On Wednesday, West Virginia Gov. Jim Justice signed a bill banning transgender procedures for minors into law in the state. However, it comes with exceptions that sometimes allow for treatments to be administered.
The law, which goes into effect in January 2024, lets doctors prescribe puberty (hormone) blockers or hormone therapy if the minor is considered at risk of self-harm or suicide.
Specifically, the minor needs to be diagnosed as suffering from severe gender dysphoria by two medical doctors with relevant training in the field. One of the clinicians must be a mental health provider or adolescent medicine specialist.
The two clinicians would also need to document in writing the medical necessity of treating the minor with either puberty blockers or hormones to limit self-harm or the possibility of self-harm. Furthermore, the minor’s parents must agree to the treatment in writing.
Hormonal treatments, however, are not allowed if the minor has not gone through puberty. Furthermore, according to the bill: “Any use of gender altering medication is for purposes of pubertal modulating and hormonal therapy and is limited to the lowest titratable dosage necessary to treat the psychiatric condition and not for purposes of gender transition.”
The exception was added at the urging of Senate Majority Leader Tom Takubo, a physician.
“These kids struggle. They have incredible difficulties,” the Republican said on the Senate floor earlier this month.
Medical professionals define gender dysphoria as psychological distress experienced by those whose gender identity differs from their sex assigned at birth.
Besides the exception, doctors in West Virginia are now generally banned from providing any transgender procedures, including prescribing various drugs or carrying out surgeries to those under 18.The new West Virginia law has other exemptions that let doctors provide treatment to minors who are born intersex and those who suffer from an infection, injury, disease, or disorder that was “caused by or exacerbated by the performance of gender transition procedures.”
Doctors can also perform any surgery to help a minor at risk of “imminent danger of death, or impairment of a major bodily function.”
A 2017 study by UCLA Law’s The Williams Institute estimated West Virginia had the highest per capita rate of transgender youth in the country. The rate of suicidal thoughts or ideas for transgender youth in West Virginia is three times higher than the rate for all youth in the state, according to West Virginia Youth Risk Behavior Survey data.
The American Medical Association (AMA) and the American Academy of Pediatrics (AAP), and the American Psychiatric Association (APA) have signaled support for gender transition procedures, or what they call “gender-affirming care,” for minors.
The medical organizations assert that gender transition procedures may improve a gender dysphoric person’s mental health and lower rates of suicide in the immediate future and that forgoing such care puts the patient at higher risk of anxiety, stress, substance abuse, and suicide.
But the groups do not point out that some gender transition procedures render the minor highly unlikely to be able to reproduce in the future or make other irreversible changes.
The group warned that gender transition procedures are “generally irreversible and have a high probability of causing sterilization.” The procedures also “commit a patient to a lifelong need for medical, surgical, and psychological care.”
The AAPS stated that such procedures in minors are also medically and ethically contraindicated due to a lack of informed consent.
“For the safety and well-being of all trans and gender dysphoric people, we need our health care, especially our mental health care, disentangled from a well-meaning yet misappropriated academic philosophy,” the Gender Dysphoria Alliance (GDA) said in its letter.
“As people living with Gender Dysphoria, we want competent, evidence-based care. This includes mental health care and thorough psychosocial assessment prior to any medicalization, at any age,” the group said in their letter.
