Mississippi lawmakers are attempting to pass a bill that would ban anyone under the age of 21 from receiving gender-affirming medical care.

The bill is the first of its kind to impose a restriction on personal medical decisions for adults of legal age who are otherwise entitled to vote, enter contracts, fight in the Armed Forces, attend college, get married, and serve on juries.

But it is similar to bills introduced in other legislatures that seek to prevent minors from obtaining hormones and puberty blockers, or undergoing surgery to treat their gender dysphoria.

The bill, known as the “Transgender 21 Act,” introduced by State Sen. Angela Burks Hill (R-Picayune), would prohibit medical providers from recommending certain treatments, particularly surgical interventions, for transgender minors, and would penalize doctors and medical providers who attempt to assist minors in transitioning to a gender that does not match their assigned sex at birth — even if the treatment does not include surgical intervention.

The bill explicitly states that people under 21 should be barred from receiving gender-affirming care because they “are incapable of comprehending the negative implications and life-altering difficulties” of their decisions.

But the bill goes further, punishing providers who even attempt to diagnose a minor with gender dysphoria, unless they have express permission from the minor’s parents to broach the subject, and effectively requiring doctors to “out” minor patients who may be struggling with their gender identity.

Hill’s bill contains one exception, allowing surgeries in the cases of minors who are intersex or have “external biological sex characteristics that are ambiguous and irresolvable,” but requires them to undergo a medical examination or genetic testing to “verify” their identity or determine they do not have a “normal sex chromosome structure.”

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Of course, in practice, surgeries on intersex individuals often occur in infancy or early childhood, meaning that they are performed without obtaining the consent of the individual undergoing a procedure.

Perhaps most galling, the bill will allow cisgender minors to receive breast enhancement or reduction surgeries, but would deny the exact same procedures to transgender youth.

For extra measure, Hill’s bill also contains a provision — unrelated to medical interventions for transgender youth — intended to protect practitioners of conversion therapy.

The provision bans any arm of state or local government from prohibiting or penalizing any person who “gives or receives counsel, advice, guidance or any other speech or communication consistent with conscience or religious belief, whether or not the counsel, advice, guidance, speech or communication is described as therapy or provided for a fee.”

Hill introduced a similar measure last year, but it failed to pass the necessary committees and did not receive a floor vote.

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The ACLU of Mississippi released a statement opposing Hill’s bill, and expressing hope that it would not become law, calling it “so repugnant that it does not have the oxygen to make it out of committee.”

“According to the [Centers for Disease Control and Prevention], almost 2% of high school students identify as transgender,” the statement reads. “A bill like this would likely impact at least 10,000 young people in Mississippi, preventing them from receiving needed healthcare. Best practice medical care for transgender youth simply delays puberty until young people are old enough to make their own decisions about their lived gender. The bill aims to take away healthy choices.

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“If a bill like this were to pass, medical professionals could be punished for even mentioning gender identity without the consult and express permission of a trans youth’s parents or guardians, banning best practice medical care that is backed by the American Academy of Pediatrics, the American Medical Association and other leading health agencies. It would also bar state employees from trying to protect trans youth’s gender identity, and make it legally required for medical professionals to ‘out’ trans youth if they made an attempt to receive healthcare services.”

Noting that statistics show that close to 40% of transgender people will attempt suicide at some point in their lives — often due to being denied medical care or not having their gender identity acknowledged — the ACLU of Mississippi said in the statement that the government should not be intervening in personal medical decisions.

“Patients and their health care providers, not politicians, should decide what medical care is in the best interest of a patient in accordance with current medical best practices,” the statement reads.

Hill’s bill has been referred to two separate Senate committees for consideration. If passed, and ultimately signed into law by Gov. Tate Reeves (R), the provisions would take effect on July 1.

Ivy Hill, the community health care program director for the Campaign for Southern Equality, notes that similar bills have been introduced in several other Southern states, including Kentucky, Texas, South Carolina, and Alabama, but says Mississippi’s is by far the worst in terms of denying gender-affirming medical care, which the leading medical associations deem “best practices” for treating those with gender dysphoria.

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“What’s happening in Mississippi is really one of the worst, most egregious attacks on trans folks that we’ve seen in recent history for several reasons,” Hill says. “A lot of these other medical bans, which are also horrible, are banning trans folks who are under the age of 18 from getting gender-affirming medical care, versus the one in Mississippi, which does the same thing to folks who are all the way up to the age 21. So what we’re telling trans folks is: you’re able to make decisions about who runs our country, your state, your town, but you’re not old enough to make medical decisions about what’s right for you in your life, in your body.

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“This bill not only bans best practices, it condones and allows space for things like conversion therapy, which we know is also incredibly damaging, especially to trans youth, who are already one of our most vulnerable populations,” Hill adds.

Hill says that the Campaign for Southern Equality will consider taking legal action to stop the state from enforcing the bill’s provisions if it is ever signed into law. They also noted that the mere introduction of such a bill sends negative messages to transgender Americans, particularly youth.

“We know that even when legislation like this is just introduced, even if it doesn’t pass, it’s still damaging to folks because of the message to us that our identity is not valid, that we don’t deserve to be respected, and that there’s something dangerous or wrong with us getting what is actually lifesaving medical care for many people,” Hill says, calling the ban “shameful” and “outrageous.” 

“Honestly, we’re in the middle of a global pandemic and a huge public health crisis, and our legislators are focusing on how to make medical care less accessible to people,” Hill adds. “What we need to be focusing on is in our health, and how to make health care more accessible. This is just one of the worst bills we’ve ever seen.”

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