A bill banning gender-affirming medical care for minors passed a Senate health committee easily on Wednesday, despite the nonstop chanting and outrage of opponents.
Under the legislation, doctors could no longer provide any “gender transition procedures,” which includes surgery – which testimony showed isn’t happening in Indiana – as well as puberty blockers and hormonal treatments.
Sen. Tyler Johnson talks on the House floor before the State of the State address in January 2023. (Monroe Bush for Indiana Capital Chronicle)
The bill’s author, Sen. Tyler Johnson, introduced the proposal as a “medical, moral and legal obligation to protect Hoosier children.”
The Leo Republican, a physician, said the treatments were irreversible, life-altering and unproven. The higher risk for suicide in gender diverse populations, Johnson said, was likely due to underlying conditions or comorbidities.
“The physical and mental well-being of Hoosier children is a priority of this legislative body,” Johnson said. “A child cannot understand the weight and permanency of these decisions… how can a child understand the ramifications of this on the rest of their life?”
Sen. Shelli Yoder, D-Bloomington, on the Senate floor in a 2022 file photo. (Monroe Bush for Indiana Capital Chronicle)
Sen. Shelli Yoder, D-Bloomington, questioned Johnson’s focus on an estimated 0.4% of those who receive gender-affirming medical care as teenagers and later regret it. The greater portion, 94%, had no issues and another 4% chose to live a nonbinary life.
Of the remaining 2%, Yoder said that the majority of those choosing to reverse their gender transition were pressured by their friends and families. Just 0.4% regretted it themselves.
Johnson disputed Yoder’s reported statistics, though he didn’t provide more than anecdotes for his justification.
Testimony in support of trans youth
At times, the testimony against the bill was very emotional and a gathered crowd outside of the Senate Chamber called out “shame on you” and “save trans lives” throughout the two-plus hours of testimony.
Several trans Hoosier youth and their parents said that medical care had saved their lives and denying that care would increase suicide rates among the LGBTQ+ population.
“What you are saying with this bill is that you are okay with kids considering or actually attempting to kill themselves by targeting families and doctors who are trying to save their children’s lives,” Killian Provence, a 16-year-old transgender boy, said. “We already experience so much bullying and so much discrimination simply for being who we are… we know that you’re trying to eradicate us but no matter how hard you try we’re going to be here regardless.”
According to The Trevor Project, 59% of transgender boys and men reported considering suicide compared to 28% for their cisgender counterparts in 2022. For transgender girls and women, the rate was 48% compared to 37% for cisgendered girls and women. Having just one supportive adult, including a teacher, made children 40% less likely to report a suicide attempt in the last year.
Numerous medical groups opposed the bill, including the American Medical Association and the American Academy of Pediatrics, saying banning such care went against evidence-based care.
Rachel Katzenellenbogen, a physician with Riley Children’' Health who practices in its Gender Health Program, described a lengthy process for evaluating a child that was individualized for each experience.
Generally, the clinic supports social transitions, such as wearing clothes or changing their pronouns, before puberty and at the onset of puberty would discuss treatments to delay puberty, if the child was interested.
Later, hormones may be prescribed at a low dose but only with a parent’s consent. For many patients, the doctors said, socially transitioning or using hormones was sufficient but this bill would stop all of that medical care.
“This diagnosis and process is very hard for patients and families. The treatments we offer really improve the lives of youth and their families,” Katzenellenbogen said. “Without this program, transgender youth in Indiana will not get the care they need and we fear that this may result in some choosing to take their own life.”
Some evidence suggests that hormone replacement therapies may decrease bone density but could be alleviated by the proper diet and exercise. As Yoder noted, the state doesn’t ban experimental therapies for cancer or other maladies in minors, though they frequently have less documentation on their long-term effects.
Puberty for many transgender individuals is a stressful time as their body develops secondary sex characteristics that don’t match their gender – as detailed in the testimony of older transgender Hoosiers who didn’t have the opportunity to transition until adulthood.
Two sets of parents pleaded with legislators to defeat the bill, with one father saying his family, which included a young transgender daughter, would leave the state if it passed.
Though their child is now an adult, Krisztina and Ken Inskeep said that gender-affirming medical care saved their son’s life.
“This bill is cruel and arrogant and evil,” Ken Inskeep said, fighting his emotions. “It is arrogant because it says that we parents are incompetent and unable to make medical decisions for our kids… it is evil because it sacrifices other people’s children on the altar of a culture war.
“Your children, our children, will suffer and die if you pass this bill.”
Katie Blair, the Advocacy and Public Policy Director of the American Civil Liberties Union of Indiana, said her organization stood ready to pursue court action should a ban be enacted.
Misinformation in favor of the bill
Roughly half of those testifying in support of the bill didn’t live in Indiana and many were well-known anti-trans activists who travel the country testifying on similar bills before state legislatures.
Proponents described gender-affirming medical care as “snake oil” and transgender acceptance as a “social contagion.”
Mikel Kelly, a licensed mental health counselor whose LinkedIn bio describes him as a “psycho-theological theorist,” has a “Christian practice” in Plainfield who treats “transgender disorder.”
Mikel Kelly, a Christian counselor in Plainfield who treats “transgender disorder.” (Photo from Kelly’s LinkedIn profile)
“The disorder happens to cause the brain to think it is one thing when it is not,” Kelly said. “Gender dysphoria comes from a situation where people have experienced some measure of trauma in their life that somehow gets associated with their gender.”
Several studies from the 1980s spreading the misinformation related to trauma have subsequently been dismissed, and “no empirical support has been produced” as of 2018.
Just one Hoosier, Corinna Cohn, said he regretted his decision to transition, but this bill wouldn’t have protected him because his surgical intervention occurred at the age of 19 in Wisconsin.
Lawmakers also heard testimony from the Alliance Defending Freedom (ADF), a national Christian legal organization that pushed Indiana’s ban on transgender female athletes last year.
Matt Sharp, the attorney with ADF, noted that other states had passed similar laws – though most are held up in litigation.
“Parents undoubtedly have the right to direct a child’s mental and physical healthcare but they do not have the right to demand that doctors perform harmful, unlawful services,” Sharp said. “A parent cannot demand that a doctor perform assisted suicide on their child… legislators have a duty to protect children from harmful things that they lack the maturity and experience to handle.”
The Southern Poverty Law Center designates ADF as an extremist anti-LGBTQ hate group. The organization also defends the discredited practice of conversion therapy and argues for the criminalization of homosexuality.
One of many national bans
The bill is one of many introduced in Indiana, and elsewhere, that LGBTQ+ advocates have dubbed a “slate of hate,” and youth in Indiana are already feeling ostracized, according to S. Alexander Kemery.
Dr. S. Alexander Kemery, a professor of nursing and the University of Indianapolis (Photo from the University of Indianapolis)
“(The bills are) really sending the message that LBGTQ identities are taboo or controversial. We’re telling these youth that who they are is shameful,” Kemery said.
Kemery, a professor of nursing with the University of Indianapolis, has a doctorate and specializes in LGBTQ+ health. He notes that puberty blockers are considered to be reversible.
“There have been some studies that link discrimination through things like legislation or just daily acts of discrimination to things like heart disease, diabetes, hypertension – so it’s not just the mental health impact,” Kemery said. “We know that legislation… that denies access to gender-affirming care is going to increase depression, isolation (and) suicidality.”
Only one Republican joined the committee’s two Democrats in voting down the bill barring gender-affirming medical care for transgender youth: Sen. Vaneta Becker, of Evansville.
Becker said she had concerns about the bill infringing on the rights of parents, saying “I think decisions like this should be left to the parents.”
The bill passed 8-3 and moves to the full Senate Chamber, where the bill must be heard twice more before the end of the month to continue advancing.