Facts or fictions? SC lawmakers pass teen’s trans restrictions regardless of answers

Despite conflicting evidence on whether puberty blockers for gender transitions are dangerous or if gender transition surgeries even occur in South Carolina, a bill prohibiting both is headed toward the governor’s desk.

A number of statistics and statements such as “mutilation of children” and “transgenderism ideologies being pushed by doctors” have been thrown around during the the “Help not Harm” bill (H. 4624) debate. But are these statements true?

Lawmakers from both sides of the aisle have cited evidence for and against gender transition procedures. Much of it conflicting with the other side, creating confusion. While some arguments have been rooted in differences of opinion, other reference facts that may misconstrue the truth.

From the first week of session to the second-to-last, representatives and senators have been working to pass a bill that would prohibit anyone under 18 from receiving gender transition surgery or using puberty blockers for transitioning.

The bill passed 27-8 Thursday in the Senate.

The latest version includes an amendment requiring public school administrators to let parents or legal guardians pronoun use and confirming their gender is inconsistent with sex.

Here’s five points that both sides disagree on, including some misleading information.

Regret after transitioning

Republicans in the House and Senate made multiple statements regarding those who decide to transition later regretting the decision, or even detransitioning.

The argument stems from the concern that children and teens are too developmentally naive to understand the complexity of transitioning and what it will do to the body.

“I’m known as the Senator for the children,” state Sen. Katrina Shealy, R-Lexington, said to state Sen. Mia McLeod, I-Richland during debate. “I’m troubled in a lot of ways here because I’m torn. I’m torn because I know that we know we don’t need to have surgeries on children before they’re 18 years old, we know that. Children can make crazy decisions when they’re young.”

While some listed concerns, others cited statistics. State Sen. Josh Kimbrell, R-Spartanburg, cited an April 2021 survey, of 237 individuals surveyed, 46 percent had undergone surgeries, two-thirds of the 237 people had undergone either a surgery or a hormone replacement therapy. And 50 percent said afterward that their concerns before the procedure were not alleviated, but exacerbated or made worse.

Chase Glenn, Alliance for Full Acceptance Executive Director, said multiple studies contradict the high regret rate quoted by legislators.

“There are some trans adults who regret having gender confirmation surgery, but there are people who have regrets for all types of surgeries. If you look at regrets for knee replacement, it’s actually higher than regret rates for gender confirmation surgery,” Glenn wrote over text.

According to the National Institute of Health, a 2021 study found an extremely low prevalence of regret in transgender patients after gender surgery. Out of 27 studies, pooling 7,928 transgender patients who underwent any type of gender surgery, the pooled prevalence of regret was 1%.

Regret for knee surgery in a 2020 study was 18%, according to the NIH.

65 “gender transitioning” clinics in South Carolina?

On the House floor Jan. 17, Rep. Josiah Magnuson. R-Spartanburg, said South Carolina has 65 gender transitioning clinics.

“That is actually more than doubled since 2022 when there was only 31. This is big business, a lot fo places are opening new clinics, and many have opened in this past year, alone,” Magnuson said.

Magnuson told The State he was referencing the Campaign for Southern Equality website. It cited 65 different medical facilities, some hospitals, some OBGYN offices, some general doctors and a plethora of others.

Magnuson said not all of these places are necessarily providing drugs or surgeries, Some of them offer counseling, he said, but all were pushing for and friendly towards transgender issues, he said.

“This is a big business for certain medical professionals who have a different world view,” Magnuson said.

However, that doesn’t mean these are “gender clinics,” advocates say.

“The list Rep. Magnuson provided you is a list trans-affirming providers in the state,” Glenn said. “This is simply a list of providers who are affirming of trans folks — not necessarily those who provide trans what is called “gender affirming care” in this legislation. As a trans man, I can tell you that I have had providers turn me away once they found out I was trans and there are others I’ve had to educate about my individual needs as a trans person.”

Glenn added that organizations like Campaign for Southern Equality and AFFA publish lists of providers that they know are safe and knowledgeable to provide for all types of care regarding the trans community, including gender affirming care.

Medical professionals pushing drug

Along with other legislators, Magnuson and Rep. Jordan Pace, R-Berkeley, both members of the House Freedom Caucus, said on the House floor that this is a business people profit from.

In addition, representatives stated that doctors will give the drugs to patients immediately after being asked. Patients go into a doctors office, want to transition, and doctors just hand them over.

“This particular wing of the medical industry is incredibly profitable,” Pace said on the House floor Jan. 17. “If someone is making their living by sterilizing children and chopping off their body parts and the worst they get is a five-year suspension and a $5,000 fine, then they have been shown a great amount of mercy from the state, when it should have been much, much worse.”

Pace then went on to say the procedures can be millions of dollars per patient.

Dr. Elizabeth Mack, a pediatrician in Charleston, said no one is walking in and getting medicine immediately, and this notion is considered medical malpractice.

Mack said the care as dictated by the guidelines involves mental health evaluation and care, and in many cases, this is the case for years before medication is prescribed. Some transgender individuals decide to not use hormones or get the surgery.

“There is not profit in this,” Mack wrote over text. “This state has chased off several physicians who provided gender affirming care. Similarly this is not fun for any family or patient to walk this walk. The bullying these families experience such as what is happening at the state house is dangerous. These decisions must be left to families and physicians in the exam room.”

How many transgender youth are in the state?

Few studies have shown how many transgender youth are in South Carolina. As of 2020, according to the Williams Institute out of UCLA, there is an estimated 2,150 trans youth, ages 13-17.

Lawmakers said there has been an increasing number of transgender individuals.

While many lawmakers didn’t cite specific research, the New York Times reported in 2022 that the number of young people who identify as transgender had nearly doubled in recent years. According to a report by Williams Institute, it was estimated that 1.4 percent of 13- to 17-year-olds and 1.3 percent of 18- to 24-year-olds were transgender, which was a rise from the 0.7 percent in 2017.

Experts told the New York Times that “young people increasingly have the language and social acceptance to explore their gender identities, whereas older adults may feel more constrained.”

Is the process irreversible?

“No studies have attempted to determine whether the effects of puberty blockers as currently prescribed for gender dysphoria are fully reversible,” Sen. Richard Cash, R-Anderson, said on the Senate floor Thursday.

Puberty blockers are used to put puberty on pause. They are used in a variety of medical circumstances, including for children who have precocious puberty — puberty that starts before it’s supposed to. They are also used to treat cancer, endometriosis and other health issues.

The drugs are only given to transgender or gender non-nonconforming kids after they start puberty, never before, said Michael O’Brien, a pediatrician in the Lowcountry.

Also, the drugs are reversible, O’Brien said. The only major long-term side effect of these drug is having a short stature. “You might not be as tall as you would otherwise,” O’Brien said. “It’s not super significant because puberty resumes either the moment you stop taking that drug, or once you start taking the hormones of the opposite sex.”

Mack also confirmed the drugs are reversible. When someone stops taking them, puberty resumes where it left off, she said.

“Suicide is not reversible and gender affirming care is lifesaving. I see this in my practice in the pediatric ICU,” Mack wrote over text.

The U.S. Food and Drug Administration approved puberty blockers in 1993, but hasn’t approved them for gender transition uses.

Multiple Republicans , including Magnuson, said once the hormone treatment has been given, the body can no longer bear children. It’s about protecting children, Magnuson added.

“The body still changes. The body keeps on growing, moving, developing. I am not convinced these hormones don’t effect the body somehow. I don’t think they effect everyone the same way. But I’m not going to risk it. ” Penry Gustafson, R-Kershaw said. “I just don’t think there is a medical consensus saying there are not going to be long term consequences to taking these specific hormonal drugs. I know there is no procedures going on in South Carolina. Our hospitals have told us. We have some smart doctors here.”

Were transition surgeries happening for youth in SC?

Lawmakers and bill opponents brought up numerous times that gender transition surgeries were not happening in South Carolina.

In 2023, pediatricians testified to lawmakers that no doctors in South Carolina perform gender-transition surgeries on minors. And recent reporting by ProPublica found that due to political pressures surrounding transgender health care, the Medical University of South Carolina (MUSC) stopped performing gender affirming care for minors.

But Republicans continued to emphasize they needed to protect children, and if it wasn’t a problem currently, it was a preventative measure to ensure it never would be one.

“I believe the question of surgical procedures may not be a point of immediate consideration today,” said Sen. Daniel Verdin, R-Laurens, and head of the Senate Medical Affairs Committee. “We respond to our constituencies. For this matter, if you put it out there in a polling question ... if you put it alongside taxes, if you put it alongside restructuring, if you put it alongside paying our school teachers and our law enforcement officers, it’s up there, it’s above them all.”