Oklahoma providers, advocates worry as trans youth face gender care restrictions

OKLAHOMA CITY — Transgender youth who receive hormone medications as part of their gender-affirming care will have their access cut off next month.

Advocates and providers are worried about what full implementation of a new state law that bans gender-affirming care for minors could mean for transgender youth who will soon be prohibited from accessing gender-transition hormone therapies and puberty blockers.

When Oklahoma lawmakers passed Senate Bill 613, they built in a six-month transition period for children already receiving treatment to gradually decrease and discontinue the use of gender-affirming drugs.

As implementation of the law, which also bans gender-transition surgeries for minors, was on hold pending a federal lawsuit, many transgender and gender-nonconforming youth continued to receive hormone treatments.

Now, a federal judge’s decision to let the ban take effect means that transition period will end Nov. 1, six months after Gov. Kevin Stitt signed the new law, according to Freedom Oklahoma, an LGBTQ+ advocacy group.

“When we get to the end of this official six-month period, that is going to have a much larger impact, not only on trans young people that are currently receiving care but those on the long waitlist of people waiting for care,” said Nicole McAfee, executive director of Freedom Oklahoma.

Medical providers say gender-transition surgeries for minors are rare. Transgender youth are more likely to use puberty blockers, which prevent the physical changes that come with puberty, or other hormone therapies to treat gender dysphoria — a feeling of distress that can occur when a person’s gender identity differs from their sex assigned at birth.

Oklahoma judge upholds Legislature’s ban on gender-affirming care for minors

Since Oklahoma federal Judge John Heil III last week allowed the state to enforce SB 613 while litigation over the constitutionality of the law continues, Freedom Oklahoma has received calls from medical providers trying to understand what’s legal and what’s not. Families also are trying to understand what the ruling means for their access to care, McAfee said.

There’s been “a lot of calls from people who are questioning what that means for their ability to safely stay here and keep their kids here,” McAfee said.

The ACLU and other legal groups are appealing Heil’s ruling.

McAfee compared the gender-affirming care ban to the state’s abortion ban that has forced some Oklahomans to seek the procedure in neighboring states. But an abortion is typically a one-time appointment, whereas gender-affirming care is a consistent, long-term treatment, McAfee said.

Republican elected officials praised Heil for upholding SB 613.

“The purpose of SB 613 is to protect children from making these life-changing, irreversible medical decisions until they reach some level of maturity. The court recognized the state has an interest in protecting the physical and psychological well-being of minors from these protocols, which are not settled science,” Sen. Julie Daniels, R-Bartlesville, the bill’s author, said in a statement.

Major medical groups, including the American Academy of Pediatrics and American Medical Association support gender-affirming care for transgender adolescents and oppose laws that punish health care professionals for providing such treatment.

Mark Fergeson and his wife own a health and wellness clinic in Oklahoma City where they provide hormone treatments to fewer than 20 transgender adolescents.

A nurse practitioner, Fergeson started seeing patients under age 18 after GOP lawmakers gave OU Health an ultimatum last year that led the hospital network to stop offering some gender-affirming care. He took on some of the patients that were left to find care elsewhere.

Noting transgender people who don’t receive gender-affirming care are more likely to attempt suicide, Fergeson predicts Oklahoma’s youth suicide rates will increase as a result of Oklahoma’s ban.

“Some of these children are going to kill themselves because of this,” he said.

Abruptly stopping hormone treatments can affect each patient differently, Fergeson said.

For patients that are relatively new to the treatment, the hormone effects will reverse, and they will start presenting over time as their birth gender rather than their desired gender. But the outcome could be different for patients who have been taking hormone treatments for longer, he said.

“When you stop hormones altogether, you can have fatigue issues, you can have mood issues — both anger and depression — and anxiety,” Fergeson said. “Hormones are a powerful regulator of your moods, and then on top of that, there’s the fact of patients not feeling that they’re seen or heard or appreciated, or even worse, feeling like they’re targeted.”

Oklahoma’s suicide rate is among the worst in the nation. Kris Williams, program development coordinator at The Diversity Center of Oklahoma, an LGBTQ+ community resource center, worries about that rate worsening as a result of SB 613.

A member of the American Foundation for Suicide Prevention Oklahoma, Williams has spent more than two decades working with queer youth.

“Hormone replacement therapy is reversible,” she said. “Suicide is not.”

Under SB 613, health care providers could face felony charges, license revocation and civil penalties if they provide “medical or surgical services performed for the purpose of attempting to affirm the minor’s perception of his or her gender or biological sex, if that perception is inconsistent with the minor’s biological sex.”

The law does not ban behavioral health services, counseling or medication to treat depression or anxiety.

Williams predicted more LGBTQ+ youth may seek out mental health services once the law is fully implemented.

The Trust Women clinic in Oklahoma City offers some hormone treatments and will continue to do so until additional restrictions take effect.

“Until we cannot legally provide this care, we will continue to offer gender-affirming care for all people and ages,” said spokesperson Zachary Gingrich-Gaylord. “We do work with a wide network of providers and clinics, and we will provide as many resources for our patients as needed for them to continue to receive appropriate medical care.”

Trust Women’s Kansas clinic also offers gender-affirming care, and it is located in one of just a few neighboring states where the practice is still legal for minors.

Texas, Arkansas and Missouri have also passed gender-affirming care bans. Like Oklahoma, those states have faced lawsuits as a result.