This article was first published on the website A1Saluda.com.
There has been a bill in the works in Columbia since last fall, H.B. 4624, more commonly called the “Help Not Harm” Bill. In short, it bans sex change procedures for children under the age of 18, and provides penalties for health care providers provide them anyway. It also requires teachers, or other adults who work with children, to notify the child’s parents if the child mentions confusion about their gender or sex, or suddenly changes his or her name.
Our State Representative, Cal Forrest, was one of the sponsors of the bill, and our State Senator, Billy Garrett, was one of the questioners on the Medical Affairs Committee.
I attended a hearing by the Senate Medical Affairs Committee on H.B. 4624 this morning. The Committee first heard from several witnesses on different aspects of the issue.
Witness 1 – Miram Grossman, MD
Miriam Grossman, M.D. is a Board Certified Child, Adolescent, and Adult Psychiatrist, who has been speaking and writing on transgender issues for over fifteen years.
To buttress her opinion that H4624 should be passed, Dr. Grossman testified about two of the growing number of lawsuits over gender affirming care in the US. In Montana, parents are suing the doctor who convinced them that puberty blockers were necessary to the well-being of their 12-year-old, possibly suicidal daughter, and were totally reversible. When they learned that such treatment is linked to improper bone development, they
insisted that the puberty blocking implant be removed, albeit after pushback from the doctors who, instead, recommended placing the child on testosterone, without warning the parents that such treatment carried a high chance of infertility. The implant was removed, and the young girl became comfortable with her female gender, but was, at the time of the lawsuit suffering from Osteopenia, a low-density of bone minerals that usually occurs in post-menopausal women.
Dr. Grossman was the first witness of the day to cite to a recent reversal in eight of the European countries who were pioneers in the field of sex transition of minors – Finland, Sweden, England, Scotland, Norway, France, New Zealand, and Australia. All have either pivoted away from “gender-affirming care” for minors or have made the criteria for such procedures much tighter, such as by raising the age at which puberty blockers can be given. These policy changes have occurred as a result of new systematic analyses of all available data which show little or no benefit to early treatment, but increasing evidence of harm.
Grossman completed her remarks with the observation:
The edifice that these gender-affirming procedures should be used on minors is crumbling.
After Grossman’s comments, she was questioned by Democrat Senator Brad Hutto of Orangeburg whose main point was that her opinion does not comport with the published Standard of Care of the AMA (American Medical Association) and the AAP American Association of Pediatricians.) Grossman firmly replied that she is in total disagreement with them, and observed that both organizations are also being sued over their support of these procedures. Hutto also asked Grossman if she thought parents were in the best position to make decisions on behalf of their children. She responded that they were as long as they were given complete information.
Witness 2 – Laura Becker
Laura Becker is a young woman from Wisconsin who grew up as a tomboy on the autism spectrum. She had a difficult relationship with her parents, and at a time when she was suffering from depression and thoughts of suicide, she learned about being transsexual online and through her high school’s LGBTQ+ Club. Shortly thereafter at the age of 16 she felt she was beginning to experience gender dysphoria and came out as non-binary.
Increasingly, Laura began hating her female body. She was supported in her feelings of confusion by her therapist and teachers, and in her senior year, she came out as a gay, transgender man.
Over the next period of time, Laura struggled for acceptance and did not know what to do. She did not know how to go back to being the quirky female she had been before, or how to adjust to her new identity. At nineteen, Laura finally went to a gender clinic and told them she was suicidal. After a one-hour appointment, she was prescribed a high dose of testosterone and sent home to administer the injections to herself on a weekly basis. On the testosterone, her mental health began to deteriorate, however. Her doctors suggested that she would find relief when the transition was complete, and that she met the conditions to consent to surgery. At twenty Laura underwent a double mastectomy, thinking it would relieve some of her complex distress and help her fully become her true self, but it did not. Instead she was diagnosed with PTSD from the surgery.
By the age of twenty two, Laura began to awaken to the reality that her whole life had been spent dealing with the psychological effects of various traumas exacerbated by the magical thinking that a sex change would solve her problems. Curiously, this was at about the same time , mid-twenties, that her prefrontal cortex, the part of the brain that controls maturity, developed in the normal fashion, and she finally began to feel comfortable in her own skin.
Despite being happier in life now, Laura does live with the grief that if she is able to have children she will not be able to nurse them, and that she will never be able to enjoy her full natural sexuality as a woman. She is in the process of preparing a lawsuit against the professionals who influenced her at a time she was vulnerable and immature.
Senator Hutto pointed out that Ms. Becker was past the age of 18 at the time she consented to her mastectomy. She acknowledged that point, but was quick to add that she was influenced in that direction during her minor years. In response to a question by Hutto, she said she was not being paid for her testimony in favor of H. 4624.
Witness 3 – Matt Sharp
Matt Sharp is senior counsel for for Alliance Defending Freedom, currently working as co-counsel with the state of Alabama in protecting Alabama children from dangerous sex change drugs and surgeries. He was there to testify to the legal justifications for of H.4624 and to urge its passage.
Sharp emphasized that children who are experiencing discomfort with their biological genders deserve effective and compassionate mental health care, must also be protected from pressure from activists and profit-driven gender clinics who are deceiving them and their parents into believing that unnatural, life-altering, and even permanently sterilizing puberty blockers, hormones, and surgeries, are the answer to their distress. H.4624 would protect parents and children from being pressured into these harmful, experimental, and often irreversible procedures that can deprive children of their health, their fertility, not to mention, healthy body parts that can never be replaced.
Our state laws have long protected children from things that society and the legislature have deemed harmful to them or that they lack the maturity to handle. Children cannot sign contracts, vote, purchase alcohol or tobacco, or even get a tattoo. How then can they be deemed capable, as minors, of consenting to such a profound, life-altering decision as attempting to change their genders?
The Supreme court has held that states have a compelling interest in protecting the physical and emotional well-being of its children. As a result, South Carolina and all other states, may limit the freedoms of children to make decisions before they have developed the maturity to do so. The high court also recognizes the right of each state to regulate the practice of Medicine within its boundaries, especially in regard to new and experimental practices.
Mr. Sharp also referred to the same recent studies in Europe that Ms. Grossman mentioned earlier, that have found little to no evidence that gender affirming practices on minor children are of benefit, but they have found ample evidence of harm; therefore, there has been a huge reversal regarding these practices among the very countries that pioneered them over the past thirty years.
As a result of these studies, 23 states in the US have adopted laws banning gender affirming care from being practiced on minor children, and appellate courts are upholding these laws. At the current time, South Carolina is the only state in the deep south that has not banned sex change procedures on minor children.
Before concluding, Mr. Sharp, returned to the topic of Medical associations like the AAP and AMA, which he likened to politicized trade organizations. He pointed out that they and other professional organizations have often observed that children lack experience, judgement, and maturity. The AMA, for instance, came out against capital punishment for children because adolescents are immature in the very fibers of their brains, saying that the regions of the brain responsible for impulse control, risk assessment, and moral judgment do not develop until closer into adulthood.
Senator Hutto asked Mr. Sharp if parents should have the right to make medical decisions for their children. Sharp replied that they have the right to choose from all legally available treatments for them.
At this point, Senator Hutto began a series of impertinent questions to Mr. Sharp. On the subject of a recent British study backtracking on transition procedures for children, Hutto asked Sharp if we didn’t leave England around 1776 or so. Without missing a beat, Mr. Sharp observed that yes, we did, and we brought a lot of English laws along with us!
Shortly thereafter Hutto was at it again. “You’re trained as a lawyer, and I am too,” Hutto directed to Sharp, “And do you know how much knowledge I have in medicine? I am married to a doctor, that’s as close as I get, Okay? ”
I found myself wondering how Senator Hutto could have served on the Medical Affairs Committee for so long without learning a little about medicine, or without taking the time and the trouble to learn. (In my experience, lawyers often have to learn subject matters pertaining to cases they are involved in.)
Be that as it may, Senator Hutto asserted that they should only be listening to doctors. Sharp replied that there are differences of opinion even among doctors within the most preeminent medical associations. For instance, in March of 2021, when the AAP (American Association of Pedatricians) presented the new studies coming out of Europe that resulted in their reversals on gender affirming care for minors, 80% of their members voted to revise the current recommended standard of care recommended by their own organization. Regardless, the standards were not changed. Many physicians left that organization. (Only 15-18% of American physicians are members of the AMA.)
Witness 4 – Elizabeth Mack, M.D.
Dr. Elizabeth Mack from Charleston, is a Board-Certified Pediatrician and Pediatric Critical Care Physician and President of the SC Chapter of the American Academy of Pediatricians. She began her testimony against H. 4624 by claiming it would outlaw “medically necessary suicide prevention care.” and naming five misconceptions people have about the bill.
First, she said there are no gender confirming surgeries happening in South Carolina. “It is not a concern,” she said, “It’s not happening.”
Second, gender affirming care (puberty blockers and/or hormones) are not given without the intense participation of parents. Children are not making these decisions solo.
Third, half of trans kids seriously contemplate suicide and a third actually attempt it. Mack says this is largely due to bullying and forced outing.
Fourth, Mental health assessment and counseling is a prerequisite for receiving gender affirming treatment, both in practice and in policy under the current standard of care. According to Mack, this would be made illegal under this bill. There is no such thing, she said, as a child who comes in after being on social media and declaring, “I think I’m Trans,” and being started on meds. “This is not happening,” Mack says.
Fifth, gender-affirming care is not fringe care, it is scientifically based standard of care. It is done in adherence to strict guidelines, with the intimate participation of parents or guardians and caregivers. detransitioning is rare. Less than 1%, according to Mack.
Dr. Mack referenced 55 Cornell studies and 18 Major Medical Associations that support gender-affirming care. She resolutely maintained that gender affirming care is evidence-based, suicide prevention care, and that it is done slowly and thoughtfully with mental health and medical professionals and the parents and guardians of the children they know first hand and care about deeply.
Senator Danny Verdin from Laurens read an excerpt from the WPATH (World Professional Association of Transgender Health. Standard of Care indicating that there is uncertainty about long-term effects of puberty blockers on neurological and bone development. Dr. Mack kept repeating the fact that puberty blockers are fully reversible in that puberty fully returns after puberty blockers are stopped. She seemed unwilling to acknowledge the brain and bone effects mentioned by WPATH.
My Senator, Billy Garrett, then quoted a very recent opinion of the ACP (American College of Pediatricians) that since there are no long-term studies of the effects of sex-change procedures on minors, they recommend psychotherapy for the family and the patient with gender incongruence in hopes of treating the underlying etymology. “So there is a battle in the science it sounds like to me,” Garrett said, addressing Mack. She confirmed that there was disagreement, but went on to point out that there are 70,000 members of the AAP (American Academy of Pediatrics.) Astutely, Garrett recalled to Mack the earlier testimony that 70% of AAP members disagreed with the people at the top. He asked how that could happen. Mack said resolutions go up to leadership and they vote and submit their decision to the board. She indicated that it was not 70% who disagreed, but did not give a figure, nor could she explain to Senator Garrett how the membership body is assessed. She did, however, confirm that the decisions are made by leadership, not rank and file.
Senator Verdin also read WPATH standards of care that would include transition surgery to minors. He asked Dr. Mack if that means South Carolina is doing a disservice to its children by not offering these surgeries. Dr. Mack answers that:
The law allows today. It is not happening.
Well, if it is currently legal to perform sex-change surgeries on minor children in SC, then SC definitely needs H.4624.
Witness 5 – Adam Saucedo
Adam Saucedo, who introduced himself along with his pronouns “he, she, they, in no particular order,” a licensed professional counselor supervisor and a registered play therapist. He received his Bachelor’s degree in Psychology and his Masters from University of Northern Iowa. He has also completed the Global Education Initiative Certification from WPATH. He also has 28 years experience in the mental health field.
Before he began his testimony he wanted to “meta communicate” that his reluctance to testify initially was due to concerns about his safety and fears of being targeted, but the regret he imagined he would feel for not providing expert witness testimony based on his expertise, overshadowed that fear. He further explained that he felt fortunate to have built enough resilience to move through the discomfort of knowing that people who disagree with his testimony could set out to try and hurt him.
“Despite that,” he said, “I’m here today.”
Adam began by sharing a little bit more about some of the intersections of his identity. He is a gender-diverse, multi-ethnic, queer, person. He is Hispanic, Native American, German and Irish. He was born and raised in San Antonio, Texas. He is part of the middle class, is in his early forties, and is neuro-typical. He has been married to his husband for twelve years and they have a nine-year-old kiddo who is ultrafem and likes all things glitter and rainbows and unicorns.
Adam continued by explaining that he is able-bodied and an athlete. He also recognizes that he is afforded privilege in some environments based on how people read him as a man, because of how he presents himself to the world. He is also familiar with the experience of being, marginalized, in, other, environments. Adam chooses to share some of these intersections of his identity to give an idea of the lens through which he views the world. Introducing himself in this manner also allows him to feel grounded, he said.
Adam moved on to talk about his approach to working with trans and gender-diverse adolescents in their families. He operates from a gender-affirmative model. What that means is that they don’t pathologize gender diversity. They believe that gender variations are not disorders. They recognize that gender is complex, we believe that it’s an integration of our biology, the way we are socialized, our development, and culture. They also understand, or believe, that gender can be fluid for some people and not necessarily binary, in ways that can look different over time, especially as new terminology evolves to better describe our differences.
Adam also thinks it’s important that we note that any pathology that is present as it relates to gender diversity is likely due to external variables like experiencing transphobia, or oppression, or being marginalized or discriminated against, or by being bullied.
He said they want to help people communicate more effectively we wanna help people become more assertive. We wanna help people create healthy boundaries. Every day we want to teach people how to treat us, and I wanna help people be able to do that in a way where they can be proud of who they are.
The goal, really, is to help people move from a place of shame and stigma to a place, of, empowerment, and, pride. Another goal is to help people secure social supports, we think there’s a lot of value in being able to connect to other people who might be experiencing something similar.
And that also goes for parents of transgender at-risk youth. Parents oftentimes just want their kids happy, healthy, and safe and being able to talk with other people about how they’re managing.
Next Adam began to speak about the effect it has on his patients and their families when gender-affirmative health care is not available to them. Banning gender-affirming health care has resulted in youth experiencing higher levels of mental symptomology. They also feel a sense of injustice that some states ban it and others do not, making them also feel angry. These policies make 74% feel stressed, 56% feel sad, 40% feel hopeless, 47% feel scared, 46% feel helpless, and 45% feel nervous. I’ve seen the impact that a bill similar to this one has had on youth and their families. It terrifies them.
Adam is currently working with an adolescent client who refuses to attend high school in person until they’re able to access gender-affirming care.
Know that we do not live in isolation, but in systems, Adam said. So you can imagine what it must be like to not be invited to family functions, be harrassed at school, or not be able to play sports because of embracing your gender. Or use the restroom that aligns with your gender, or unable to continue accessing gender-affirming medical care, or being discriminated against by employers. Or being rejected by your spiritual or religious community. All because of who you know yourself to be.
Adam closed by recommending that the SC Senate is guided by the standards of care espoused by the AMA, the AAP, and the APA (American Psychological Association) by opposing H.4624.
Witness 6 – David Bell
The next witness was David Bell who was accompanied by his wife, Rebecca. They live in Charleston. Mr. Bell is a retired Chief Petty Officer in the United States Navy and served as a nuclear Chinese submarine warrior from 2018 to 2022. He served as Vice Chair of the Charleston County Constituent Board, District Ten. He also has an MBA from Charleston Southern University. Mr. Bell is a building automation cyber security engineer, and his wife, Rebecca, is a software integrator. They are both very involved in their community and volunteer for many causes. “We are like everyday South Carolinians,” he said, “and we are here in opposition to H.4624.”
The Bells have two daughters aged 15 and 14, and one of them is transgender. He gave the following account:
Bell began by saying that though it was difficult for his family, he and his wife felt it was important for them to tell their story, so that the everyone could understand the negative impacts this bill will have on their family.
Our daughter showed signs of gender nonconforming as early as three years old, Bell continued. She preferred playing with girls toys and wanted to wear girl clothing. When denied, she would have tantrums that lasted several hours, where she repeatedly told them that she was a girl and not a boy.
At five years old, in one tantrum, she screamed, “I’d rather die than be a boy!” The Bell’s daughter showed great distress, including self mutilation, when told that her that her male gender was permanent. She told them that all she wanted was to look on the outside the way she felt on the inside. Bell described how she would lash out at them and hit her sister because she got to be a girl. She told her mother that she wished she were dead. At age four, the Bell’s began mental health treatment for their daughter with a pediatric psychiatrist and a behavioral therapist. When she started school, her depression and the increase in her anxiety became crippling. They even held her back in second grade because of her poor school performance. Extreme tantrums became more common, and that included destroying her boy toys and clothing and other inanimate objects.
Before a family vacation, when he wouldn’t buy her sparkly shoes, Bell said, she threw a tantrum worthy of an Oscar, asking him why we didn’t believe she was a girl. “Why can’t she be a girl and be happy, is what she’s asked us.” That was the moment for them that they knew this wasn’t a phase or that she would grow out of it. That was roughly eleven years ago. Their daughter was bullied so intensely she contemplated suicide twice. She spent a total of four weeks as an inpatient at the Medical University of South Carolina due to suicidal ideations within a two year period. Bell said they now know that receiving gender affirming care saved her life and eliminated her suicidal ideations.
Bell said he had been with many other people are now. He, personally, had a really hard time conceptualizing that their daughter was, in fact, transgender. Most of his working career had been around men in very masculine type jobs. He had the same misconceptions that many others may have today, others who have never been where he and his family are today.
Bell then described that after trying everything, with nothing getting better, and feeling like huge failures, he and his wife began allowing their daughter to dress like a girl at home. In other situations where she had to dress like a boy, she became depressed, had tantrums, and engaged in self harm. After allowing her to live for a year as a girl, they saw a Pediatric Endocrinologist for three and a half years. They monitored her until testing confirmed that she had reached puberty.
By this time, as she reached the age of twelve, the Bells’ daughter had had eight years of continuous mental health counseling from several psychiatrists and behavioral therapists. . Mr, Bell emphasized that no medical interventions were offered or recommended before puberty. At that time, after being fully informed at every step, they gave permission for their daughter to begin began puberty blockers. None of the medical personnel involved were in disagreement. They fully discussed side effects, long term effects, and stopping treatment if any one of the seven or eight adults, including Mr. and Mrs. Bell, along with the doctors and mental health professionals licensed by the state of South Carolina were to say no. If they had, they would have stopped and reevaluated their daughter’s treatment plan
According to Mr. Bell, his daughter’s grades improved dramatically once treatment began. Her behavior steadily improved. Instead of daily or multiple times a day of behavior outbursts, they were down to a few times a week, like most normal pre-teens and teenagers.
After her thirteenth birthday, the team of health care providers the Bell’s had built, recommended their daughter start hormone replacement therapy. They went through the same process, with approval from all her care providers, and she began her hormone replacement therapy. They had solid evidence she was improving with gender affirming care and medical intervention.
By this time, as she reached the age of twelve, the Bells’ daughter had had eight years of continuous mental health counseling from several psychiatrists and behavioral therapists. . Mr, Bell emphasized that no medical interventions were offered or recommended before puberty. At that time, after being fully informed at every step, they gave permission for their daughter to begin began puberty blockers. None of the medical personnel involved were in disagreement. They fully discussed side effects, long term effects, and stopping treatment if any one of the seven or eight adults, including Mr. and Mrs. Bell, along with the doctors and mental health professionals licensed by the state of South Carolina were to say no. If they had, they would have stopped and reevaluated their daughter’s treatment plan
According to Mr. Bell, his daughter’s grades improved dramatically once treatment began. Her behavior steadily improved. Instead of daily or multiple times a day of behavior outbursts, they were down to a few times a week, like most normal pre-teens and teenagers.
After her thirteenth birthday, the team of health care providers the Bell’s had built, recommended their daughter start hormone replacement therapy. They went through the same process, with approval from all her care providers, and she began her hormone replacement therapy. They had solid evidence she was improving with gender affirming care and medical intervention. As of today, Mr. Bell said, his daughter has been on hormone replacement therapy for two and a half years in Boston. She has blossomed into a beautiful young lady. Life has been improving for our family quickly as her tantrums and depression have dwindled away. But now that H. 4624 is threatening their ability to continue this gender-affirming care, Mr. Bell is furious. He ended his testimony by saying:
I never thought my state would actively criminalize doctors are being threatened by taking their license away for providing a standard of care. I never thought that love and compassion for my child would be a crime. I never thought that I would have to fight for my daughter to exist, after giving up 20 years of my life and spending over five years of days under the water in the Navy to protect the freedoms of everyone in this room, in the state of South Carolina. In the United. States of America.
I’m utterly disgusted by this bill. Please vote no on H.4624.
The panel had no questions for Mr. Bell so the hearing came to an end. Next on the agenda was the time allotted for public comment.
