SIOUX FALLS, S.D. (KELO) — For the third time in four years, South Dakota lawmakers are attempting to legislate what kind of health care transgender children can receive.

House Bill 1080, introduced by Republican Representative Bethany Soye, would prohibit the prescription of puberty blockers or suppressants, gender-affirming surgery and cross-sex hormones for children that Soye describes as seeking to “change [their] biological sex.” The bill has the support of 35 lawmakers.

The bill passed through its first hurdle Tuesday where the House Health and Human Services committee heard over an hour of testimony from both proponents of the bill and opponents. Among the opponents was Dr. Anne Dilenschneider, a mental health counselor who works with transgender youth in the state.

What does care look like for transgender kids?

Prior to her testimony to lawmakers, Dilenschneider spoke with KELOLAND News about the process of providing mental health care to transgender children seeking to transition.

Before receiving any sort of medical care, including hormones or surgery, Dilenschneider said transgender children will work with a team of specialists for years to determine whether they are transgender and able to receive gender-affirming care.

“There’s a very clear criteria that have to be met; there’s assessment that takes years, I mean, this is not like a checklist, right?” Dilenschneider said.

That assessment means not only working with a counselor like Dilenschneider, but also meeting with the child’s primary care physician, endocrinologists and working closely with the child’s parents throughout the entire process.

Sanford Health physician Keith Hansen told the Prairie Doc program in 2021 children must meet diagnostic criteria and experts will look at underlying psychological issues as well.

“And then, you know, when they come to us, we do a thorough history, physical examination, trying to make sure that there’s not some other underlying genetic, hormonal, or other issue that might be playing an important role,” Hansen said. “Or that if there’s some complication, or potential issue that could cause a complication from taking the cis-affirm– the affirming hormones.”

But the process to get there is complex and takes years, Dilenschneider explained.

The exploration of one’s gender is natural to childhood development, the counselor explained, and so through an extensive period of assessment, Dilenschneider works to determine if a child is transgender. Sometimes, she said, they are not.

“I’ve had kids who were born assigned male and said they were girls and play princesses for years and then go back to presenting as boys,” Dilenschneider explained. 

That’s an experience similar to what Soye told lawmakers about during the introduction of her bill to the committee on Tuesday.

“As a child, I wanted to be a boy. I wore boy clothes, and I came up with a name for myself, and in third grade, I wrote that name on all my class assignments,” Soye said. “However, my parents didn’t take me in for chemical treatments; they just supported me, loved me and allowed me to experience childhood. I went through natural puberty and changed to loving being a girl.”

Once a child is determined to be transgender, they are given a referral letter to meet with doctors like Hansen to begin building a care plan.

“There’s so many checks and balances already in play that we have to do exactly right,” Dilenschneider said. “Or, you know, surgeons will deny letters that are coming from people who aren’t appropriately trained. The insurance will deny letters if you’re not, you know, I mean, if there’s not information that needs to be in there, the processes haven’t been followed.”

Elliot Morehead, a 16-year-old transgender student in South Dakota, recently received one of those letters.

“After six months of working with my therapist, I’ve finally received my HRT letter, which, FYI, only allows me to schedule an appointment and maybe start testing and maybe start talking about gender-affirming treatment,” Morehead testified to lawmakers.

Another factor in the process is the informed consent of the child and their understanding of what is happening.

“We have to look at their development; we have to look at their ability to make decisions. So, there’s so much stuff going on there. You know, they have to demonstrate emotional and cognitive maturity; they have to demonstrate it,” Dilenschneider said.

It’s not just a walk-in appointment to get hormones, Dilenschneider added.

Proponents say care is dangerous, opponents call it lifesaving

During Tuesday’s hearing, two doctors spoke in support of Soye’s bill.

Dr. Michael Laidlaw, an endocrinologist based in California, has testified across the country in support of similar legislation. He told lawmakers that puberty blockers can cause stunting of sex organ development, infertility and loss of bone density.

The Mayo Clinic lists potential weight gain, hot flashes and headaches as side effects of using puberty suppressants. For cross-sex hormones, they list a risk of diabetes, high blood pressure, stroke, heart problems and infertility.

“For males… complications include increased risk of heart attacks and deaths due to cardiovascular disease, infertility and sexual dysfunction,” Laidlaw said. “For females, very high levels of risks. For males that have a five times increased risk of deadly blood clots, breast cancer risk is increased 46 times. Surgeries such as mastectomy result in large scarring, loss of normal sensation as a possibility and of course, inability to breastfeed.”

In the 2021 interview, Hansen said those undergoing treatment with hormones are constantly being evaluated and receiving psychological consultation related to their care.

“During that time, we watch them for other potential complications from the pubertal blocker. And the most common one is a drug called leuprolide acetate,” Hansen explained. “And we usually continue that pubertal blocker till they reach the age of 16.”

Hansen said after the age of 16, they begin talking to the families about beginning a second pubertal blocker, which he says is reversible. Then, when children are around 18-years-old, they start thinking about “permanent changes” like surgery, Hansen continued.

When asked if a 13-year-old who has started puberty may potentially be prescribed hormones, Dilenschneider said it’s a “big might.”

“A 13-year-old is not going to be on gender-affirming hormones. Okay, they might, might, and that’s a big might, be a candidate for puberty suppression or birth control. However, I have a number of 13-to-15-year-olds who don’t meet the criteria. They might meet, like, six of the eight,” Dilenschneider said.

Sioux Falls pediatrician Nicholas Torbert spoke against the proposed bill saying that he has worked with patients experiencing gender dysphoria.

“If passed, HB 1080 will prevent me from recommending medical care that is supported by many major medical associations in the United States, including the American Academy of Child and Adolescent Psychiatry, the American Medical Association, the American Academy of Pediatrics and the Endocrine Society,” Torbert said. “There’s standards of care and medicines dictated by research. By taking this therapy off the table respectively to individuals will only injure the hard working people at this state.”

Retired physician Don Oliver disagrees. He told lawmakers that he is “embarrassed” by his profession.

“I believe organized medicine, and especially the American Academy of Pediatrics, has followed an errant and harmful path in our current times, trying to keep up with the variations of the sexual revolution,” Oliver said.

How frequently do children receive this care in SD?

According to Hansen’s 2021 interview, there were not many children receiving this care in 2020.

“Went back to last year counted and I think we saw like 29 individuals who were transgender below the age of 18, over that period of a year,” Hansen said.

When questioned during the House Health and Human Services hearing, Soye said that children are currently receiving this kind of care in the state.

“We do have evidence that it’s happening here in South Dakota,” Soye said. “We had a newspaper article that showed that an eight-year-old was getting cross-sex hormones. We have a request for a name change that shows that a 13-year-old is getting cross-sex hormones.”

Soye brought three adults who said that they had detransitioned and regretted their decision to receive hormones and gender-affirming surgery as adults. When asked by Democrat Erin Healy whether there was evidence of children regretting receiving gender-affirming care in South Dakota, Soye could not provide an answer.

Healy: I believe that that’s gender-affirming care. So, can you please tell me if any transgender adolescents are transitioning in South Dakota? Detransitioning in South Dakota?
Soye: I guess I don’t totally understand your question. Could you please rephrase?
Healy: Well, we’re hearing from testifiers who have detransitioned. So, I’m wondering if this is a problem in South Dakota.
Soye: I’d just like to say that it takes a lot of guts to come up here and tell your story. And with this going on in South Dakota, yeah, maybe the kids here don’t want to come up and tell their story because it takes a lot to be up here.

After more than an hour of discussion, the committee voted 11-2 along party lines to advance the bill to the House floor where it will be debated amongst lawmakers. If passed through the House, it will then move to the Senate where it will undergo similar public testimony.

In January, KELOLAND News reached out to Sanford Health, asking to speak with Dr. Hansen about harassment he was receiving for providing care to transgender patients led by Republican Representative Jon Hansen on Twitter. We received the following statement:

Dr. Hansen is a tremendous asset to our team of exceptional health care providers at Sanford Health. He is a highly regarded physician who has helped thousands of families across our region impacted by infertility. He always puts his patients first, building comfort and trust while delivering the best possible care to those we serve.

Dr. Joshua Crabtree, vice president of clinic at Sanford Health in Sioux Falls