After late changes, West Virginia transgender health bill may have little effect on access to care

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While a myriad of bills aiming to limit LGBTQ+ rights came before the West Virginia Legislature this past session, no bill received quite as much public attention as House Bill 2007. The bill, which was fiercely debated by both citizens and elected officials, threatened to ban gender-affirming surgery and medication for transgender residents under the age of 18. 

Lawmakers passed the bill earlier this month, and it now awaits Gov. Jim Justice’s signature to become law. But Sen. Tom Takubo, R-Kanawha, the Senate Majority Leader and a pulmonologist, pushed for a late amendment and successfully changed the bill to permit gender-affirming medication for adolescents diagnosed with severe gender dysphoria by two physicians.

“When it comes to health care, that’s one of the main reasons I’m in the Legislature in the first place,” Takubo said in a recent interview. “I think everybody should use their expertise and bring those strengths.”

While providers and their lawyers are still waiting to see how the new law will be implemented, some doctors expect little to change in how health care workers prescribe gender-affirming medication like hormones and puberty blockers, medications that peer-reviewed papers find improve mental health and reduce suicide attempts.

“Big picture, I think everybody who needs care is still going to be able to get care,” said Dr. Kimberly Becher, a Clay County family physician and former health policy fellow at Marshall University. 

Late amendment changes bill’s impact

When state delegates first introduced the bill in January, it was written to prohibit gender-affirming surgery for anyone under 18. West Virginia doctors have said the procedure isn’t done in the state and there are no plans to start offering it to any minors. 

But when the legislation went to the House Judiciary Committee early in the session, Republican delegates added a clause to also ban state doctors from prescribing gender-affirming medication to adolescents.

As the bill was up for final passage on the penultimate night of the session, Takubo spoke up to change the bill.

He had tried unsuccessfully to change it a week earlier in a committee meeting. This time, he spent about 10 minutes parsing through and reading out summaries of over a dozen peer-reviewed studies on his laptop. 

All of them found that puberty blockers and hormones had positive health effects for aiding teenagers with gender dysphoria, the medical term for being transgender.

“When it comes to medical stuff, I listen to the medical community,” Takubo said on the Senate floor.

The amendment he proposed then, one that protected a pathway for trans West Virginians under 18 to get gender-affirming medication, passed, 20-12 in the Senate. It was included in the final version of the bill which passed 88-10 in the House.

“At the end of the day, this is still a ban,” said Ash Orr, the co-founder of the West Virginia Trans Coalition and a transgender West Virginian themself. “But it could have been so much worse.”

Little impact expected

The amendment Takubo proposed lays out how adolescent West Virginians can get gender-affirming puberty blockers and hormones. It requires that someone be diagnosed with gender dysphoria by two physicians — a pediatrician and a mental health specialist who both have gender-affirming care training. 

If the doctors write that the medication would help prevent self-harm, and if both the teenager and their legal guardian want to move forward with the treatment, a physician can prescribe it at the lowest dose to reduce risk of self-harm.

Becher, the Clay County doctor, said she has some uncertainty about the process but expects little to change from the current process. 

“Nobody is just starting somebody on these hormones when they’re a kid without getting psychiatry input,” she said. “There’s already a behavioral health and a medical provider involved no matter what.”

In terms of the dosage requirements, Becher said physicians are expected to start patients at the lowest level of medication necessary to improve someone’s symptoms, regardless of what the symptoms are. 

When medications, including gender-affirming hormones and puberty blockers, are impossible to get legally, people can take to finding the drugs themselves and administering them improperly. 

Some worried about repercussions

Despite the bill’s reduced impact, some believe it could still have negative repercussions. According to Jack Jarvis, communications director for the LGBTQ+ nonprofit advocacy group Fairness West Virginia, the few providers and clinics that offer this care are working with legal teams to determine exactly how the law will be implemented.

Jarvis said he thinks care could be harder to access if pediatricians are unwilling or do not have the training to diagnose a patient with gender dysphoria, and he highlighted that Fairness maintains a list of some of the gender-affirming doctors in the state. 

WVU Medicine, the largest health care provider in the state, maintains a clinic that specializes in pediatric transgender health care. A spokesperson for the hospital system wrote in an email that the clinic “plans to continue providing evidence and guideline-based care within the limitations set forth by the Legislature,” but did not respond to a follow-up question about what those limitations will be.

The bill also does not address some of the health care obstacles already in place for trans West Virginians, such as finding doctors who affirm their identities. Because there are few health care workers in the state with experience treating openly-trans teenagers, long delays between seeking gender-affirming medication and getting it are common. 

Joseph Singletary, a 17-year-old transgender Putnam County resident, has been seeking gender-affirming hormones for the past five months; but because his psychiatrist hasn’t treated many openly-trans teenagers, and because he’s been unable to find an appointment with a gender-care specialist, he has yet to get a diagnosis of gender dysphoria. 

Singletary remains unsure if he’ll be able to get the medication anytime soon.

“It sucks,” he said. “How I want to continue my transition is very dependent on hormone replacement therapy.”

Additionally, Orr said it sets a bad precedent for a state government to determine whether doctors can prescribe evidence-based medicine. While West Virginia doctors were already not performing gender-affirming surgery on minors, they said the ban reflects a lack of trust the state Legislature has in medical professionals.

As a physician, Takubo also worries that bills that attempt to regulate medicine based on politics will come up again in future sessions. He said he thinks that his fellow GOP lawmakers’ support for restricting gender-affirming care does not align with conservative values.

“In this case, you have a physician, you have evidence-based medicine, you have the sovereign rights of a parent and the decision of the child, all to do with therapy. But they want to get in the middle of that,” Takubo said. “I mean, that’s the most anti-Republican bill that I’ve maybe ever seen.”

Reach Allen Siegler at [email protected]