Defeated anti-trans bill revived to bar gender conforming surgeries for trans youth

A week after a move to ban all gender-affirming care for transgender youth in Arizona was rejected, GOP lawmakers passed a measure barring gender confirmation surgery for minors.

“This bill mirrors the international standards that have been implemented in other countries such as Finland, which is one of the most transgender friendly countries,” Sen. Tyler Pace, R-Mesa, said.

The language, he said, was derived from the standards of care written by the World Professional Association for Transgender Health.

Initially, the language of the strike-everything amendment added to Senate Bill 1138 would have allowed gender confirmation surgeries for youth who had lived in their gender identity for at least 12 months. But Pace added an amendment which would remove the 12 month exception, making it a blanket ban for every surgery done for the purpose of transitioning, a change he said mirrors the WPATH standards, which recommend postponing surgeries until age 18.

The re-working of SB1138 came a week after Pace cast the deciding vote to kill the original version of the bill, which would have banned hormone therapy and puberty blockers, as well as surgeries, for all transgender youth in Arizona. He said he agreed with the bill’s language blocking surgery, but couldn’t support a ban on things like hormone therapy. 

In an email to the Arizona Mirror, Bridget Sharpe, the Arizona state director of the Human Rights Campaign, denounced legislators’ efforts to interfere in the medical needs of trans youth. 

“The bill allows the legislature to decide what kind of age-appropriate, medically-necessary, gender-affirming care is acceptable for transgender youth in Arizona. These decisions should be made between parents, children, and their medical care teams,” she said. 

Last week’s hearing saw dozens of parents, children, and trans advocates share their stories and fears about SB1138. But this time, Health and Human Services Committee Chair Nancy Barto didn’t allow testimony on the bill. The Phoenix Republican said the previous hearing took too long because of the number of speakers, and she wanted to spend less time considering the bill. 

Sen. Raquel Terán, a Phoenix Democrat, pointed out that the new version of the bill involved different concerns, but Barto did not budge. 

“The bill has been narrowed and so the concerns should be less serious,” she said. 

Terán resorted to reading the comments written in the electronic Request to Speak system, in which those who wish to weigh in on bills can offer comments. 

Sam Ames, the director of advocacy and government affairs for The Trevor Project, an organization focused on suicide prevention for LGBTQ youth, wrote about how the discussion of anti-trans legislation affected the well-being of trans kids. 

“Our research shows that in the past year more than half of transgender and nonbinary youth seriously considered suicide and 1 in 5 attempted suicide. When asked how the debate about these bills is affecting them, 1 in 3 said (they’re) scared,” he said, via the RTS system. 

Sen. Kelly Townsend, R-Mesa, dismissed the idea that state laws restricting access to gender-affirming care could result in suicides, and she accused those saying otherwise of using the threat to get their way with lawmakers.

“There is such a thing called coercive suicide,” she said. “Please remember that, if you’re using suicide as a form of manipulation to get what you want, that is abuse.” 

Gender dysphoria, social stigma and discrimination are among the top reasons youth consider suicide. A 2017 survey of LGBT students found that 70% experienced name calling or threats in the previous year, and a 2019 clinical observation report states that anxiety, depression and suicidal ideation is highly prevalent among gender dysphoric youth. 

The Arizona Mirror contacted people who were denied the ability to speak publicly at the hearing. Derrick Fiedler, whose young transgender son came out last year, shared how disheartening it was seeing so many anti-trans bills in the legislature. 

“What (parents) want is for our kids to have the freedom to live authentically, to have hope for their lives, for their futures, and to have the opportunity to realize those hopes,” he said in a written statement. “We need gender-affirming medical and mental health care, we need supportive sports and education programs, we need a society around us that doesn’t treat our child as a freak or a threat.”

These sentiments were shared by Terán, who said that SB1138 contributed to the stigmatization of trans youth. 

Pace argued that was not the intent of the bill, but rather to emphasize the irreversibility of surgeries. He added the purpose was not to shame or discourage the procedure, but rather ensure that only fully aware and informed adults made the decision to undergo surgery.

“I do not want an eight-year-old child who is going through a very difficult gender transition — in this day and age — to never be informed that some of these surgeries are irreversible,” he said, “They need to know and their physicians need to advocate that these are steps that are adult steps.”

The Arizona Chapter of the American Academy of Pediatrics disputed the implication that transition services are offered to prepubescent children. 

“There is no medical therapy for transgender children prior to puberty and no surgical therapy prior to age 18,” wrote the Academy in an email to the Arizona Mirror, adding that, despite that fact, surgeries may yet be necessary for a “multitude of other medical conditions” that the bill prohibits.

“Legislative mandates regarding the practice of medicine do not allow for the infinite array of exceptions or cases in which the mandate may be harmful to an individual patient,” they wrote.

Children go through many doctor’s appointments throughout their teen years to access puberty blockers and hormone therapy, which are the predecessors to surgical procedures that are themselves generally only recommended to 18 year olds. Breast surgeries are the only procedure which WPATH — Pace’s key source — advises may be provided prior to adulthood. 

During last week’s hearing, several parents emphasized the involvement of medical expertise and recommendations in their children’s lives, and one mom said her own daughter had to wait six months for estrogen.

Sen. Rosanna Gabaldón, D-Sahuarita, said that politicians have no place in doctor’s offices, and expressed concern that prohibiting health care would constrict its ability to evolve. 

“We as a legislature are not doctors,” she concluded firmly. 

The bill was approved along party lines and moves next to consideration by the full Senate.