Access to gender-affirming care has now been limited under law for South Dakota youth

Gov. Kristi Noem signed House Bill 1080 into law Monday, prohibiting several forms of gender-affirming care for minors.

The bill prohibits several forms of bottom surgery, prohibits the potential for top surgery for those assigned female at birth and prohibits hormone therapy and puberty blockers.

This is the farthest any healthcare ban has gone for transgender individuals in the state in the last five years, and will have several implications for gender-diverse children, their parents, medical providers and the LGBTQ+ community at-large.

Bill introduction:South Dakota Republicans introduce legislation prohibiting gender-affirming care for trans children

Noem signed this bill with little media notice and without any press conference or media event as she held when she signed House Bill 1217, which limited transgender students’ participation in sports, into law last year.

The only indication Noem had received the bill came during the House of Representatives’ session when it was communicated that the bill had been delivered to Noem’s desk at about 2:40 p.m. Reporters weren’t invited to the bill signing as they were for HB 1217.

This is the 34th bill Noem has signed into law this legislative session.

What does HB 1080 do now that it's law?

The new law prohibits health care professionals from providing the following forms of care for patients under 18 who want to alter the appearance of, or validate their perception of, their gender if it doesn’t match their sex assigned at birth:

• Any drug to delay or stop puberty;

• Testosterone, estrogen or progesterone, “in amounts greater than would normally be produced endogenously in a healthy individual of the same age and sex;”

• Performing “any sterilizing surgery, including castration, hysterectomy, oophorectomy, orchiectomy, penectomy and vasectomy;”

• Performing “any surgery that artificially constructs tissue having the appearance of genitalia differing from the minor’s sex [assigned at birth] including metoidioplasty, phalloplasty and vaginoplasty;” or,

• Removing “any healthy or non-diseased body part or tissue.”

Any minors taking prescriptions or being administered drugs or hormones prohibited by this new law will have to stop taking those prescriptions, drugs or hormones by Dec. 31, 2023.

More:Sanford, Avera won’t comment on the state of transgender healthcare in South Dakota

This law doesn’t apply to minors born with a medically verifiable disorder of sex development, diagnosed with a disorder of sexual development, or minors needing treatment for an infection, injury, disease or disorder that’s been caused or exacerbated by gender-affirming care.

Noem said in a statement that the bill protects kids from “harmful, permanent medical procedures.”

Medical, judicial impacts likely to follow

The new law also allows professional or occupational licensing boards to revoke licenses or certificates held by health care professionals providing those types of gender-affirming care to minors, and allows them to be sued by former patients who received gender-affirming care from them.

House committee:Effort to limit gender-affirming care for trans youth in South Dakota moves forward

Opponents of this legislation have repeatedly testified the bill will likely cost the state millions of dollars in lawsuit costs and will stick taxpayers with those bills.

While the bill prohibits several forms of care, the top transgender medical association doesn’t even recommend those for children, and has some limitations on each of those things for adolescents.

House vote:Push to limit access to gender-affirming care for youth passes in South Dakota House

The World Professional Association for Transgender Health acknowledges childhood gender diversity is an expected aspect of general human development, isn’t a pathology or mental health disorder and that diverse gender expressions in children can’t always be assumed to reflect a transgender identity or a gender incongruence.

Local doctors and medical professionals have testified against the legislation, including: the South Dakota State Medical Association; the South Dakota Section of the American College of Obstetricians and Gynecologists; the South Dakota Academy of Family Physicians; Dr. Nicholas Torbert, a neonatologist at Avera; Dr. Henry Travers, an emeritus pathologist at Avera McKennan Hospital and a clinical professor at the University of South Dakota Sanford School of Medicine; and several local mental health counselors.

Senate committee:Senate committee passes bill limiting gender affirming care, despite opposition from doctors

The bill was also opposed by multiple LGBTQ+ people and their allies, including: 16-year-old trans student Elliott Morehead; local registered nurse and trans man Dylan Daniels; Brian and Elizabeth Broekemeier, parents to 13-year-old trans son Asher Brokemeier; the Human Rights Campaign; the ACLU of South Dakota; the Transformation Project and its Advocacy Network; Sioux Falls Pride; the Black Hills Center for Equality; South Dakota Youth Activism; Brookings Pride; Brookings PFLAG (Parents For Lesbians and Gays); Quilting Allies; Equality South Dakota and more.

The ACLU argues HB 1080 violates the U.S. Constitution in three separate, concurrent ways: discrimination against individuals based on sex, discrimination against individuals based on transgender status and a violation of parents' rights under the due process clause.

Senate vote:Ban on gender-affirming care for transgender children heads to Noem's desk for signing

Bill mirrors other legislation outside of South Dakota

The ACLU of South Dakota said in an earlier statement the bill continues a streak of bills that would codify discrimination against trans youth.

Similar bills were filed and failed in past legislative sessions, including HB 1205 in 2019, HB 1057, SB 93 and SB 109 in 2020, and HB 1247 in 2021. But HB 1080 has gone the farthest this year.

More:More than 100 protest in Sioux Falls against state ban on gender-affirming care

Bills like HB 1080 have been introduced the following states: Arizona, Arkansas, Georgia, Hawaii, Idaho, Indiana, Iowa, Kansas, Kentucky, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, North Carolina, North Dakota, Oklahoma, Oregon, South Carolina, Tennessee, Texas, Utah, Virginia, Washington, West Virginia and Wyoming this year, according to an LGBTQ+ bill tracker.

This article originally appeared on Sioux Falls Argus Leader: Kristi Noem signs bill limiting gender-affirming care for trans youth