CHARLESTON, W.Va. -- West Virginia's Republican supermajority Senate followed a growing national trend of GOP opposition to health care for transgender youth by passing a bill that would ban certain treatments and therapies, while approving a significant change to add exceptions for mental health.
The Senate version of the bill passed by a count of 30-2 on Friday was noteworthy in the addition of allowances for some transgender youth to continue receiving medical interventions, including hormone therapy, when they are considered at risk of self harm or suicide.
The bill faces steep opposition in the state House of Delegates, which will take up the amended Senate version. The GOP-dominated House last month passed a proposal including a ban on puberty-blocking medication and hormone therapy, with no exemptions for mental health.
Republican Gov. Jim Justice has not taken a public stance on the measure.
Lawmakers in West Virginia and other states advancing bans on transgender health care for youth and young adults often characterize gender-affirming treatments as medically unproven, potentially dangerous in the long term and a symptom of “woke” culture.
Every major medical organization, including the American Medical Association, the American Academy of Pediatrics and the American Psychiatric Association, supports gender-affirming care for youths.
The West Virginia Senate bill passed Friday would outlaw those under 18 from being prescribed hormone therapy and fully reversible medication suspending the physical changes of puberty, buying patients and parents time to make future decisions about hormones.
“These kids struggle, they have incredible difficulties,” said Majority Leader Tom Takubo, a pulmonologist, who urged support for mental health protections.
Takubo’s approved change would allow young people to access puberty blockers and hormone therapy if they are experiencing severe gender dysphoria, under certain circumstances.
Gender dysphoria is defined by medical professionals as severe psychological distress experienced by those whose gender identity differs from their sex assigned at birth.
The rate of suicide ideation for transgender youth in Virginia is three times higher than the rate for all youth in the state, according to research and data complied by WVU Medicine physicians using the West Virginia Youth Risk Behavior Survey.
During a speech on the Senate floor, Takubo referenced 17 peer-reviewed studies showing a significant decrease in the rates of suicide ideation and suicide attempts among youth with severe gender dysphoria who have access to medication therapy.
He found a supporter in Senate Health and Human Resources Committee Chair Sen. Mike Maroney, another trained physician, who said lawmakers would set “a dangerous precedent” by disregarding medical research in favor of political gain.
“Who are we, to win an election, to tell people how to practice medicine? To change treatments? It’s unbelievable,” the Republican said, adding that lawmakers wouldn’t apply the same standard for drugs for cancer or mental illness.
The legislation also includes a ban on gender-affirming surgery for minors, something medical professionals emphasize does not happen in West Virginia.
During Friday's debate, Republican Sen. Eric Tarr repeated those concerns, saying the medical interventions doctors are practicing are too extreme and driven by “woke” culture.
“They’re trying to take pronouns out of our textbooks for kids,” Tarr said.
With Takubo's change, a person under 18 would have to be diagnosed with severe gender dysphoria by at least two medical or mental health providers to access medication therapy. One would have to be a mental health provider or adolescent medicine specialist.
The dosage must be the lowest possible necessary to “treat the psychiatric condition and not for purposes of gender alteration," according to the bill.
The providers must be specifically trained to diagnose and treat severe gender dysphoria in adolescents and would have to provide written testimony that medical interventions are necessary to prevent or limit self-harm or the possibility of self-harm.
The minor’s parents and guardians also would be required to give written consent to the treatments.
Hormonal therapy could not be provided to minors before the age of puberty, something West Virginia physicians say doesn't happen anyway.
The House version of the bill passed last month 84-10, with all ‘no’ votes coming from the body’s shrinking delegation of Democrats. They accused GOP lawmakers of putting children’s lives at risk to score political points with the national conservative movement.
That version provides exceptions for individuals born with a “medically verifiable disorder” including people with “external biological sex characteristics that are irresolvably ambiguous” and for people taking treatments for infection, injury, disease, or disorder that has been “caused by or exacerbated by the performance of gender transition procedures.”
People also can access the treatment if they are in “imminent danger of death, or impairment of a major bodily function unless surgery is performed.”
Speaking against Takubo's amendment Friday, Republican Sen. Mark Maynard said he didn’t see why any changes were necessary. He worried additions could make the state vulnerable to a lawsuit.
“This amendment would disintegrate the clarity of the bill in its very simple terms,” Maynard said. “These guardrails are already in this bill as it came to us from the House.”
The vote came a day after a crowd of protesters descended on the state Capitol, where cries of “trans kids matter” could be heard from the Senate chamber as lawmakers debated bills.
Democratic Del. Danielle Walker, the only openly LGBTQ member, led chants of the state motto: “Mountaineers are always free.”
“They are trying to come for trans kids in West Virginia, and they’re going to come for every single one of us next,” said Sam Green of Huntington, wearing a transgender pride flag draped around their shoulders while addressing the crowd.
Cecelia Moran, an 18-year-old high school student from Marion County, said she feared banning any kind of medically proven health care could result in more young people leaving West Virginia, one of only three states to lose population in the 2020 U.S. Census.
“I think a lot of young people already struggle to stay here and feel welcome here and are already planning on getting out of the state as soon as possible,” she said.
Her mother, Rebecca Moran, said the bill is “just completely unnecessary” and decisions about healthcare should be made by families and health care providers.
“This is not what’s harming our kids,” said Rebecca Moran, a city councilor in Fairmont. “There’s so many other things: homelessness, poverty.”