South Carolina Just Proposed An Adult Trans Health Ban, End To Informed Consent HRT

South Carolina is the latest state to propose a ban of gender affirming care up to the age of 21. It also forces teachers to out trans students, ends public funds, and ends informed consent.

Photo by Clint Patterson on Unsplash

South Carolina just released a new law that goes beyond trans youth and instead would ban transgender people up to the age of 21 from receiving gender affirming care. It would criminalize doctors from providing gender affirming care for trans youth as well. It doesn’t stop there though. The bill would also ban informed consent hormone therapy, the most common form of hormone therapy for all transgender adults, and would require psychiatrists to sign off on gender affirming care - a model of care that has been outdated since the 1990s. It bans public funds for gender affirming care. It bans comprehensive health programs from encouraging transition for trans students. Lastly, it forces teachers to out students who they even suspect are trans to their parents. This is an absolutely devastating bill, and if it is allowed to go through, it would dramatically harm many trans youth in the state.

The portion of the law defining the ages of the ban.

The first part of the law, which defines gender affirming care as any services that alter or remove physical or anatomical characteristics or features that are typical for a person’s biological sex, would likely lead to bans of things like hair removal, fillers, and more. It applies to all people under the age of 21, and applies to both the patient AND the provider. Previous laws have only said that providers cannot prescribe, but this law states that “a person younger than 21 years of age may not undergo gender transition procedures.”

The portion of the bill eliminating informed consent

One of the most damaging portions of the ban is the end to informed consent. Informed consent is the most common way transgender people obtain their hormones. This simply means that doctors believe trans people are who they say they are and supervise their gender affirming care medically while giving them the information they need to obtain that care. The previous gatekeeper model required years of psychiatric monitoring and gatekeeping - this meant that transgender people who were low income were often entirely barred from transitioning. Often they would require things like years of real life experience before they would even consider providing gender affirming care.

Eliminating informed consent would be untenable. I track informed consent clinics with my informed consent hormone therapy map, used nearly 4,000,000 times for transition care. WPATH 7, released in 2010, allowed for informed consent HRT and it has been the standard of care since. I personally used and continue to use informed consent to obtain my hormone therapy. Under this law, I would be forcibly medically detransitioned unless I sought out a psychiatric letter for gender affirming care. Many people do not have access to these letters or access to health insurance, and many disadvantaged communities depend on local clinics using informed consent for gender affirming care.

The portion of the bill that bans health education from recommending gender affirming care as well as forcible outing by teachers.

The last section of the law tells comprehensive health education programs that they cannot recommend transition to people who are transgender. It also forces teachers to out transgender students - not just people who are openly trans, but people who they suspect could be trans. If for instance a kid comes in with a different haircut, or the teacher overhears the kid using a different pronoun, the teacher would have to contact the parents. The ban on public funding would also mean that health insurance coverage would likely end up banned for transgender people.

This bill is the worst detransition bill that I have ever seen. If it passes, South Carolina will be the most restrictive state in the United States for gender affirming care. Organizations have indicated they intend to continue to raise the age of transition to 25, with some places like Texas putting forward bills declaring they desire an end to gender affirming care entirely. We knew that this year would be bad, and I have previously said that I expect at least one state to propose adult transition bans. We now see multiple ones doing just that.