. It found that about 5% of LGBTQ adults identified outside those terms. Most of them — about 0.1% of all U.S. adults — said they are queer, pansexual or asexual.
“Queer” is an umbrella term that generally refers to people who aren’t heterosexual or cisgender, meaning they don’t identify with their assigned sexes at birth. “Pansexual” means someone experiences sexual or romantic attraction regardless of sex or gender identity. “Asexual” describes someone who doesn’t experience sexual attraction to others.
Bisexuals continue to make up the majority of LGBTQ adults, at 58.2% (or 4.2% of all U.S. adults), Gallup found, while 20.2% identify as gay, 13.4% identify as lesbian, and 8.8% identify as transgender.
Those who said they are straight or heterosexual made up 86% of respondents, while 7% chose not to answer the question.
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Continuing previous trends, Generation Z, or those ages 19 to 26, are the most likely to identify as LGBTQ, at 19.7%, compared to 11.2% of millennials, who are 27 to 42; 3.3% of Generation X, who are 43 to 58; 2.7% of Baby boomers, who are 59 to 77; and 1.7% of the Silent Generation, who are 78 or older.
Gallup found that younger generations are much more likely to identify as bisexual than older generations. For example, 66% of LGBTQ people in Generation Z and 62% of LGBTQ millennials identify as bisexual, compared to 48% of Generation X, 26% of baby boomers and 35% of the Silent Generation.
LGBTQ respondents in the two oldest generations are most likely to identify as gay (37% of baby boomers and 47% of the Silent Generation) and lesbian (26% of baby boomers and 12% of the Silent Generation).
Gallup noted that the share of LGBTQ adults in the U.S. is expected to continue to grow but that the growth “depends on younger people who enter adulthood in future years continuing to be much more likely to identify as LGBT than their parents, grandparents and great-grandparents.”
South Dakota has joined five other states that have restricted transition-related care for transgender minors in just the past two years.
On Monday, Gov. Kristi Noem, a Republican, signed the “Help Not Harm” bill, which bans health care professionals from providing puberty blockers, hormone therapy and surgery to minors as treatment for gender dysphoria, which is the distress caused by a sense of conflict between the assigned sex at birth and the person’s gender identity.
Providers who are already treating trans minors with puberty blockers, which temporarily pause puberty, or hormone therapy will be required to taper the minors off the medications by Dec. 31.
The measure makes exceptions for intersex infants and for the treatment of conditions unrelated to gender dysphoria.
“South Dakota’s kids are our future,” Noem said in a statement. “With this legislation, we are protecting kids from harmful, permanent medical procedures. I will always stand up for the next generation of South Dakotans.”
Health care providers who violate the law could have their medical license revoked. Until they turn 25, minors who receive care in violation of the law can also sue providers.
People protest a bill that would bar transgender girls from playing on sports teams that match their gender identity outside the state Capitol in Pierre, S.D., on Jan. 15, 2022.Toby Brusseau / AP for Human Rights Campaign
Elliot Morehead, a trans teen who uses they/them pronouns and had planned to access gender-affirming care within the next year, said the measure has “affected my future deeply.”
“I was hoping to maybe start any kind of treatment for myself and now our legislators, who are supposed to support us, have taken away that opportunity for me and I’m bummed,” they told CBS affiliate KELO-TV in Sioux Falls on Thursday after the bill passed the Senate.
Morehead, 16, told House committee members last month that they had to receive six months of therapy and a letter from their therapist before they could begin hormone therapy.
“People think you can just like walk in and then get like testosterone or estrogen or puberty blocking — it doesn’t work like that,” they said, according to The Associated Press.
Over the years, South Dakota has been what advocates have described as a testing ground for legislation targeting trans people.
In 2016, the state was the first to pass a school “bathroom bill,” which would’ve required students to use the school facilities that correspond with their assigned sex at birth. The measure was ultimately vetoed by then-Gov. Dennis Daugaard, a Republican, who said at the time that it did not “address any pressing issue concerning the school districts of South Dakota,” according to the Argus Leader, a local newspaper.Three states — Alabama, Oklahoma and Tennessee — bar transgender students from using the school facilities consistent with their gender identity, according to the Movement Advancement Project, an LGBTQ think tank.
On Saturday, more than 400 South Dakotans, including trans youths, their families and allies, protested the bill’s passage in the Senate, according to Transformation Project Advocacy Network, a local trans rights group.
Following Noem’s signing of the bill Monday, the American Civil Liberties Union and the ACLU of South Dakota said in a joint statement that the measure “won’t stop South Dakotans from being trans, but it will deny them critical support that helps struggling transgender youth grow up to become thriving transgender adults.”
“But make no mistake–this fight is not over,” the groups said. “We will never stop fighting for the right of trans youth to get the love, support, and care that every young person deserves. As much as Governor Noem wants to force these young people to live a lie, we know they are strong enough to live their truth, and we will always fight for communities and policies that protect their freedom to do so.”
So far this year, lawmakers in at least 24 states, including South Dakota, have introduced legislation that would restrict transition-related care for minors, according to an NBC News analysis. Governors in six states — Alabama, Arkansas, Arizona, South Dakota, Tennessee and Utah — have signed such restrictions. Federal judges have blocked bans in Alabama and Arkansas from taking effect pending the outcome of lawsuits.
Missouri has launched a multi-agency investigation into a pediatric transgender center after a former case worker alleged children were being routinely prescribed puberty blockers or hormone therapy without “appropriate or accurate” mental health assessments, the state’s attorney general announced Thursday.
Missouri Attorney General Andrew Bailey speaks to reporters after taking the oath of office in Jefferson City on Jan. 3.David A. Lieb / AP
“We have received disturbing allegations that individuals at the Transgender Center at St. Louis Children’s Hospital have been harming hundreds of children each year, including by using experimental drugs on them,” state Attorney General Andrew Bailey said in a statement. “We take this evidence seriously and are thoroughly investigating to make sure children are not harmed by individuals who may be more concerned with a radical social agenda than the health of children.” The investigation was launched two weeks ago after Jamie Reed, who worked as a case manager at the Transgender Center from 2018 to November 2022, alleged the center caused permanent harm to many of the patients being treated for gender dysphoria. The attorney general’s office, which said it had previously received a sworn affidavit and supporting documentation from Reed, confirmed the existence of the investigation Thursday after Reed went public that same day with her allegations in an op-ed published in The Free Press, a news website started by Bari Weiss, a former op-ed writer and editor at The New York Times. Reed concluded her op-ed by calling for a “moratorium on the hormonal and surgical treatment of young people with gender dysphoria.”
In a 23-page affidavit shared on the attorney general’s website, Reed alleged the staff repeatedly violated the center’s own treatment guidelines. She said the center required minors to meet four criteria — a minimum age, a therapist referral, parental consent and a clinical visit with an endocrinologist or an adolescent medicine specialist — before they could receive puberty blockers, which temporarily pause puberty, or hormone therapy, such as estrogen or testosterone. But she alleged the center’s staff would provide the medication “without complete informed parental consent and without an appropriate or accurate assessment of the needs of the child.”
Reed alleged in the affidavit that providers at the center prescribed hormone therapy to patients as young as 13, even though the World Professional Association for Transgender Health, a nonprofit professional association, recommended at the time that minors be at least 16 years old for such treatment. She also alleged providers at the center only used therapists they “knew would say yes” to a patient’s medical transition and that parents were “routinely pressured” into consenting to have their child receive transition-related care.
In her affidavit, Reed also alleged that doctors at the Transgender Center did not share information with patients and their parents about the possibility of sterility following hormone therapy, though, in her op-ed, she said patients were “told about some side effects, including sterility,” but that she “came to believe that teenagers are simply not capable of fully grasping what it means to make the decision to become infertile while still a minor.” She also said she witnessed minors experience “shocking injuries” from the medication, including one patient who experienced “severe atrophy of vaginal tissue” after receiving testosterone and had to have subsequent vaginal lacerations treated surgically.
Reed alleged she raised concerns to doctors at the center and university administrators for years and was discouraged from tracking adverse outcomes of patients, she stated in the affidavit. She wrote in her op-ed that her experience at the Transgender Center has led her to support a nationwide moratorium on gender-affirming care for young people due to “the secrecy and lack of rigorous standards that characterize youth gender transition across the country.”
Washington University in St. Louis, the parent institution of the Children’s Hospital,said in a statement shared on its websiteThursday that it is “alarmed by the allegations reported in the article published by The Free Press describing practices and behaviors the author says she witnessed while employed at the university’s Transgender Center.”
“We are taking this matter very seriously and have already begun the process of looking into the situation to ascertain the facts,” the statement said. “As always, our highest priority is the health and well-being of our patients. We are committed to providing compassionate, family-centered care to all of our patients and we hold our medical practitioners to the highest professional and ethical standards.”
The state’s Division of Professional Registration, one of the agencies assisting in the investigation, is looking into whether any licensed professionals at the Transgender Center are in violation of their respective licensing board’s policies, while the Department of Social Services will be investigating concerns surrounding fraud, waste or abuse in the state’s Medicaid program, according to the attorney general’s news release.
Missouri is one of at least 24 states that have introduced measures this year to prohibit gender-affirming care for minors. Five states — Alabama, Arkansas, Tennessee, Arizona and Utah — have already placed restrictions on such care, though federal courts have blocked Alabama’s and Arkansas’ laws from taking effect pending the outcome of the litigation.
Transition-related care for minors is supported by major medical organizations — including the American Medical Association, the American Academy of Pediatrics and the American Psychological Association. These associations oppose governmental restrictions on care, including puberty blockers and hormone therapy, which they say are safe and have been used for decades to treat other conditions in minors.
The World Professional Association for Transgender Health’s most recent Standards of Care guidance, which is used widely by clinicians who provide transition-related care, recommends that this type of care be provided to minors using a multidisciplinary team of medical experts in a variety of fields, including psychology and endocrinology. The group doesn’t recommend any medical intervention for children prior to puberty. Rather, it recommends that children socially transition, for example, by using a different name and pronouns or wearing a different hairstyle or clothing. Adolescents who begin the early stages of puberty — usually between 8 and 14 — may be eligible for puberty blockers, but the group recommends they meet a list of criteria, including receiving a comprehensive psychosocial assessment.
The group also recommends that older youths meet a list of criteria before beginning hormone therapy. For example, the standards say adolescents have to demonstrate the emotional and cognitive maturity required to provide informed consent for treatment, the adolescent’s other mental health concerns should be addressed, and the adolescent and the parents or guardian should be informed of the potential reproductive effects of the treatment.
Minors rarely receive surgery, but when they do, the group recommends they receive hormone therapy for at least 12 months prior, receive ongoing mental health support and assessments and be informed of the potential health effects of surgery, including infertility.
More than half a dozen studies published in major medical journals over the last few years have found that access to puberty blockers and hormone therapy improves mental health outcomes, including significantly reducing suicidality, for trans youths.
Florida Gov. Ron DeSantis filed a complaint against the Orlando Philharmonic Plaza Foundation alleging that the nonprofit group held a sexually explicit drag show in December in the presence of minors.
The complaint, filed Friday through the Department of Business and Professional Regulation’s Division of Alcoholic Beverages and Tobacco and shared with NBC News, alleges the foundation violated Florida statutes on lewdness and maintaining a public nuisance and seeks to revoke its liquor license.
The administration cited the same decades-old case in its complaint against the foundation and argued that it is “operating and maintaining a nuisance” that injures “the health of the citizens in general” or corrupts “the public morals.”
DeSantis’ administration announced Dec. 27, the day before the foundation’s show, that it was investigating the performance after receiving “multiple complaints,” according to Bryan Griffin, the governor’s press secretary.
The administrative complaint says the foundation — which owns and operates The Plaza Live theater and supports the Orlando Philharmonic Orchestra — advertised “A Drag Queen Christmas,” a performance being held at the theater, as holiday-themed and welcoming of all ages.
The Plaza Live theater in Orlando, Fla. Google
The department said in its complaint that it sent a letter to the foundation prior to the show and notified it that “sexually explicit drag show performances constitute public nuisances, lewd activity, and disorderly conduct when minors are in attendance” and, if the foundation didn’t prohibit minors from the show, The Plaza Live could lose its liquor license.
Despite the warning, the complaint says, the foundation allowed minors to attend and posted a sign outside the entrance that read: “While we are not restricting access to anyone under 18 please be advised some may think the content is not appropriate for under 18.”
According to the complaint, the show featured “acts of sexual conduct,” simulated sexual activity and “lewd” displays, including performers intentionally exposing prosthetic female breasts and prosthetic genitalia to the audience. The show also included “sexualized adaptations” of popular Christmas songs, such as “Screwdolph the Red-Nippled Reindeer,” the complaint alleges.
The complaint claims that the foundation violated six Florida statutes by allowing minors to attend the show.
The Orlando Philharmonic Plaza Foundation did not immediately return a request for comment, but its board of directors told the Orlando Sentinel that The Plaza Live has hosted drag performances for eight years, and added that the venue is a “welcoming and inclusive establishment that operates in good faith and compliance with all applicable laws.”
“That includes respecting the rights of parents to decide what content is or is not appropriate for their own children,” the statement said, according to the Sentinel. “We have just been made aware of this administrative complaint and are working with our legal team to evaluate and respond appropriately.”
DeSantis’ complaint against the foundation is part of an escalating campaign against drag shows. In June, for example, former state House Rep. Anthony Sabatini called on the governor to hold an emergency special legislative session to consider legislation that would make it a crime for parents to bring their children to drag shows. That same month, when asked by a reporter whether he would support such legislation, DeSantis noted that the state has child protective statutes “on the books.”
“We have laws against child endangerment,” he said. “It used to be kids would be off-limits. Used to be everybody agreed with that. Now it just seems like there’s a concerted effort to be exposing kids more and more to things that are not age appropriate.”
The governor’s efforts are part of a nationwide backlash against drag and LGBTQ rights more broadly. Nationwide, state lawmakers have introduced at least 200 bills targeting LGBTQ people, according to an NBC News analysis.
At least 13 states have considered bills that would redefine any venue that hosts drag performances as an adult-oriented business or cabaret; some of the bills, including two in West Virginia, would also make it a crime for a person who is dressed as a sex different than the one they were assigned at birth to perform at all in front of minors.
Utah is the first state to ban gender-affirming medical care for transgender minors this year.
Gov. Spencer Cox, a Republican, signed a bill Saturday that bars minors from receiving gender-affirming surgeries and places an indefinite moratorium on their access to puberty blockers and hormone therapy.
The bill, which passed in the Utah State Legislature last week, is prospective, so minors who were diagnosed with gender dysphoria before the bill’s effective date, May 3, 2023, would still be able to receive care if they meet a list of requirements.
“Legislation that impacts our most vulnerable youth requires careful consideration and deliberation. While not a perfect bill, we are grateful for Sen. Kennedy’s more nuanced and thoughtful approach to this terribly divisive issue,” Cox said in a statement Saturday, referencing the bill’s sponsor, Republican State Sen. Michael Kennedy. “While we understand our words will be of little comfort to those who disagree with us, we sincerely hope that we can treat our transgender families with more love and respect as we work to better understand the science and consequences behind these procedures.”
In an emotional letter about his veto, Cox cited research about the high risk of suicide among trans youths and additional research that has found that acceptance reduces the risk of suicide.
“I don’t understand what they are going through or why they feel the way they do. But I want them to live,” he wrote. “And all the research shows that even a little acceptance and connection can reduce suicidality significantly.”
But Cox told local news station Fox 13 on Thursday, after the ban on gender-affirming care passed the House, that he did not plan to veto the bill. His office did not immediately return a request for additional comment.
State Sen. Kennedy, a family practice physician, told colleagues in a hearing this month that gender-affirming treatments “lack sufficient long-term research,” according to local radio station KUER.
“But still, our country is witnessing a radical and dangerous push for children to enter this version of health care,” he said.
State Sen. Daniel Thatcher, one of Kennedy’s Republican colleagues, disagreed and was the only Republican to speak out against a previous, though similar, version of the bill, KUER reported. He argued that though he and his colleagues might not understand gender-affirming care, “every credible medical organization on the planet says that that is the safest, best and most appropriate care to save those lives.”
Thatcher added that the bill could face legal challenges because it only prohibits the care for people who are transgender, but it does not prohibit the care for children who might need it for other reasons, KUER reported. The bill provides exemptions for intersex minors, for minors who experience early puberty and for those who have “medically necessary” reasons that don’t include treatment for gender dysphoria.
Thatcher, who is recovering from multiple strokes, was absent from the Senate vote Friday.
A crowd of protestors gathered outside the Utah Capitol on Tuesday ahead of a committee hearing on the bill, during which a number of transgender teens spoke out against it.
Bri Martin, the editor of the student newspaper at West High School, described gender-affirming care as “nothing short of life-saving,” the Salt Lake Tribune reported.
“Me and my family were saved from the arduous and painstaking task of adult transition,” Martin said. “I would like to make clear that no matter the opposition, transitioning was always the only option for me. I deserve a body to feel proud of.”
In addition to barring access to care for minors who don’t already receive it, the legislation also requires the state’s Division of Professional Licensing to create a certification for those who provide hormone treatment to minors. The certification process requires “at least 40 hours of education related to transgender health care for minors from an approved organization,” and providers must obtain this before they can continue to provide such treatment.
It also directs the state’s Department of Health and Human Services to conduct a systematic review of the medical evidence regarding hormonal transgender treatments and provide recommendations to the Legislature, but it does not require the Legislature to review the indefinite moratorium on care after the review is complete.
The measure also allows minors to sue medical providers for malpractice for gender-affirming medical care if the minor “later disaffirms consent” before they turn 25.
Cathryn Oakley, the state legislative director and senior counsel for the Human Rights Campaign, a national LGBTQ advocacy group, condemned the bill last week, just before Cox signed it.
“Utah legislators capitulated to extremism and fear-mongering, and by doing so, shamelessly put the lives and well-being of young Utahans at risk — young transgender folks who are simply trying to navigate life as their authentic selves,” Oakley said, in part, in a statement Friday. “Every parent wants and deserves access to the highest quality health care for our kids.”
Transgender youths reported more life satisfaction and fewer symptoms of depression and anxiety after receiving gender-affirming hormone therapy for two years, according to a new study.
The research, published Wednesday in the New England Journal of Medicine, evaluated 315 transgender youths between 12 to 20 years old, with an average age of 16, over the course of two years while they were being treated with gender-affirming hormone therapy.
The researchers are a group of physicians and professors associated with universities and children’s hospitals in Chicago, Boston and Los Angeles. The study was supported by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development.
The researchers used scales that measured depression and anxiety, positive emotions and sense of life satisfaction, and appearance congruence — meaning how much a trans person feels their external appearance aligns with their gender identity. Participants rated each of these factors numerically.
Researchers found that, on average, participants reported increases in positive emotions, life satisfaction and appearance congruence. Those increases were associated with decreases in depression and anxiety symptoms.
The findings, researchers wrote, support the use of hormone therapy as an effective treatment for trans and nonbinary youths.
The researchers said their findingsalso suggest appearance congruence is important for trans and nonbinary youths’ well-being. The mental and physical health differences between youth who had undergone substantial “gender-incongruent” puberty — which is the puberty associated with their assigned sex at birth — and those who had not also supported the importance of appearance congruence for well-being.
Only a small subgroup (24 participants) in the study did not undergo extensive gender-incongruent puberty, either because they began puberty blockers at an early stage of puberty, or started gender-affirming hormones when their puberty began later.
“Those who had not gone through substantial gender-incongruent puberty had higher scores for appearance congruence, positive affect, and life satisfaction and lower scores for depression and anxiety at baseline than youth who had undergone substantial endogenous puberty,” meaning the puberty associated with their assigned sex, the researchers wrote.
They also noted that depression and anxiety symptoms decreased significantly and life satisfaction increased significantly among trans and nonbinary youth designated female at birth but not for those designated male at birth. This difference, they wrote, could be attributed to a few factors: First, some physical changes associated with estrogen, such as breast growth, can take between two to five years to reach their “maximum effect.”
As a result, the researchers speculated that a longer follow-up period may be necessary for trans feminine youth to see an effect on mental health.
Second, they wrote that physical changes that result from going through testosterone-driven puberty, such as a deeper voice, might be “more pronounced and observable” than those associated with an estrogen-driven puberty.
Third, the researchers wrote that it’s possible the differences in anxiety and life satisfaction could be related to less social acceptance of transfeminine people, compared with transmasculine people.
Research published in the Journal of Adolescent Health in 2021 suggested that transfeminine youth may experience more minority stress, which is stress faced by stigmatized minority groups like LGBTQ people, than transmasculine youth.
The authors of the new study wrote that understanding the effect of gender-affirming hormones on the mental health and well-being of transgender and nonbinary youth “would appear crucial, given the documented mental health disparities observed in this population, particularly in the context of increasing politicization of gender-affirming medical care.”
Over the last two years, state legislatures have considered dozens of bills that seek to restrict access to gender-affirming medical care, such as puberty blockers, hormone therapy and surgery for transgender minors.
Governors in four states — Arkansas, Alabama, Tennessee and Arizona — have signed restrictions on such care into law, but measures in Arkansas and Alabama have been blocked from taking effect by federal judges pending litigation.
So far this year, lawmakers have introduced such legislation in at least 16 states.
Supporters of this legislation argue that the care is experimental and that minors are too young to make decisions about medical care that could have irreversible impacts.
These groups point to the growing body of research that has found the care to have significant positive mental and physical health effects for transgender youth, who have disproportionately high rates of suicide.
A national survey released last year by the Trevor Project, a national youth suicide prevention and crisis intervention organization, found that more than half of transgender and nonbinary youth (53%) seriously considered suicide in the past year. Nearly 1 in 5 (19%) reported that they had attempted suicide in the past year.
In addition to the New England Journal of Medicine study, about half a dozen others have shown that access to puberty blockers and hormone therapy can improve mental health outcomes, including reducing suicidal ideation, among transgender youths.
Three studies — two published in 2020 and another published in 2021 — found that earlier access to gender-affirming medical care is associated with better mental health.
And a 2021 study published in the Journal of Adolescent Health, which was based on data from the Trevor Project, found that gender-affirming hormone therapy is strongly linked to a lower risk of suicide and depression for transgender youths between the ages of 13 and 24.
The researchers behind the New England Journal of Medicine Study noted that there were some limitations to their study. For example, they recruited participants from gender clinics at children’s hospitals in Chicago, Boston and Los Angeles.
As a result, they said the findings might not apply to youth who cannot access comprehensive gender-affirming care or youth who are self-medicating with gender-affirming hormones.
They also noted that improvement in mental health varied widely, and that some participants continued to report high levels of depression and anxiety and lower levels of positive emotions and life satisfaction.
Two participants died by suicide during the study and six withdrew, according to the researchers. The information gathered before they died or left the study was included in the analyses, they added.
The study did not examine other factors that are known to affect psychosocial functioning among trans youth, such as parental support. The study also lacked a comparison group, which the researchers said limits their ability to establish causality. They plan to study those other factors and will continue to follow the cohort to see whether the improvements are sustained over a longer period of time.
More than 100 bills targeting LGBTQ rights and queer life— from transgender health care to drag shows — have been filed in 22 states for 2023 so far, leading advocates to expect this year will set a new record for anti-LGBTQ legislation.
So far, Texas has taken the lead with 36 such bills, according to Equality Texas, a statewide LGBTQ advocacy group. Missouri is next with 26, then North Dakota with eight and Oklahoma with six.
The majority of these approximately 120 bills focus on transgender young people, continuing a trend that began about two years ago.
In the past three years, 18 states have banned transgender student athletes from competing on school sports teams that align with their gender identity rather than the sex they were assigned at birth, according to the Movement Advancement Project, an LGBTQ think tank. Four states — Arkansas, Alabama, Tennessee and Arizona — have enacted restrictions on gender-affirming medical care for minors, though federal judges have blocked them from taking effect in Arkansas and Alabama.
Texas House members with family and guests on Jan. 10, 2023, at the opening of the 88th Texas Legislative Session. Eric Gay / AP
This year lawmakers in at least three states have introduced bills to restrict transgender girls and women from playing on female sports teams, and lawmakers in at least 11 states have proposed bills that would restrict gender-affirming health care for minors.
For the third year in a row, efforts to restrict LGBTQ rights and queer life have been escalating, according to Chase Strangio, the deputy director of the American Civil Liberty Union’s LGBT and HIV Project. Strangio, one of the attorneys who is representing transgender young people and their parents in their lawsuit against Arkansas’ prohibition on gender-affirming medical care, said he expected the number of anti-LGBTQ bills filed this year to outpace those filed last year, when more than 340 such bills made it to state legislatures, according to an estimate from the Human Rights Campaign.
He said he’s most worried about more states restricting access to gender-affirming care and, if the makeup of Congress becomes more conservative in 2024, a potential federal ban.
“The rightward shift in state legislatures is really scary,” he said. “We’re seeing continued erosion and efforts to restrain and constrict and limit bodily autonomy across the board. … There’s just a lot that I think people are taking for granted, particularly people who live in states like New York and California and aren’t paying attention to what’s going on in states like Arkansas, Oklahoma and Texas.”
Markus Thurman speaks during a news conference by supporters of gender-affirming care at Vanderbilt University Medical Center in Nashville, Tenn., on Oct. 19, 2022.Nicole Hester / The Tennessean / USA Today Network
One bill transgender advocates are particularly worried about is an Oklahoma proposal that would bar transition-related care not only for minors but for anyone under the age of 26; it would also prohibit Medicaid from covering such care.
State Sen. David Bullard, the Republican sponsoring the bill, told The Oklahoman that gender-affirming medical care is a “permanent change in your body that cannot be reversed.
“At the age of 21 you can drink, but at the end of the day if you decide to put the alcohol down, you can put the alcohol down,” Bullard told The Oklahoman. “But with this surgery, there is no going back. We just want to make sure that the brain is fully developed before we allow this kind of surgery, permanent thing to happen.”
Bullard did not immediately return a request for comment.
Advocates and doctors who treat trans youth have said many of the health care restrictions proposed by state legislators mischaracterize what gender-affirming care is. The World Professional Association for Transgender Health, a nonprofit professional and educational organization dedicated to transgender health, doesn’t recommend medical interventionat allbefore puberty.
Before puberty, trans young people might socially transition, meaning they might change their name, pronouns and clothing. For some transgender youths, going through puberty in the sex they were assigned at birth can have a negative effect on their mental health, so WPATH recommends puberty-blocking medications in the early stage of puberty (Tanner stage 2), which temporarily pauses puberty, or hormone therapy at the same stage, but only if they meet a list of criteria. Gender-affirming surgery for minors, even post puberty, is rare.
A new slate of bills targeting drag performers has also emerged, likely in response to increasing protests in the past year against children attending drag brunches or Drag Story Hour, a national program started in 2015 in which drag performers read books to children at libraries, schools and bookstores
Bills filed in Arizona, Arkansas, Montana, Tennessee, Texas and West Virginia would ban minors from attending drag performances and seek to classify any business that hosts such performances as a cabaret or a “sexually oriented business.”
Tennessee state Sen. Jack Johnson — a Republican who filed a billthat would make it a misdemeanor for “male or female impersonators who provide entertainment that appeals to a prurient interest” to perform on public property or in front of minors — told WSMV-TV, an NBC affiliate in Nashville, that he had received complaints about drag shows from constituents.
Molly Gormley, Johnson’s press secretary, said the bill is “aimed at protecting children from being exposed to sexually explicit drag shows or other performances inappropriate for children.”
“It is similar to laws that prohibit children from going to a strip club or that prohibit public nudity,” Gormley said in an email. “This is a common-sense measure and is not anti-drag or anti-transgender. It is about protecting children.”
Jace Wilder, the education manager at the Tennessee Equality Project, described the climate for LGBTQ people in the state as “vicious.”
Over the past two years, the state has passed both a law that bars trans student athletes from playing on school sports teams that match their gender identity, and a law that prohibits gender-affirming medical care for children before puberty, even though medical intervention is not recommended for pre-pubertal youths.
Johnson’s bill, which is one of the four LGBTQ-related bills proposed in Tennessee for the current legislative session, would classify drag performances as adult cabaret.
A similar bill in Arizona would require businesses that host drag performers to be zoned as adult performance venues. It defines a drag performer as “a person who dresses in clothing and uses makeup and other physical markers opposite of the person’s gender at birth to exaggerate gender signifiers and roles and engages in singing, dancing or a monologue or skit in order to entertain an audience.”
Wilder said that the language in many of these bills, including those proposed in Arizona and Tennessee, is so broad that it doesn’t just include drag performers but also “attacks anyone that is gender-nonconforming or gender diverse.”
The bills feel like they’re “backtracking” to decades old cross-dressing laws, Wilder said, where “you could walk across the street and someone defined that as a sexual presence and could have you arrested for ‘impersonating another gender.’”
“Our biggest worry is, honestly, how are we going to come out of this safe?” he said.
Legislation in Florida has already made people there feel unsafe, according to Brandon Wolf, press secretary for Equality Florida, a statewide LGBTQ advocacy group. He specifically cited the Parental Rights in Education law (dubbed the “Don’t Say Gay” bill by critics), which prohibits classroom instruction on “sexual orientation or gender identity … in kindergarten through grade 3 or in a manner that is not age appropriate or developmentally appropriate for students in accordance with state standards.”
“We have over 9,000 teacher vacancies in Florida driven in part because of the character assassination they’ve been under over the last couple of years,” Wolf said. “Young people are telling us they’re really afraid. … They’re afraid that school isn’t safe for them anymore, and their families are wondering if they’re going to have to leave Florida to be able to raise their children in a state that respects them and treats them with dignity.”
Rachel Hill, the government affairs director of Equality Texas, said lawmakers in her state have pre-filed 36 anti-LGBTQ bills so far — more than were proposed during the entire legislative session in 2021.
Two years ago, Texas considered more than 50 bills that target trans people during its regular legislative session and three special sessions, and all but one — a trans athlete ban — failed to become law.
While the state didn’t have a legislative session last year (the Texas Legislature meets only every other year), Texas Attorney General Ken Paxton and Gov. Greg Abbott directed the state’s child protective services agency to investigate any claims of parents providing gender-affirming care to their minor children as child abuse. Some of those investigations have been blocked because of two lawsuits, but the threat of investigation has led many families with trans kids to leave the state.
But those who have chosen to stay are “fired up,” Hill said, echoing similar sentiments from advocates in other states.
“If anything, what we’re feeling is defiant,” she said. “While we are facing probably the toughest legislative session we’ve ever faced in Texas, we are ready to meet it.”
After five hours of tense testimony and protests, the Florida Board of Medicine voted Friday to start drafting a rule that would bar all minors in the state from receiving puberty blockers, hormone therapy or surgeries as treatment for gender dysphoria.
Florida’s medical board is the first in the country to pursue such a rule, but Florida is among a wave of states where officials have attempted to restrict gender-affirming medical care for transgender minors.
By the end of Friday’s five-hour meeting, protesters began yelling “Shame!” at the board members, and some of them staged a “die-in” in the lobby of the Orlando International Airport, where the meeting was held.
Protesters stage a “die-in” in the lobby of the Orlando International Airport on Oct. 28, 2022.Courtesy Kat Duesterhaus
The vote is the latest update in a months-long effort led by Gov. Ron DeSantis’ administration to restrict transition-related care for people under 18.
The effort to restrict such care began in April, when DeSantis and Florida Surgeon General Joseph Ladapo issued nonbinding guidancethrough the Florida Health Department that sought to bar both “social gender transition” and gender-affirming medical care for minors.
Despite that support, Florida’s Agency for Health Care Administration issued a report in June that “found that several services for the treatment of gender dysphoria — i.e., sex reassignment surgery, cross-sex hormones and puberty blockers — are not consistent with widely accepted professional medical standards and are experimental and investigational with the potential for harmful long-term affects.”
Just hours after the report’s release, Ladapo sent a letter to the Board of Medicine and asked it to establish a standard of care “for these complex and irreversible procedures.”
The board held its first meeting on the issue in August, and on Friday it officially voted to draft a ban on certain gender-affirming therapies for minors. The meeting began with expert testimony in favor of and against such care.
Dr. Michael Laidlaw, an endocrinologist in Rockland, California, cited often-criticized research that found 50% to 90% of children whose gender identity isn’t consistent with their assigned sex at birth grow out of the condition by adulthood.
“The basic problem with this treatment as I see it is: ‘What happens when you force a square peg into a round hole?’” he said. “You end up injuring or destroying the peg in the process.”
However, Dr. Meredithe McNamara, an assistant professor of pediatrics at Yale School of Medicine who treats transgender people between the ages of 10 and 25, told the board that the research Laidlaw cited and the June report issued by the Florida Agency for Health Care Administration are methodologically flawed.
“Neither of the authors of the state’s review is a subject matter expert,” McNamara said. “One individual is a dentist. The other is a post-doctoral fellow in biostatistics. At a bare minimum, the systematic review should be conducted by those who are qualified to assess the literature. I wouldn’t trust a dermatologist review of the literature on a neurosurgical procedure, for instance.”
After expert testimony, the board began the public comment period, which was scheduled to last two hours, according to multiple attendees.
The first nine attendees who spoke were in favor of restricting gender-affirming care for minors. Eight of them said they have detransitioned, or come to identify with their assigned sex at birth after having previously identified as trans. Only one of the eight had received gender-affirming medical care as a minor.
Chloe Cole, who described herself as an 18-year-old detransitioned female from California, said she began transitioning at 12 and received a double mastectomy at 15. At 16, she said, she realized she regretted her transition.
“All the talk about mental health, self perception, pronouns and ideology leads me to the question, why is a mental health epidemic not being addressed with mental health treatment to get at the root causes for why female adolescents like me want to reject their bodies?” Cole said.
The board also heard from the parents of transgender youths. Hope McClay, who has a 9-year-old trans daughter, said that she used to have to force her daughter to get short haircuts before she came out as trans.
“At one point she came up to me, at about three-and-a-half years old, and begged me, crying, and said, ‘Please, don’t make me be this way anymore. This is not who I am. I want to die,’” McClay said.
She said she and her family have consulted with medical professionals on medical care for their daughter, and they have found that allowing her to go through male puberty would be “psychologically damaging.”
“So we do not make these decisions lightly, but these are the decisions that should be made by the families, not by the state, and not by a board,” McClay said.
Jude Spiegel, the only transgender person to testify at Friday’s meeting, read the names of 17 trans teens who died by suicide “over living in a world that refused to acknowledge or accept them.”
With about 45 minutes left in the public comment period, board member Dr. Zachariah P. Zachariah said only one more person would be allowed to testify. The crowd protested, and he offered to provide an email where they could share their testimonies.
At one point, an audience member yelled that trans youths would suffer if the board voted to bar care: “The blood is on your hands!” To which Zachariah responded, “That’s OK.”
Emile Fox, a trans nonbinary person from Orlando who uses “they” and “he” pronouns, said they signed up to testify and weren’t able to, which frustrated them after the first eight people who testified were all in favor of restricting care, but none of them were from Florida.
“What was so appalling to me is how obviously staged this all was,” Fox said, adding that the board members didn’t appear to know that much about gender-affirming therapies. “They’ve been fed a narrative, and they ate it up.”
A spokesperson for the board said the committee “heard from subject matter experts and allowed for members of the public to speak on the issue at today’s workshop.”
“The content of public comment is not ‘stacked’ by Boards,” the spokesperson said in an email Saturday. “Any members of the public who were unable to provide comment can submit written comment via email to BOMpubliccomment@flhealth.gov within 24 hours of the conclusion of the workshop. These comments will be included in the rulemaking record and reviewed just as all other public comments.”
After the public comment period, the board attempted to come up with a rough draft of a rule. Initially, members considered making trans youths who were already receiving gender-affirming medical care exempt from the ban if they underwent an informed consent process, but they decided to cut that proposal.
Then, in a rushed exchange that attendees described as confusing, Zachariah pushed for a vote even as some board members asked for the proposal to be read aloud once more. He then said the motion was passed without saying what the final tally was.
Florida Rep. Anna Eskamani, a Democrat whose district includes parts of Orlando, said that there would be another meeting on Nov. 4 at the Holiday Inn, Disney Springs, to discuss the drafted rule, and then there would be a 28-day approval process that would include additional time for public comments.
She believes the timing of the rulemaking process — just ahead of the election — is intentional.
“It’s so clearly intentionally designed to create a news cycle that further polarizes and politicizes gender-affirming care to distract from the affordable housing crisis, to distract from the impact of Hurricane Ian and property insurance rates,” she said. “We have some actual real problems to solve, big health disparities that we need to address and yet, instead of talking about those real-life concerns, trans issues are going to be front and center, and that’s truly designed to continue to divide us.”
