What to know about gender-affirming care in Mississippi 

by Molly Minta, Mississippi Today
February 13, 2023

Mississippi lawmakers are considering a bill that would ban gender-affirming care for trans kids this session, sparking fear among LGBTQ+ Mississippians and their families and allies.

House Bill 11125, also known as the “Regulate Experimental Adolescent Procedures” (REAP) Act, would prevent Mississippi’s roughly 2,400 trans kids and their families from getting hormone therapy or puberty blockers in the state. Lawmakers, contradicting the recommendations of every major medical association in the U.S., have likened gender-affirming care to child abuse and say the bill will protect children.

Trans Mississippians and their allies have said the bill is part of a coordinated attack on their rights. The bill comes two years after lawmakers banned trans athletes from competing on sports teams that align with their gender identity.

As the bill moves through the legislative process, Mississippi Today compiled answers to some commonly asked questions about HB 1125 and gender-affirming care.

What is gender-affirming care?

Gender-affirming care refers to a broad range of interventions, from medical treatment to psychological and social support, that aims to affirm an individual’s gender identity, especially when it is different from the one they were assigned at birth, according to the World Health Organization. It seeks to reduce gender dysphoria, the distress trans people can experience when their physical features do not match their gender identity. The Transgender Care Navigation Program at the University of California, San Francisco, says gender-affirming care can range from “coming out” to friends and family, using different pronouns and changing one’s hairstyle, clothing to going on puberty blockers, hormone therapy or surgery.

Puberty blockers are a type of medication that prevents sex organs from producing estrogen or testosterone. They are reversible and have been used for decades for precocious puberty, the development of secondary sex characteristics at a young age, in cisgender kids. Hormone therapy – the prescription of estrogen or testosterone – typically starts at 16-years-old for trans kids.

For trans kids, who must have parental consent, the goal of gender-affirming care is often to give them time to determine if they want to go through puberty corresponding to the sex they were assigned at birth or if they want to transition, said Lee Pace, a nurse practitioner and co-owner of Spectrum: The Other Clinic, the only transgender medical clinic in Mississippi.

Gender-affirming care is recommended by every major medical association in the United States. It is also evidenced-based and, contrary to the title of HB 1125, not considered “experimental” by the medical community.

In a blog post on the American Medical Association’s website, the president, Jack Resneck, wrote that, “studies have consistently demonstrated that providing gender-affirming care that is both age-appropriate and evidence-based leads to improved mental health outcomes. Conversely, denying such care is linked to a greater incidence of anxiety, depression and self-harm.”

Nationally, trans youth attempt suicide at a rate more than four times their cisgender peers due to social stigma and discrimination. Research has repeatedly shown that gender-affirming care significantly boosts the chances that trans kids will live to see adulthood. A study published last year in the peer-reviewed Journal of the American Medical Association found that over the course of a year, gender-affirming care was associated with 60% reduced odds of moderate to severe depression and 73% less odds of suicidal thoughts.

Are trans youth undergoing gender-confirmation surgery in Mississippi?

No. On the House floor, Rep. Nick Bain, R-Corinth, could not name a single instance of a trans kid undergoing gender-confirmation surgery in Mississippi.

There is no medical clinic in Mississippi that offers gender-confirmation surgery to trans kids, according to Pace and other advocates for the state’s trans community. In general, surgery is not recommended for trans kids by medical organizations that support other forms of gender-affirming care for youth.

No clinic in Mississippi provides what’s commonly called “bottom surgery” to trans people of any age, though adults can access chest surgery in the state.

A handful of trans kids in Mississippi are receiving gender-affirming care. At Spectrum, Pace estimated that in the last two years, he has seen 30 trans kids for care and less than half have had parental consent to go on puberty blockers. The number of trans kids across the country who are on puberty blockers is similarly small. According to an investigation in Reuters based on insurance claims, just 1,390 trans kids ages 6-17 in the United States were prescribed puberty blockers in 2021.

How would HB 1125 be enforced?

HB 1125 is enforced by a civil, not criminal, process in which anyone who “aids or abets” gender-affirming care for a trans child could be sued for monetary damages for up to 30 years. In addition, doctors who continue to provide gender-affirming care after the bill passes could lose their license.

The State Board of Medical Licensure, which would enforce the bill’s provision revoking providers’ licenses, didn’t respond to questions from Mississippi Today. The University of Mississippi Medical Center, which has provided gender-affirming care to trans kids at its LGBTQ-focused TEAM Clinic, said, “we have no comment for now.”

McKenna Raney-Gray, staff attorney for the American Civil Liberties Union of Mississippi’s LGBTQ Justice Project, said on a call last month that the bill is designed to make it so doctors in Mississippi have no incentive to provide gender-affirming care.

How would this legislation affect access to gender-affirming care in Mississippi?

The bill will go into effect immediately. Spectrum is likely the one provider in the state offering gender-affirming care to trans kids, Pace said, and he will stop treating the handful of 16 and 17-year-old trans teenagers in his care the moment the bill passes. His wife and co-owner of the clinic, Stacie Pace, said they will likely post signs on the clinic’s front door saying they no longer accept trans children.

It is unclear if the bill will prevent doctors in Mississippi from referring families and trans kids to out-of-state providers.

Still, the small number of families seeking gender-affirming medical care involving puberty blockers or hormone treatment will have to go out of state if the bill passes, though some people worry this also would not be allowed under the bill’s “aids and abets” clause.

During a Senate Judiciary B committee hearing last month, Sen. Joey Fillingane, R-Sumrall, said he did not think the bill would prevent families from going out of state for care.

“We only control the law within the boundaries of the state of Mississippi,” he said. “Now if parents use it to go to New York or wherever they want to go – L.A. – and do this, that would be controlled by the laws in that state.”

Who supports HB 1125, and why?

The bill is authored by Rep. Gene Newman, R-Pearl. He has not responded to a request for comment from Mississippi Today. It is backed by a coalition of powerful Republican lawmakers in Mississippi, including Gov. Tate Reeves and House Speaker Philip Gunn, and endorsed by conservative and religious organizations like the Alliance Defending Freedom.

These lawmakers and groups have cast the measure as a way to protect children in Mississippi, sometimes likening gender-affirming care to child abuse. At a rally last month, Gunn said he did not think children in Mississippi should be allowed the choice to transition with puberty blockers or hormones.

“We have decided as a society that children are not always capable of making decisions based on age, lack of maturity and lack of understanding,” he said. “Is there any more consequential decision than changing one’s sex?”

Reeves echoed Gunn during his State of the State address.

“The fact is that we set age restrictions on driving a car and on getting a tattoo,” Reeves said. “We don’t let 11- year- olds enter an R-rated movie alone, yet some would have us believe that we should push permanent, body-altering surgeries on them at such a young age.”

What do trans Mississippians, their supportive families and providers of gender-affirming care think of the bill?

Trans Mississippians call the bill an attack on their rights. Jensen Luke Matar, director of the nonprofit Trans Program, said on a call last month that lawmakers are using trans Mississippians as political bait.

“It’s just chess,” said Matar, a trans man. “They’re playing chess, and they’re using the most vulnerable population as their pawns.”

Supportive parents are devastated by the measure and afraid of what will happen if their trans kids can no longer receive gender-affirming care, Pace said. Many parents are still trying to figure out how to tell their kids that Mississippi is considering this bill, according to parents who spoke with Mississippi Today on the condition of anonymity. Some are considering the possibility of moving away to states like California and Colorado that have laws protecting gender-affirming care.

Providers of gender-affirming care in Mississippi say the bill will contribute to increased mental illness among LGBTQ+ Mississippians and are worried it will lead to higher suicide rates if it passes.

“The number one thing, if this bill goes into effect? A lot of dead kids,” Stacie Pace told Mississippi Today. “This law goes into effect, it is, in my opinion, the direct cause of youth suicide.”

What forms of gender-affirming care for trans minors would still be permitted under HB 1125?

Raney-Gray of the ACLU said the bill will not ban social transitioning, such as using new pronouns or wearing different clothes, for trans youth in Mississippi.

It remains unclear how the bill could affect access to gender-affirming care that is provided through a counselor or if that would fall under the measure’s “aids and abets” clause. Counselors across the state who have worked with trans people told Mississippi Today that if they accept a trans child as a client, they would seek legal guidance.

READ MORE: ‘Kids will kill themselves’: Providers of gender affirming care say anti-trans bill will be a direct cause of suicide

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.