"Systematically Reduce Their Hormones" - South Dakota Passes Anti-Trans Bill With Forced Detransition Clause

South Dakota became the 2nd state to pass a gender affirming care ban for trans youth. The ban has a new and terrifying clause specifying how forced detransitions should happen.

Three years ago, South Dakota became one of the first states to introduce an anti-trans gender affirming care ban for transgender youth. The bill failed on the house floor, and the sponsor called the issue dead for the year. Now, three years later, 96 such bills have been proposed in over 20 states targeting the healthcare of transgender youth in new and cruel ways. South Dakota is now the second state to pass such a bill. House bill 1080 states that gender affirming care is against the law for transgender youth, and it is now heading to the governor’s desk. Importantly, the bill contains a new provision not seen in other bills: a mandated process by which doctors must medically detransition the transgender youth under their care.

The bill begins like most other anti-trans care bans introduced in the United States this year - defining “sex” as “biological sex” and stating that “altering or attempting to alter” with puberty blockers and hormone therapy is against the law. Of course, it contains carveouts for intersex individuals. Surgery to force an intersex person to comply with a gender binary is completely sanctioned under this law, a practice decried by intersex advocates. It allows trans people to sue their doctors for damages if they detransition. The most troublesome part of the bill is at the end, a section that spells out how doctors should medically detransition the transgender youth under their care:

Section 6 of House Bill 1080 in South Dakota

The section functions similarly to grandfather clauses proposed in other care bans - Utah has such a grandfather clause in thier care ban. However, this grandfather clause does not allow a transgender person to continue receiving their hormone therapy. Instead, it tells doctors how to practice medicine on transgender people and mandates that they “systematically reduce” transgender youth’s hormone usage until they withdraw the transgender youth from hormones entirely by the end of the year.

This provision is terrifying. Already, transgender youth who are not allowed to transition attempt suicide at a much higher rate. Gender affirming care reduces suicidality by 73% according to a study in JAMA Pediatrics. Another study in The Journal of Adolescent Health showed a reduction in suicide attempts of 40%. This latter study had a sample size of over 11,000 transgender youth. Clearly, denying transgender youth their care is bad enough. Under this bill, though, transgender youth already receiving care will be forcefully medically detransitioned and the legislature has spelled out an exact process by which this is to occur.

Medical detransition will mean extremely distressing changes for trans youth, many of whom have lived as their gender for most of their lives. A 16 year old transgender girl who has identified as a girl since early childhood may see her voice drop and facial hair grow under this law. This is particularly cruel to transgender kids who have been receiving care for a long time and who are known as their gender by all of the peers and adults in their lives. It is also extremely dangerous - transgender people who are stealth (hiding their transgender status) may find themselves unable to maintain their level of stealth given changes to their body.

It is for this reason that nearby states may become safe havens for accessing this care. Minnesota, which borders South Dakota, is considering a “safe state” bill sponsored by the state’s first transgender woman representative, Leigh Finke. These bills grant refuge to transgender people that are escaping anti-trans laws in other states. In particular, Minnesota’s bill would decline subpoenas from other states around gender affirming care. If the family of a trans youth goes over the border to seek that care in Minnesota, they may have their medical records protected from inspection by South Dakota officials if this bill passes. The clashing of state laws is expected to grow as more states criminalize gender affirming care and abortion care while other states pass laws protecting patients and providers from out of state intrusion. SB107 in California, Illinois passed the Patient and Provider Protection Act, and Massachusetts as well as Washington, D.C., likewise passed similar legislation. You can watch Rep. Finke propose her bill here:

It is indeed possible that this bill will protect young transgender South Dakotans who wish to travel to obtain gender affirming care if it passes. Unfortunately, travel for care is a luxury, and many people in South Dakota may find themselves cut off from being able to access that care. Given that nearby states to South Dakota are at high risk of likewise banning gender affirming care for transgender youth, people may find themselves forced to undergo the process spelled out by the legislature here which includes a forced medical detransition.

Doctors in several states have testified against these bans by telling legislatures that it is not their jobs to practice medicine. In neighboring Montana, representatives from the American Academy of Pediatrics, the American Medical Association, and the Association of Physician Assistants all spoke against a similar bill - these organizations represent hundreds of thousands of providers. Over 29 medical organizations have come out strongly against care bans, a list of which can be found at the Transgender Legal Defense and Education Fund website:

TLDEF List of Organizations Supporting Gender Affirming Care

This bill puts Republican legislators between doctors and patients. It forces medical providers to go against the best medical practices as outlined by experts in this field of medicine. It goes against all standards of care and will result in material harm to transgender youth. The governor of South Dakota, Gov. Kristi Noem, stated in a recent veto that “Parent’s constitutional rights include the right to care, custody, and control of their children.” Should she sign this bill, she would reveal that parental rights are just a slogan devoid of meaning and parental choice only means choices that Republicans agree with. It remains to be seen if she maintains ideological consistency, but the affected parents of trans youth will not hold their breath.