Few bills have generated the intense debate in the 2023 General Assembly session as those dealing with LBGTQ+ youth. From a ban on gender affirming care, to provisions about which bathroom a trans student may use at school, lawmakers and citizens have found themselves at odds over how to best serve the interests of Kentucky children and their parents.
Senate Bill 150 evolved from a measure on school policies dealing with transgender students and the teaching of human sexuality, to include provisions that would ban gender-affirming medical care for trans youth under the age of 18.
At issue is a condition known as gender dysphoria in which a person’s gender identity differs from their physical characteristics or the sex they were assigned at birth. An individual with gender dysphoria can experience discomfort, stress, depression, anxiety, or suicidal thoughts.
Using age-appropriate medical, psychological, and social services, gender affirming care assists an individual who wishes to transition from their birth gender to the one they prefer. SB 150 would prohibit health care providers from prescribing hormone therapies or puberty-blocking drugs and ban surgeries to alter or remove parts of a child’s body.
The legislation gained final passage on the last day before the veto period on a 72 to 22 vote in the state House of Representatives, and a 30 to 7 vote in the Senate.
“We clearly believe that we are on the side of our constituents,” says Sen. Gex Williams, (R-Verona), who was a co-sponsor of the measure. “This is Kentucky values, that’s what we are espousing.”
Opponents of the bill argue that gender-affirming health care is approved by every major professional medical association in the United States. Chris Hartman, executive director of the Fairness Campaign, also says no reputable physician following well-established standards of care would perform transition surgeries on a minor, and none of those procedures have occurred in Kentucky.
“What the legislature has done is put doctors in Kentucky in an impossible position where they either have to violate their standards of care and their medical ethic, or they have to violate this unjust law and lose their medical license,” he says.
Hartman adds that affected youth only receive gender affirming care with the consent of their parents and in consultation with doctors and counselors.
In response to SB 150, Kentucky Education Commissioner Jason Glass said: “The bill contains provisions that will put our young people at risk, have the government interfere with decisions between doctors, patients and families and puts Kentucky at the front of a series of similar hateful, ignorant and shameful efforts around the country.”
Promoting Parents’ Rights or Limiting Them?
Although supporters of SB 150 say they are protecting children and parents, opponents contend the measure actually subverts parents’ rights by not allowing them to make their own health care decisions for their children.
“A lot of the rhetoric around these bills has been about parent’s rights and I just find that so offensive as a parent... who fully endorses and embraces my kid,” says Jennifer Bird-Pollan, the parent of a trans teenager and a professor at the University of Kentucky Rosenberg College of Law. “Our vulnerable children are the ones who are targeted and we as parents have had rights taken away from us to protect our children in the way that we see fit.”
Despite some initial mistakes with pronouns and names, Bird-Pollan says her family and her community have accepted her child even if they don’t fully understand the transition. Should SB 150 become law, she fears that parents of children seeking gender-affirming care will move out of Kentucky so they can get treatment.
“The best decision-makers and the best providers of support are the people who are close to children,” says Bird-Pollan, “not people in Frankfort who, by their own admission, don’t understand what’s going on.”
For his part, Williams says he has consulted with doctors on the issue, including fellow senator Donald Douglas (R-Nicholasville), who is a physician specializing in pan management and regenerative medicine. But the Kentucky Medical Association has come out against the measure, saying it supports the use of “evidence-based standards of care for the treatment of gender dysphoria including non-surgical medical treatment provided to youth by appropriately trained and experienced health care providers.” The organization also says those standards have proven effective at helping patients.
Critics of gender-affirming care contend that children don’t have the mental maturity to understand the repercussions of any decision they and their parents may make to pursue treatment for gender dysphoria.
“I feel like I was a mentally ill teenager that hated my chest,” says Luka Hein, who describes herself as a “former trans kid.”
Hein is not a Kentuckian but she testified on behalf of the legislation. She says a childhood filled with mental health problems, a troubled home life, and sexual abuse left her hating herself. Hein says a counselor convinced her that she hated her body because she was actually a boy. To address that, her care team encouraged her to get a double mastectomy at the age of 16.
“They bullied my parents and scared them with the line, ‘Do you want a dead daughter or a living son?’ which is not what a doctor should say,” Hein says.
After the mastectomy, Hein says she endured four years of testosterone therapy, which she says left her with joint pain and muscle wasting. She also fears she will be unable to have children. The experience led Hein to pursue a “detransitioning” process.
“What happened is awful and it’s tragic, but these are not standards of care,” says Jackie McGranahan, policy strategist for the American Civil Liberties Union of Kentucky.
Hartman agrees that Hein’s case is a tragedy, but he also says gender dysphoria is not a mental illness. He contends that people who detransition do so because of societal pressures, harassment, and discrimination.
Critics of gender-affirming care say Hein’s case is a prime example of why it should be banned.
“A 7-year-old or a 12-year-old or 15-year-old cannot consent in their right mind to hormone therapy or puberty blockers or transition surgeries,” says Richard Nelson, founder and executive director of the Commonwealth Policy Center
SB 150 does allow children to receive counseling and other mental health supports for gender dysphoria. Williams says he is willing to consider state funding for such services – if there is a need for it.
“But I don’t want to fund gender-confusing therapy,” says the senator. “I want a firm therapy that will give them the underlying medical help they need and counseling they need to get past the confusion that’s happening.”
Hartman says the Fairness Campaign doesn’t advocate for minors having surgeries like mastectomies, but he says SB 150’s ban on pharmaceutical treatments for youth is dangerous.
“If you take away puberty regulators and hormone therapy, you’re going to kill kids,” says Hartman.
Other Pending Legislation on LGBTQ Matters
SB 150 also impacts trans children in the academic environment. It allows teachers to use a child’s gender pronoun at birth even if that is against the wishes of the student. It bans schools from offering instruction or presentations on sexual orientation, gender identity, or gender expression. And it forbids school policies that allow students to use restrooms, locker rooms, or showers assigned to those of a different biological sex.
Lawmakers passed a separate measure, Senate Bill 5 that creates a complaint process for parents concerned about sexually explicit materials in schools.
“Parents needed recourse to get obscene, pornographic books out of their schools,” says Nelson.
But McGranahan says such policies already exist in the state’s school districts, and that such decisions should be left up to teachers, site-based decision-making councils, and school boards. She contends the legislation is simply another way to marginalize LGBTQ+ individuals.
“It’s not a parents’ rights bill. It only serves one type of a parent,” she says. “Once we start doing this, do we start banning ideas, banning other things that we don’t like?”
Gov. Andy Beshear has yet to sign or veto either SB 5 or SB 150. McGranahan says the ACLU is reviewing both measures for potential legal challenges on constitutional grounds.
Another bill that could gain final passage in the last two days of the legislation session would restrict obscene or prurient performances by male and female impersonators. Nelson says Senate Bill 115 on so-called drag shows is necessary to prevent children from being exposed to sexually explicit activities in public places. Hartman says it is just another attempt to eradicate LGBTQ individuals and restrict pride festivals.
SB 115 has cleared the Senate, but awaits passage by the House. The General Assembly returns on March 29 and 30 to complete this year’s session.
