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Ban On Hormone Therapy For Minors Could Soon Be SC Law. Transgender Advocates Vow To Keep Fighting.
Sen. Richard Cash, R-Powdersville, stands to speak on May 23, 2023, as senators debated a six-week abortion ban. (File/Sean Rayford/Getty Images)
COLUMBIA — Legislation banning transition-related treatments for transgender youth in South Carolina could be one vote away from becoming law.
Senators approved the bill 27-8 on Thursday, returning it to the House with just three legislative days left in the session. If the GOP-dominated House agrees with the Senate's changes, the legislation will go to Gov. Henry McMaster's desk.
Advocates for transgender youth are urging the House to vote "no."
During hours of debate over two days in the Senate, Republicans argued the ban is necessary to protect children from making harmful decisions they can't undo later in life, while Democrats countered the government should not interfere in a family's medical decisions.
One part of the bill seemed to have unanimous support — a ban on gender-transitioning surgeries for anyone under 18.
"Nobody is advocating that children get any kind of surgery," said Senate Minority Leader Brad Hutto, D-Orangeburg.
But, as opponents of the bill have repeatedly testified, that's not happening anyway. Republicans said a law would ensure that doesn't change.
"I know there are no procedures being done in South Carolina. I'm very thankful for that," said Sen. Penry Gustafson, R-Camden. "But we don't want them to ever come, so I think that part is just a preventive measure."
The bill would also ban puberty blockers and gender-transitioning hormone therapy for minors. Democrats argued that will throw families in unnecessary upheaval and increase suicide rates among youth already prone to self-harm. Puberty blockers only delay puberty. Once someone stops taking them, puberty will run its course, opponents said.
Sen. Tom Davis, R-Beaufort, tried unsuccessfully to distinguish between reversible and irreversible hormone treatments and ban only the latter.
But his Republican colleagues argued the lifelong effects of what's believed to be reversible are still unclear. They pointed to studies showing bone density loss, infertility and other side effects.
Gustafon got emotional in telling her colleagues about her cousin Mike, who transitioned as an adult after years of struggling with addiction and unacceptance, then died relatively young, possibly as a result of his hormonal medications.
"I don't think they affect everyone the same way, but I'm not going to risk it," she said. "I do not think minors should be exposed to these drugs long-term. Once you're 18, I don't care, frankly. You're an adult."
Sen. Richard Cash, who led the debate, called the United States "the outlier" on what's considered the standard of care for gender dysphoria.
Last month, England became the fifth European country to restrict hormone therapy for children, citing a lack of evidence of their benefits and concerns of long-term consequences, the New York Times reported. However, unlike the laws in two dozen GOP-led states, the European countries don't ban the treatments outright, the newspaper reported.
The few hundred families in South Carolina affected by the bill don't need the Legislature coming between their children and happiness, Democrats said.
The bill is "an attack on our children. It's an attack on parents, and it's an attack on our doctors," Hutto said. "The standard of care is the standard of care, and that standard of care should not be criminalized."
"What if that standard of care is wrong?" asked Senate Majority Leader Shane Massey, R-Edgefield.
A key difference in the Senate version is a requirement that school administrators notify a student's parents when children ask to change their pronoun or say they're a different gender.
When the floor debate started, the Senate version also required parents to be notified if a child asks to be called a different name. But that was removed after senators of both parties recalled nicknames children often prefer to be called that has nothing to do with gender dysphoria.
"As a teacher, one fourth of my students had other names. Mullet was my favorite," said Sen. Mike Fanning, D-Great Falls, rattling off a list that included Bubba, Cooter, Drumstick, Princess and Tootsie.
"Teachers have said, 'Please keep your culture wars out of our classroom. Quit dragging us into your fights,'" he said. "You're dragging our teachers into a political war that doesn't need to happen in our classrooms."
Transgender advocates said the bill forces teachers to out students to potentially unsupportive families, which could endanger their lives.
"This bill is an extreme political attack on the well-being of children and on the right of families to obtain evidence-based care for their children," said Jace Woodrum, director of the American Civil Liberties Union of South Carolina. "Transgender people belong in South Carolina, and we will never stop fighting."
Two dozen states have passed similar bans, but many of them are blocked by court challenges.
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Hormone Therapy For Menopause Is Safer Than Previously Thought, Study Finds
By Lois M. CollinsLois M. Collins is a special projects and family issues reporter at Deseret News, including health, parenting and family policy.
Hormone therapy's benefits to treat menopausal symptoms outweigh the risks for women under 60. And it's safer than previously thought, according to a new study published in JAMA, the journal of the American Medical Association. But the use of menopausal hormone therapy is not recommended to prevent heart disease, stroke, dementia or other chronic illnesses. It doesn't reduce those risks.
The study says roughly 55 million women in the U.S. And 1.1 billion worldwide are postmenopausal. A national coalition of researchers launched the Women's Health Initiative, which is the biggest study of women's health in the country, enrolling 161,808 postmenopausal women ages 50 to 79, "to inform clinical practices" around aspects of health impacting older women. Recruitment for the study began in 1993 and each participant was followed for up to 20 years.
For years, it was believed that hormone replacement therapy lowered the risk of heart disease, stroke, dementia, chronic disease and even death. But as United Press International reported, one of the Women's Health Initiative's clinical trials "slammed the brakes on hormone replacement therapy in 2002, however, reporting that women taking combination (estrogen and progestin) hormone therapy had an increased risk for breast cancer, heart disease, stroke and blood clots."
But they continued to study the issue, as the popularity of hormone replacement therapy dropped and many doctors stopped prescribing it. The article said that "a more nuanced picture of hormone therapy's risks and benefits has emerged" as the research continued.
The article said that research over time has continued to show that hormone therapy doesn't solve age-related risks like heart disease or hip replacements, which other early studies suggested. But it's not as risky as believed for younger women bothered by symptoms as they approach menopause. And in menopause, hormone replacement therapy can offer relief from those symptoms. .
Per NPR, "Most significantly, there are now different types of hormones — delivered at lower doses — that are shown to be safer."
"Women should know that hormone therapy is safe and beneficial," Dr. Lauren Streicher, a clinical professor of obstetrics and gynecology at Northwestern University Feinberg School of Medicine, told NPR.
Other findingsThe same study's findings do not support routinely recommending women take calcium plus vitamin D supplements to prevent fractures, "but these supplements are appropriate to fill nutritional gaps" for women who don't get enough of those nutrients through their diet, the researchers said.
They also noted that "a low-fat dietary pattern with increased intake of fruits, vegetables and grains did not prevent breast or colorectal cancer, but was associated with lower rates of death from breast cancer in long-term follow-up, offering an option for women seeking to reduce this risk," Dr. JoAnn Manson, chief of Preventive Medicine at Brigham and Women's Hospital and first author of the new report in JAMA, said in a news release. "Women also have more options for treatment now, including estrogen in lower doses and delivered through the skin as a patch or gel, which may further reduce risks; non-hormonal treatments are also available."
Four things to knowThe Mayo Clinic News Network talked with Dr. Taryn Smith, one of Mayo's internists and women's health specialists, about the value of a personalized approach to medicine when it comes to hormone replacement therapy. Smith offered four things women should know:
Menopause Hormone Therapy May Not Help Prevent Heart Disease
Hormone replacement therapy to prevent cardiovascular disease, a low-fat diet to prevent breast cancer or colorectal cancer, and calcium with vitamin D supplementation for fractures in postmenopausal women have been used as preventive treatments.
However, in a new study from the Women's Health Initiative published in the journal JAMA, researchers looked at these treatments and concluded they can no longer support these therapies as preventive measures for certain diseases.
Clinical trials from the Women's Health Initiative examined the health effects of several treatments for postmenopausal women:
The studies included 161,808 women ages 50 to 79, with up to 20 years follow-up periods. The researchers noted that 55 million women in the United States and 1.1 billion worldwide are postmenopausal, and many have used at least one of these therapies to help improve their health.
Participants in the study received oral hormone treatment.
The researchers compared the cardiovascular health of those who received hormone treatment with those who received a placebo.
They said their findings did not support using hormone therapy to prevent cardiovascular or heart disease, stroke, dementia, or other chronic diseases. They added that the therapy significantly increased the incidence of breast cancer.
The scientists did find that this treatment helped reduce vasomotor symptoms in women in early menopause. Vasomotor symptoms include hot flashes, night sweats, heart palpitations, and changes in blood pressure.
"Data on hormone therapy and calcium supplementation over the years has been a roller coaster," said Dr. Nicole Weinberg, a cardiologist at Providence Saint John's Health Center in California who was not involved in the research. "One study shows it works and another shows it doesn't. I like this study because it is a conglomeration of data that has been accumulating for years."
"I think the data is pretty conclusive that hormone therapy should be used symptomatically, for example, for vasomotor symptoms," Weinberg told Medical News Today. "But it is clear it does not prevent cardiovascular disease. In the postmenopausal years, women's bodies become more chemically aligned with men and, therefore, I am going to treat symptoms accordingly. If someone has high blood pressure, I will treat that. If someone has high cholesterol, I will treat that."
"Overall, I think this is a great study and provides very helpful information for treating women in the different stages of menopause," Weinberg added.
Research from the 1980s and 1990s found a decreased risk of heart disease in women who took hormone therapy, according to Dr. Cheng-Han Chen, an interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in California who was not involved in the study.
More recent ones, Chen explained, did not find the same results, however.
"Because of this, we have recommended against the use of hormone replacement therapy for heart disease prevention for quite some time now," Chen told Medical News Today.
"Our recommendations for cardiovascular risk reduction in postmenopausal women are essentially the same as those for the general public: eat a heart-healthy diet, get plenty of exercise, maintain a healthy weight, avoid tobacco and alcohol, get good sleep, and watch your blood pressure, blood sugar, and cholesterol levels," Chen added.
"[The use of] estrogen plus progesterone therapy in postmenopausal women, this combination appeared to significantly increase the risk of developing stroke or pulmonary embolism," Chen noted.
The women in the new study received 1,000 milligrams per day of calcium and 400 IU/d of vitamin D daily.
The researchers assessed the participants for hip fractures and reported that supplementation did not prevent these injuries in postmenopausal women. The researchers noted that women not meeting the national dietary guidelines might benefit from taking supplements.
According to the NIH Office of Dietary Supplements, the recommended daily allowance for calcium and vitamin D is 1,200 mg/day and 600 IU/day, respectively, for women aged 51 to 70.
Additional research published in March 2024 found that calcium and vitamin D supplementation in postmenopausal women might reduce the risk of death due to cancer but could potentially increase the risk of death from cardiovascular disease.
The participants in this new study followed a diet that reduced their fat intake by about 20%. They also increased their fruit and vegetable intake to at least five servings per day and their grain intake at least six servings daily.
The researchers assessed these women for incidence of breast or colorectal cancer.
They reported that the low-fat diet did not significantly decrease the incidence of either of these cancers. However, a long-term follow-up did note a reduction in breast cancer mortality.
The scientists did indicate the diet may be an option for postmenopausal women who wanted to reduce their risk of death due to breast cancer.
"Perimenopause marks a period of transition and transformation for women, characterized by hormonal fluctuations affecting various parts of the body, including the brain," Dr Adi Katz, the director of gynecology at Northwell Lenox Hill Hospital in New York who was not involved in the research, told Medical News Today. "Research has linked these hormonal changes to conditions like PCOS [polycystic ovary syndrome], PMDD [premenstrual dysphoric disorder], and PMS [premenstrual syndrome], which may heighten the risk of anxiety and depression. It's crucial to destigmatize these experiences and offer support to women during this significant life phase."
The researchers noted several limitations to their study:
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