SIOUX FALLS, S.D. — Faced with the possibility of breaking the law, Dr. Keith Hansen took a moment to consider his options.
If legislation now before South Dakota state lawmakers is made law, Hansen could go to jail if he prescribes the use of a drug commonly used to pause the onset of puberty in children conflicted about their gender identity.
The Class 1 misdemeanor could result in up to a year in jail and a $2,000 fine.
Hansen is a reproductive endocrinologist at Sanford Health in Sioux Falls, where he treated 19 transgender minors last year. What would he do if the bill becomes law?
"I mean, I wouldn't break the law," Hansen said. "I was an officer in the Navy. "
Hansen's potential jeopardy is a matter the South Dakota medical community is taking seriously. Both the South Dakota State Medical Association and Sioux Falls-based Sanford Health are standing alongside numerous in-state doctors to oppose the bill, called House Bill 1057.
Their opposition, so far, and a wave of negative national attention hasn't seemed to resonate with lawmakers. The legislation sailed through the overwhelmingly Republican state House and goes before a Senate committee on Monday.
South Dakota's transgender legislation has spurred a striking clash between doctors armed with the consensus of scientific research, and bill proponents equipped with anecdotal evidence and lurid language they use to describe doctors and parents as irresponsible enemies in a battle to protect vulnerable children.
Rep. Fred Deutsch, a Republican and a chiropractor from Florence, is HB1057's main sponsor. In his first introduction of the legislation to fellow lawmakers in a Jan. 22 hearing, he introduced those he had lined up to testify about the bill with a stark description framing the work of Hansen, as others like him, as not even being health care.
“This diverse group supports the bill because they believe that the procedures listed in this bill are not health care, but are criminal acts against vulnerable children, who are too young to understand the impact that sterility, mutilation and other health risks that are life long will have on them later in life," Deutsch said.
In the room, people in white medical coats who opposed Deutsch's bill visibly crowded the seats. Doctor Michelle Schimelpfenig, a board-certified pediatrician with Sanford Health and assistant professor in the department of pediatrics at University of South Dakota Sanford School of Medicine, referred to the host of doctors in the audience as she pleaded with House lawmakers.
"Please don't let us choose between evidence-based medicine and jail," she said.
Research versus regret
A Forum News Service review of the research on transgender children, future regret and mental health shows an overwhelming consensus that aligns with mainstream medical treatment, at odds with what's been claimed by HB1057's proponents.
The research indicates treating transgender children with reversible puberty blocking drugs such as Lupron is a crucial factor in future happiness and the reduction of the risk of mental health concerns, including the risk of suicide.
New research supports these conclusions. Earlier this month the peer-reviewed journal Pediatrics published research showing transgender people who wanted and received puberty blockers had a lower risk of considering suicide than those who wanted the treatment and didn't get it.
“The data is so strong for treating these individuals appropriately and with care, and that it lowers the rate of suicide, suicidal ideation, self-mutilation," Hansen said. "There’s no questions about it."
Doctors who care for transgender patients rely on treatment protocols described by Hansen as painstakingly developed by the American Academy of Pediatrics and the Endocrinology Society, based on the latest and best medical research, he said.
"It's not like they just drop in and we give them a shot," Hansen said. "They have to go through counseling, often times years of counseling and such."
The mismatch in research firepower was evident in HB1057's first full hearing before state representatives in a Jan. 22 House committee. Bill supporters phoned in out-of-state transgender people who said they had regretted their transitions, and several medical professionals who made claims unsupported by the bulk of medical research.
A psychiatrist and therapist claimed a diagnosis of gender dysphoria (the distress over a mismatch between gender identity and sex assigned at birth) isn't an objective medical condition, a claim refuted by the medical community, and an endocrinologist compared transgender transitions to eugenics experiments conducted by Nazi Germany. A Sioux Falls family practice doctor, Dr. Glen Ritter, described the prescribing of puberty blockers and hormones as criminal acts committed by physicians.
Presented with some of the research that contradicted their claims, bill proponents presented the bill's topic as one where dueling scientific views essentially canceled each other out.
Representative Jon Hansen, R-Dell Rapids, a co-sponsor of the bill and no known relation to Dr. Hansen at Sanford Health, described the bill in lurid terms he later echoed in a speech on the House floor. He detailed surgical procedures the bill would ban for South Dakota children under age 16, surgeries not recommended or performed by the medical community.
"A small number of doctors (in South Dakota) … are experimenting on little kids without knowing all the consequences, and that’s wrong," he said.
House Bill 1057 will get its first appearance before state senators on Monday. Many members of the medical community, again, will be there to testify against it.
Hansen, the reproductive endocrinologist, said if the bill becomes law he'll be forced to refer his patients for care at the Mayo Clinic in Rochester, Minn.
”For the life of me, I just don’t know why at this time we’re doing this, when we finally got effective guidelines that are safe, and we’ve reduced the risk of suicide, suicidal ideation, self harming, and the risk of regret is very low according to most studies," he said.