MTAAP Advocacy Committee

A bill to prohibit critical health care for transgender Montana youth was just signed by Governor Gianforte. His signature came despite the objections of Montana’s health experts, child advocates, parents and the people who will be directly impacted.

The Montana Chapter of the American Academy of Pediatrics, an organization representing pediatric care providers in Montana, has sought to give clear and consistent information on the harmful health impacts of this bill, SB99, on a small but vulnerable group of Montana youth.

We know that for youth who have persistent gender dysphoria, meaning persistent long-term significant psychological distress at how their body and their identity don't align, gender-affirming care can be truly life-saving.  Withholding such care is not a neutral act, but actively causes harm.

The misconceptions underlying SB99 are illustrated in an April 17 letter by the Governor to the legislature, to which his office has referred for comments on his decision. This letter contains factually inaccurate information.

What are some of the issues with the Governor’s letter? First, it states that SB99 “does not prohibit thoughtful, noninvasive care”. Gender-affirming care is based first and foremost in valuing children where they are, rather than predicting or trying to control who they may become.  This care is thoughtful, individualized, and developmentally-appropriate, like all pediatric care.

The Governor is mistaken in his claim that SB99 “does not prohibit social affirmation”. The bill explicitly DOES prohibit social transitioning, which it defines as “acts … including the changing of the minor’s preferred pronouns or dress…” in certain settings, such as on state property.  This would prohibit counselors from being able to discuss a child's feelings about gender, and prohibit these professionals from using appropriate pronouns.

The Governor also calls the science “unsettled”. Although all medical care can and should continuously evolve over time, major medical organizations throughout the country are unified in recognizing the strong, cohesive evidence that appropriate gender-affirming care improves health and well-being. The American Medical Association, American Psychiatric Association, Endocrine Society, and almost 30 other professional organizations have statements and guidelines supporting this care.

The letter also focuses in depth on surgery, which is itself misleading. Let us be clear.  "Bottom" surgeries on minors do not happen in Montana. Other gender-affirming surgeries are rare - much rarer than cosmetic surgeries on minors. By far the main effect of this bill is not on surgery but on necessary medical treatments.

The letter stresses that gender-affirming care is "permanent" and "life-altering." In fact, these medical treatments are either fully or partially reversible. Parents are able to, and frequently do, make thoughtful medical decisions for their children that are necessarily permanent and life-altering.  For example, parents make decisions for their child around chemotherapy options, surgical procedures for intestinal diseases, or hormonal treatment for short stature. Parents weigh risks and benefits to all medical treatment. This medical treatment is no different.

Parents, not lawmakers, should be the ones making difficult decisions for their children. Parents do not want the state legislature in the exam room overruling the advice of their chosen provider based on national best-practice guidelines.

Even if transgender people and the details of gender-affirming care are unfamiliar to you, know that nothing about this care is fundamentally different than other routine medical care. Research shows that access to this medically-necessary care reduces suicidal thoughts by 70%.  Taking away this care will, without a doubt, harm kids.

This bill is a mistake for Montana, and misinformation, such as that in the Governor’s letter, is harmful. Even debating this legislation and the surrounding furor in the news is contributing to discrimination, stigma, and in some cases violence, against transgender Montanans. We have seen this in our communities. We have seen this in our clinics and hospitals.

SB99 is written to take effect October 1, and a legal challenge is anticipated before that happens. In the meantime, we ask that you support your gender diverse neighbors, and that we stop debating their rights to medical care in the public arena and allow them to live their lives freely.

Lauren Wilson, MD, President, Montana Chapter, American Academy of Pediatrics; and the MTAAP Advocacy Committee.