Alabama Republican lawmakers are pushing a bill that would bar transgender youth under the age of 19 from accessing gender-affirming medical care and also contains a provision to force school authorities to out transgender children to their parents.

The bill, proposed by State Rep. Wes Allen (R-Troy), is called, in Orwellian fashion, the “Alabama Vulnerable Child Compassion and Protection Act.” But its intent is to make it a Class C felony, meaning that any doctor or medical provider who prescribes, dispenses, or administers puberty blockers or hormones to transgender children, or performs gender confirmation surgery on a trans youth could end up serving up to 10 years in prison.

The House Judiciary Committee held a hearing last week to debate the bill, but did not vote on whether to move forward with the measure, although a nearly identical bill passed last year just prior to the COVID-19 pandemic, which disrupted the legislative calendar. 

The intent of the bill, as stated by Allen, is to delay transgender youth from accessing gender-affirming treatments for gender dysphoria, using the rationale that youth pursuing a gender transition are making an impulsive, life-altering decision that they will come to regret. The bill argues that studies have shown that ‘pre-pubescent children who claim a gender identity different from their biological sex will ultimately identify with their biological sex by young adulthood or sooner when supported through their natural puberty.”

The bill also maintains that the effects of puberty blockers, hormones, or gender confirmation surgery is irreversible, resulting in “sterility, loss of sexual function, bone fractures, thromboembolic and cardiovascular disease, malignancy, and may even contribute to mental illness and suicide.” It also condemns such gender-affirming interventions as a “public health risk.”

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Republicans in the Alabama Senate are considering a nearly identical bill, sponsored by Sen. Shay Shelnutt (R-Trussville) which was approved by the Senate Health Committee on Wednesday by an 11-2 vote and will soon be voted on by the Republican-dominated upper chamber.

The House bill also contains a provision stating that “no nurse, counselor, teacher, principal, or other administrative official at a public or private school attended by a minor shall do either of the following: (1) Encourage or coerce a minor to withhold from the minor’s parent or legal guardian the fact that the minor’s perception of his or her gender or sex is inconsistent with the minor’s sex. (2) Withhold from a minor’s parent or legal guardian information related to a minor’s perception that his or her gender or sex is inconsistent with his or her sex.”

The provision is couched in terms of protecting parental rights, but, in practice, means that transgender children will not be able to talk to school officials about their struggles with gender dysphoria or even bullying at the hands of other students without those officials reporting back to their parents, who may not be accepting of their child’s gender identity, potentially resulting in a trans youth being kicked out of their home or subjected to conversion therapy against their will.

See also: Mississippi wants to block transgender people under age 21 from receiving gender-affirming care

Critics of Allen’s bill argue that the provision around school officials is ambiguous, and doesn’t make clear whether those officials would be thrown in prison for withholding information that a youth’s gender identity doesn’t match their assigned sex at birth.

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“Because it’s ambiguous, it can absolutely be read that those felony penalties would apply to teachers and that’s part of what makes this bill so concerning, is the lack of clarity around who is going to be penalized for what,” Kaitlin Welborn, a staff attorney at the ACLU of Alabama, told the American Independent. “If you read the felony penalty as only applying to medical professionals and there’s no penalty for teachers and school counselors, then why include the information, if there’s not a penalty?”

Welborn also alleged that Alabama Republicans know such bills are controversial and likely to be challenged in court if they pass, but are pursuing the measures as part of a larger fight against transgender rights, hoping that judges on the conservative 11th U.S. Court of Appeals or U.S. Supreme Court ultimately decide to uphold the law based on their personal preferences.

During the House Judiciary Committee’s hearing on Wednesday, some lawmakers, including Rep. Matt Simpson (R-Daphne) questioned why a bill on a medical issue would be put before the Judiciary Committee — where the members are mostly practicing lawyers — than another more relevant committee dealing with health or licensure of medical professionals.

The committee heard testimony from several medical experts, both those testifying in favor of the bill and against it. Prior to that testimony, Committee Chairman Jim Hill (R-Moody) said he would be adding an amendment meant to clarify that nothing in the bill is meant to inhibit or prevent licensed psychologists from treating patients struggling with various mental health or social issues as they see fit.

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Supporters of the bill argued that transgender youth are not mature enough to make potentially “impulsive” or life-altering decisions about their health, and claimed that many underage children who experience gender dysphoria at some point in their lives eventually grow to accept a gender identity that matches their assigned sex at birth. Much of the testimony speaking to those assertions focused on the idea of “rapid onset gender dysphoria,” or the claim that youth who identify as transgender have been overly influenced by social media, peer pressure, and gender-affirming models of treatment.

“If vulnerable, gender-confused minors are validated in their confusion or convinced by social media or a therapist that ‘sex change will bring them happiness,’ they can be led into a life with medical and emotional disfunction,” said Dr. Den Trumbull, a pediatrician and a fellow and co-founder of the American College of Pediatricians, a socially conservative advocacy group of health care professionals that serves as an alternative to the “liberal” American Academy of Pediatrics. The group has previously gone on record as opposing abortion rights, same-sex adoption, and the recognition of non-traditional sexualities, and supports allowing parents to choose whether to enroll their children in conversion therapy.

“The so-called ‘gender-affirming therapy,’ which involves the off-label use of puberty blockers, cross-sex hormones, or surgical rearrangement of sex organs is entirely unproven, can cause irreversible sterility, and physical injury to a young child,” Trumbull added.

But Dr. Morisa Ladinsky, a pediatrician by training and member of the American Academy of Pediatrics who serves as an associate professor of pediatrics at University of Alabama-Birmingham’s School of Medicine, re-asserted the AAP’s opposition to the bill and pushed back against what she claimed were misrepresentations of pushed by proponents of the bill about the treatments recommended for transgender-identifying youth.

See also: American Academy of Pediatrics calls for ‘gender-affirming’ approach to treating transgender youth

“These youth are not mentally ill. They’re not jumping on a trend,” she said. “In using the gender-affirmative model of care, we use evidence-based standardized practices to keep these youth healthy throughout their journey.”

Ladinsky noted that gender confirmation surgical interventions are not recommended for minors, and that the effects of puberty blockers are irreversible and have been used successfully to treat other medical conditions, such as the early arrival of puberty. She noted that, with the express permission of their parents, some older teens may opt for hormonal therapy to better align their bodies with their gender identity, but noted that the process is long and carefully monitored, requiring patients to undergo therapy and mental health screenings so that they are well-informed about the choice they are making to pursue a gender transition.

Ladinsky said that provisions of the bill criminalizing pharmacists who fill prescriptions for transgender youth are “unenforceable” in practice, as it is unlikely that pharmacists know why a particular medication was described or what it’s being used for, especially with medications that may be used to treat multiple afflictions. She suggested that the committee refer the bill to a subcommittee for further study, instead of pushing for its passage.

“This bill tells truly vulnerable youth that you’re going to make their health care a crime. It invades the sacred domain of parenting, reaches into the practice of medicine, and shut downs the parent voice in medical decision-making,” she said. “If this legislature embraces the tenets of limited government, and the rights of the people, how can this body endorse [this bill]?”

Perhaps the most heart-wrenching testimony came from David Fuller, a sergeant with the Gadsden Police Department who has been raising three children, including a transgender daughter, since the death of his wife. Fuller recounted his gradual journey to accepting the gender identity his daughter, who came out as transgender at age 16, and how the professionals he worked with at UAB Medicine over the past five years had helped his daughter make sober, well-informed decisions about her health care and the transition process — something he said saved his daughter’s life.

“They made us feel like we weren’t alone, that we were normal in an abnormal situation and they could help us,” Fuller said, rejecting claims that he and other parents were being coerced into approving treatments for their children. “[T]hey didn’t push anything on us. Just the opposite. They reeled us in at every step. They made sure it was baby steps. It’s been a five-year process now and they haven’t pushed anything on us. Just the opposite.”

He also said he viewed the medical professionals at UAB Medicine as “angels” for helping him accept his daughter’s transition, and balked at the idea of possibly having to arrest them.

“As a police officer, you’re asking me to someday put handcuffs on these people that are heroes in my life?” Fuller said. “Please don’t ask me to do that.”

Fuller’s testimony earned praise from State Reps. Merika Coleman (D-Birmingham) and Chris England (D-Tuscaloosa).

“You said you’re 5’7″? Well, today, as a father, you are 10 feet tall,” Coleman, the Assistant Democratic Leader, remarked. “I want to thank you, parent-to-parent, for what you are doing for your daughter and all of your children today.”

The committee did not vote on whether to pass the bill out of committee and send it to the floor of the full House for consideration, with Hill saying they’d address the bill in two weeks after returning from a temporary recess the week of Presidents’ Day.

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