It was a big week in Helena, which wrapped up with a very long hearing on Senator John Fuller’s harmful anti-transgender bill, SB 99. This bill was designed to cut off trans, nonbinary, and Two Spirit youth from caring professionals and gender-affirming care.


The good news is that opponents to SB 99 turned out in huge numbers! Transgender Montanans, parents, physicians, and Montana residents from every corner of the state turned out to say that SB 99 is wrong for Montana! We are especially proud of the many transgender youth who stood in their power and told their truths today. Let’s do right by these courageous souls and keep up momentum against SB 99. Read more below on what to do next!


Top action items!

  • Tell your Senator to say no to SB 99.

  • Tell your Senator to support SJ 6.

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On pastel background, text says: It's go time! Say no to SB 99. SB 99 attacks the rights of 
trans, nonbinary, and Two Spirit youth. Bans gender-affirming care
Bans social transitioning at school
Harms trans youth & families
Penalizes physicians, therapists, and teachers HEARING 8am on Friday, January 27

All hands on deck! The first anti-transgender bill of the 2023 Legislative Session has a hearing on Friday, and we need everyone to pitch in to reject SB 99. Click here to register to testify via Zoom. by 5pm TODAY.

Two medical care bans proposed by Sen. John Fuller (R-Kalispell) during the 2021 Legislative Session were rejected by Montanans, and SB 99 is even more extreme. Transgender and nonbinary youth are specifically targeted in this bill using misinformation from well-funded national anti-LGBTQ+ groups – not medical professionals who have been researching and providing gender-affirming care for years. Click here to read MHRN’s Transgender Healthcare Guide, which is full of accurate information on gender-affirming care. 


Please contact the Senate Judiciary Committee and your senator and tell them that you support full rights, freedoms, privacy, and opportunities for LGBTQ+ Montanans. SB 99 has a hearing in the Senate Judiciary Committee at 8 am on Friday, January 27, and you can testify in person or online!



Let’s join together to make sure Montana is a place where everyone knows their rights are protected no matter who they are or who they love.

Contact your legislator
  • Send your message using the online form. There’s a dropdown menu to select the Senate Judiciary Committee.

  • Call the Capitol switchboard at 406-444-4800.


Testify or watch

  • We want to have a HUGE turnout to Friday’s hearing, but if you can’t come to Helena, no problem. Click here to register to testify online via Zoom. The deadline to register is 5pm on Thursday, January 26.

  • For in-person testimony, please arrive early. The hearing is scheduled for room 303 in the Capitol, but that could change.


SB 99 talking points

It’s fine to keep your message simple, so don’t feel obligated to write long paragraphs.

If you were going to send one message to the Senate Judiciary Committee and your Senator, we would recommend something like this: “
SB 99 is an attempt by government officials to interfere in people’s personal lives. People have the right to make private medical decisions with their families and trusted healthcare providers without red tape or unnecessary restrictions.”

Please keep in mind that all submissions will be part of the official record, so exercise care when including personal or identifying information.

Under SB 99:

  • Transgender youth would be denied crucial healthcare.

  • Health care professionals would be fined for providing the standard of care for youth. 

  • Severe penalties for physicians, therapists, and school officials who support trans youth, even those who are questioning their gender without medical intervention.

  • Youth needing hormone therapy for any reason could be denied care.

  • Legislators would be determining health care access, not physicians.

  • Studies show that when transgender youth are able to access medically appropriate medical care, suicidality drops by 70%.

  • Makes healthcare access more difficult for any family seeking medical attention for their child who is intersex or has a birth defect.

  • Destroys physicians’ ability to adhere to best practices established by years of research and approved by reputable medical associations.

  • Normalizes misinformation about transgender, nonbinary, and Two Spirit people and their healthcare needs.

  • Makes life more difficult for youth and families who already experience bullying and discrimination.


Questions? Please email cherilyn@mhrn.org.
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We’re 14 days into the 2023 Legislative Session, and the fights for essential rights and freedoms are heating up! Your calls and emails matter! On Friday, we learned that Governor Gianforte has requested a whopping $2.6 million in taxpayer funding to fight lawsuits filed against bills that Christian nationalists and extremists are working to pass this session.

Bills that infringe on basic rights and freedoms, and the lawsuits undertaken to overturn them, are a waste of taxpayer funds. If we can encourage enough moderates to vote against unconstitutional bills like SB 154 and SB 99 (see below), we can not only protect essential rights but also avoid expensive lawsuits.

KEEP READING FOR ACTION ITEMS ON LGBTQ RIGHTS, INDIGENOUS SOVEREIGNTY AND REPRODUCTIVE FREEDOMS!

Here are the issues for MHRN for the session: 

  • LGBTQ+ rights

  • Indigenous sovereignty

  • Protecting democracy & dismantling extremism

  • Economic rights

  • Reproductive rights 

  Read More

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The second week of the 2023 Montana Legislative Session is over! Bills are just starting to roll in, so keep reading to find out what you can do to support LGBTQ+ rights and
reproductive rights. Here are the top issues for MHRN for the session:
 

  • LGBTQ+ rights

  • Indigenous sovereignty

  • Protecting democracy & dismantling extremism

  • Economic rights

  • Reproductive rights 

 

Write or call 2-3 times each week!

As the session ramps up, there will be a lot more bills and action items coming your way. We know that we can score some big wins if a few more people commit to sending 2 to 3 emails a week on the 2 to 3 bills they care about most. Our updates will help make this simple and manageable, so stay tuned!
 

You can also get involved by testifying in person or on Zoom or listening live to hearings and floor sessions. Whether you’re from Billings, Havre, Libby, the Blackfeet Nation, or Butte, you can raise your voice and take an active part in our democracy! 

 

How to contact your legislators 
We’re very lucky to have many legislators who are responsive to their constituents. Please feel free to reach out as often as you like to give them your perspective on bills. It’s easy to contact them by phone or email. Here are a few tips!

  • Look up your legislators here.

  • Call the very friendly Capitol operators at (406) 444-4800. Hours are 7:30 a.m. to 5 p.m. weekdays, and you can leave messages for up to 5 individual legislators or 1 legislative committee per call.

  • Send an email using contact information from the legislative roster or using the online email form. The email form is especially helpful when you’re emailing an entire committee.

  • Use our online action forms! When possible, we will provide an easy-to-use online form via a link to help you send a message on specific bills and actions.  



LGBTQ+ Rights 

Say NO to the Slate of Hate 

There are several anti-LGBTQ+ bill drafts that we’re watching closely this year. National LGBTQ+ groups are using these bills to spread misinformation and legislate LGBTQ people out of existence, deny access to critical services, and encourage bullying, harassment and discrimination.  

We’re calling these bills the Slate of Hate because they’re designed to incite fear, restrict access to healthcare, deny people the right to live as their authentic selves, and take away the freedom of expression. Here are the Slate of Hate bills of the week.
 

Say NO to SB 99  

In 2021, Senator (then Representative) John Fuller (RKalispell) sponsored two bills that would have cut off access to essential healthcare for transgender, nonbinary, and Two Spirit youth. Montanans said no to this kind of government interference, and both bills failed.  
 
SB 99 is even more extreme. This bill: 


  • Interferes with Montanans’ right to make private medical decisions with trusted healthcare professionals

  • Ignores reputable research and practices recommended by major medical professional organizations 

  • Restricts school officials from using the name and pronouns that a student has chosen

  • Suggests harsh penalties for health care providers who offer gender-affirming care 


SB 99 action
– This bill will have a hearing in the Senate Judiciary Committee soon. If you sent a message about this bill last week, feel free to send another one. Click here to say no to SB 99. 

Indigenous Sovereignty 

We’re celebrating victories this week! 
 

HB 18, which would establish a missing persons response team training program and grant fund, passed unanimously in the House! This bill will help search and rescue teams have a quicker response to missing persons reports, and we’re hoping this will help address Montana’s missing and murdered Indigenous people crisis. We’ll let you know when HB 18 is scheduled for a hearing with a Senate committee. 

LC 1964 appears to be dead! This is a draft joint resolution written by former businessman and Tea Party activist Mark Agather and sponsored by Senator Keith Regier (R–Kalispell) was a blatant attack on Indigenous sovereignty. Both Regier and Agather vocally opposed the Flathead Water Compact by disparaging treaty rights and Tribal sovereignty when the Compact was being negotiated and moving through the legislative process. After receiving backlash from Indigenous groups and nations plus non-Native residents, Regier stated that he would not pursue this draft resolution.  

Your emails and calls made a difference! We’ll keep an eye on this and let you know if anything changes.  
 

YES to HB 163
HB 163 will extend the Montana Department of Justice’s Missing Indigenous Persons Task Force through 2025. The bill is scheduled for a hearing in House Judiciary on Wednesday, January 18.
 

Action on HB 163 –  Please contact the House Judiciary committee members and tell them to support the bill. 

Reproductive Rights

NO on HB 213 

HB 213, sponsored by Rep. Braxton Mitchell (R-Columbia Falls), appears to require that a certificate of nonviable birth must be filed in addition to the fetal death certificate for any miscarriage in Montana. Similar laws in Florida and Iowa do not force parents to fill out this form.  
 
HB 213  is very vague. As written, it could create more trauma and invade the privacy of people who are already coping with pregnancy loss.  

Action on HB 213 – This bill has a hearing in House Judiciary at 8 am on Monday, January 16. Please tell the House Judiciary Committee to vote no on this bill.  

NO on SB 154 

SB 154 would chip away at the personal right to privacy by excluding abortion care. This defies the Montana Constitution and the Armstong decision, which specifically protects the right to abortion in our state.  

Action on SB 154 – Please tell the Senate Judiciary Committee to reject this unconstitutional bill and protect all aspects of privacy in Montana. 


 

 

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Today ends the first week of the 2023 Montana Legislative Session, and we would like to take a moment to remember how precious our democracy is. Two years ago, extremists attacked the U.S. Capitol and tried to overthrow free and fair elections using violence. Click here to read MHRN’s reflections on this day and our efforts to support communities so that violent extremism, militia groups, and anti-government ideology don’t gain a foothold in Montana.

Please keep reading for action alerts on LGBTQ+ rights and Indigenous sovereignty! 


Legislative updates – keep it simple!
 

Since the session just started, we don’t have too many updates for you. It’s a good time to make sure you have all of the information you need to contact legislators. 

In 2021, we had great participation from allies and supporters! This year, we know we can score some big wins if a few more people commit to sending 2 to 3 emails a week on the top 2 to 3 bills they care about most. To help you do this, keep an eye out for our updates, so you have the confidence to participate all session long.  

How to contact your legislators 
We’re very lucky to have many legislators who are responsive to their constituents. Please feel free to reach out as often as you like to give them your perspective on bills. It’s easy to contact them by phone or email. Here are a few tips!

  • Look up your legislators here.

  • Call the very friendly Capitol operators at (406) 444-4800. Hours are 7:30 a.m. to 5 p.m. weekdays, and you can leave messages for up to 5 individual legislators or 1 legislative committee per call.

  • Send an email using contact information from the legislative roster or using the online email form.

  • Use our online action forms! When possible, we will provide an easy-to-use online form via a link to help you send a message on specific bills and actions.  

 

Engage and participate 
MHRN is working hard to ensure that people from every crossroad in Montana have the information they need to participate in the 2023 Montana Legislative Session. You can also stay involved by testifying in person or on Zoom, or listening live to hearings and floor sessions. Whether you’re from Billings, Havre, Libby, the Blackfeet Nation, or Butte, you can raise your voice and take an active part in our democracy! 
 
Here are the bills and issues MHRN is prioritizing this year: 

  • LGBTQ+ rights

  • Indigenous sovereignty

  • Protecting democracy & dismantling extremism

  • Economic rights

  • Reproductive rights 



LGBTQ+ Rights 

Say NO to the Slate of Hate 

There are several anti-LGBTQ+ bill drafts that we’re watching closely this year. All are attempts to spread misinformation from anti-LGBTQ+ national groups in order to legislate LGBTQ people out of existence, deny access to critical services, and encourage bullying, harassment and discrimination.  

These bill drafts are designed to restrict access to healthcare, deny people the right to live as their authentic selves, and take away the freedom of expression. As we saw during the 2021 Legislative Session, anti-LGBTQ+ bills are an attempt to inject misinformation and confusion about LGBTQ+ rights into mainstream news, social media, and daily discourse. 
 
When bills fit the Slate of Hate category, we’ll let you know and tell you how you can speak out against them! 
 
We’re very encouraged by the conversations we’re having with legislators about the realities of being transgender and nonbinary people in Montana. We’re happy to see these big wins so early in the session! 
 

Say NO to SB 99  

In 2021, Senator (then Representative) John Fuller (RKalispell) sponsored two bills that would have cut off access to essential healthcare for transgender, nonbinary, and Two Spirit youth. Montanans said no to this kind of government interference, and both bills failed.  
 
SB 99 is even more extreme. This bill: 


  • Interferes with Montanans’ right to make private medical decisions with trusted healthcare professionals

  • Ignores reputable research and practices recommended by major medical professional organizations 

  • Restricts school officials from using the name and pronouns that a student has chosen

  • Suggests harsh penalties for health care providers who offer gender-affirming care 


SB 99 action
– This bill will have a hearing in the Senate Judiciary Committee soon. Click here to say no to SB 99. 


Office of Public Instruction speaker makes anti-transgender comments
 

Even before legislators were sworn in on the first day of the 2023 Legislative Session, Office of Public Instruction (OPI) Superintendent Elsie Arntzen hosted an event at the Capitol that featured several speakers who made negative comments about public schools. One made misleading comments about transgender students.  
 
MHRN is concerned that OPI may testify in favor of Slate of Hate bills based on inaccurate information and the extremist ideology of “parental rights,” which has been used to justify physical abuse and the withholding of educational opportunities for children. We’ll let you know when to take action.  

Indigenous Sovereignty 

 NO to LC 1964 

We are watching several bill drafts that would undermine the rights of Indigenous people in Montana. None have been scheduled for a hearing, but a draft joint resolution was filed by Senator Keith Regier (R – Kalispell) which calls for an investigation to end to the Indigenous reservation system based on hostile and unsubstantiated statements about Indigenous people, their lives, and treaty rights, which have been violated by state and federal governments for generations. 
 

Read more about the American Indian Caucus’ response to this proposal and Senator Shane Morigeau’s (D – Missoula) plan to expand the Indian Education for All requirement for state legislators. “This is why it’s so important to have basic civics in Montana,” said Morigeau. “If people actually understood history in Montana, they’d see that the reason they have these lands and have wealth today is from taking Indian land. They used treaties to gain wealth, and yet we still get people who feel they still don’t have enough. They always want more. It’s greed and entitlement.” 

LC 1964 actionClick here to send a message to Senator Regier, Senator Jason Ellsworth (President of the Senate), and Senator Steve Fitzpatrick (GOP Senate Majority Leader). 

YES to HB 18 

HB 18 would establish a missing persons response team training program and grant fund so search and rescue teams around the state could improve their skills to quickly locate people who have been reported missing. This could be especially helpful in addressing the crisis of missing and murdered and Indigenous people in Montana, since there are four times as many Indigenous people as non-Indigenous people on Montana’s missing person’s list.  
 
This bill passed the House Judiciary Committee unanimously. 
 
HB 18 action – Tell your House member to vote yes on this bill. Look up your legislators here 

 

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Two years ago, people across the world saw a mob incited by extremists attack the U.S. Capitol and attempt to violently overthrow free and fair elections. This violent insurrection was a painful and alarming reminder of the fragility of democracy and the dangers of unchecked extremism. 

 

MHRN has been following extremist groups and leaders for more than 30 years. We held our breath alongside everyone else as we watched the January 6 insurrection play out, but we were not surprised. This attack was a culmination of decades of organizing and practicing threatening tactics with the purpose of intimidating the rest of us from using our Constitutional rights.  

Extremism in action 
Stewart Rhodes, who has been convicted of seditious conspiracy for his actions on January 6, lived in Montana while he built the Oath Keepers militia and recruited followers. We knew he was trouble back in 2009 when he first popped up on the militia scene. Ever since he formed Oath Keepers, we’ve answered questions about the dangers posed by the group and explained how it was a current iteration of the militia groups we saw in the 1990s, which spawned terrorists like the Oklahoma City bomber. Unfortunately, Rhodes and Oath Keepers proved our concerns were correct.  

Just before the insurrection, we watched violent extremist Ammon Bundy leverage the fear and confusion of the COVID-19 pandemic to launch his anti-government group misleadingly named People’s Rights. We warned about Bundy’s dangerous behavior as he encouraged People’s Rights leaders in each state to disrupt health board and school board meetings or even protest outside officials’ homes. Months before the January 6 insurrection in 2021, Bundy organized supporters — some of them armed — to push past police and occupy the Idaho Capitol. Here in Montana, People’s Rights supporters made threatening statements about law enforcement officers in the Flathead Valley and stood outside the home of a local health official in Bozeman for days, disrupting the neighborhood and terrifying local children.

While Rhodes’ conviction puts the Oath Keepers in disarray, it’s important to remember that many rank-and-file followers won’t put aside the dangerous “political education” they received from the militia group. Instead, they will take many of those ideas with them as they find their next cause to manipulate and champion. Also, People’s Rights and other extremist groups continue their campaigns of misinformation and intimidation in Montana communities. Threats to our democracy still exist, and MHRN is here to help communities understand those threats, respond, and pull folks together to create resiliency against similar attacks in the future.   

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Transgender Healthcare 101:
Understanding Gender-Affirming Care in Montana

We are being flooded with well-financed and coordinated misinformation campaigns about the lives of transgender, nonbinary, and Two Spirit people. National anti-LGBTQ+ groups like the Alliance Defending Freedom are working overtime to spread inaccuracies, propaganda, and harmful stereotypes about trans people to sow division and fear. As they bullhorn their message to score political points, thoughtful people are absorbing those messages, and accurate information isn’t cutting through the noise.

This is an attempt to deliver clear, evidence-based information to people who want to learn more about transgender people’s lives and experiences. This is by no means a complete guide to every question people may have, but it addresses the major themes that keep appearing.

If you have questions about issues impacting trans, nonbinary, and Two Spirit people, please reach out to Shawn Reagor at shawn@mhrn.org who can direct you to an appropriate expert.

Definitions
(shared from GLAAD)


Transgender 

An adjective to describe people whose gender identity differs from the sex they were assigned at birth. People who are transgender may also use other terms, in addition to transgender, to describe their gender more specifically. Some of those terms are defined below. Use the term(s) the person uses to describe their gender. It is important to note that being transgender is not dependent upon physical appearance or medical procedures. A person can call themself transgender the moment they realize that their gender identity is different than the sex they were assigned at birth.

 

Nonbinary

An umbrella term used to describe someone whose gender identity falls outside of the traditional western binary; a gender identity that cannot be classified as exclusively male or female.

 

Two Spirit

A modern, pan-Native American term used by some Indigenous communities in the United States to describe queer and/or gender diverse people, replacing the inaccurate and often degrading phraseology imposed on gender-variant Indigenous peoples by white colonizers. Note that the term is not synonymous with western concepts like “transgender” or “queer”— it can mean many things depending on an individual’s culture or personal identity.

Facts about Transcare in Montana and the U.S.

1. Fact: Transgender people are confident about their gender identity and their decision to transition, and this decision is unwavering over time.


A study of 27,000 trans people published in 2021 in LGBT Health showed that almost 98% of trans people are happy with their transition. While 13% of trans people retransitioned at some point, only 2.4% of those people did so due to uncertainty about their gender identity. Of that 13% who retransitioned, 83% attributed their decision to factors like pressure from family, health care providers, bullying, or non-affirming environments. Concerns about vulnerability to violence and sexual assault were also cited as reasons for detransitioning. (Note: retransitioning involves affirming a cisgender identity after affirming a transgender identity.)



In July 2022, the medical journal Pediatrics published an article showing that most youth who identify as trans/non-binary do not change their identity. In 2018, an analysis assessed whether gender transition improves the mental well-being of transgender individuals. The analysis by the What We Know Project (WWKP), an initiative of Cornell University’s Center for the Study of Inequality, reviewed 56 studies regarding the impact on the menial wellbeing of transgender individuals. This analysis concluded that 93 percent of the studies found positive effects from gender transition, indicating “a robust international consensus in the peer-reviewed literature that gender transition, including medical treatments such as hormone therapy and surgeries, improves the overall well-being of transgender individuals.”

 

These findings clearly demonstrate that retransition and transition regret are not synonymous. Out of the small number of individuals who retransition, evidence suggests that retransition is largely forced upon them. These answers highlight the extreme barriers transgender people in the U.S. face. Overwhelmingly, trans folks have clarity in their gender identity and that gender identity is enduring over time.

 

Sources
Turban JL, Loo SS, Almazan AN, Keuroghlian AS. Factors Leading to “Detransition” Among Transgender and Gender Diverse People in the United States: A Mixed-Methods Analysis. LGBT Health. 2021 May-Jun;8(4):273-280. doi:10.1089/lgbt.2020.0437. Epub 2021 Mar 31. PMID: 33794108; PMCID: PMC8213007.

 

 Kristina R. Olson, PhD; Lily Durwood, PhD; Rachel Horton, BS; Natalie M. Gallagher, PhD; Aaron Devor PhD. Gender Identity 5 Years After Social Transition

 

Bustos, Valeria P. MD; Bustos, Samyd S. MD; Mascaro, Andres MD; Del Corral, Gabriel MD, FACS; Forte, Antonio J. MD, PhD, MS; Ciudad, Pedro MD, PhD; Kim, Esther A. MD; Langstein, Howard N. MD; Manrique, Oscar J. MD, FACS. Regret after Gender-affirmation Surgery: A Systematic Review and Meta-analysis of Prevalence
 

Cornell University’s Center for the Study of Inequality; What We Know Project. What does the scholarly research say about the effect of gender transition on transgender well-being?


2. Fact: Transgender youth know who they are and maintain their identity through the teen years into adulthood. 

 

A recent study of transgender teenagers from the Netherlands showed that 98% of teens who chose to take puberty blockers to prevent the onset of the wrong puberty continued hormone treatment as adults. Puberty suppression allows a teen to experience life without developing irreversible characteristics like wide shoulders, a deep voice, hips, breasts, and other secondary sex characteristics. 

 

Anti-trans operatives claim that “fickle” teens cannot be trusted to make permanent decisions about their gender identity. However, here is good evidence that being trans, like being gay, is an innate and enduring characteristic. The Endocrine Society, which tends to be quite conservative, is very clear on this subject. Gender identity is a matter of biology, not anatomy, and as such, it is enduring.

 

Gender identity was once considered malleable and subject to external influences. Today, we have a much better understanding of gender identity and this attitude is no longer considered valid.  Understanding of gender identity has followed the evolution of our understanding of what it means to be gay. Medical professionals now understand that sexual orientation is innate, it is not chosen. There is considerable scientific evidence demonstrating a durable biological element underlying gender identity, such as a genetic basis, a basis in hormonal influences in the prenatal period and beyond, as well as a difference in brain structures. For instance, studies show:

  • The complete ineffectiveness of conversion therapy, which is actually shown to harm the mental and physical health of teens who are understanding their identity

  • Identical twins (who share the exact same genetic background) are more likely to both experience transgender identity as compared to fraternal (non-identical) twins

  • Female (XX) babies who were exposed to male hormones in utero are more likely to identify as transmale

  • Male (XY)-chromosome individuals with who have a medical condition that makes them insensitive to male hormone typically have female gender identity

  • Certain brain scan or staining patterns are associated with gender identity rather than external genitalia or chromosomes.

 


Sources
Maria Anna Theodora Catharina van der Loos, MD, Sabine Elisabeth Hannema, PhD, Daniel Tatting Klink, PhD, Prof Martin den Heijer, PhD, Chantal Maria Wiepjes, PhD. Continuation of gender-affirming hormones in transgender people starting puberty suppression in adolescence: a cohort study in the Netherlands. The Lancet. VOLUME 6, ISSUE 12, P869-875, December 01, 2022.

 

Saraswat A, Weinand JD, Safer JD. Evidence supporting the biologic nature of gender identity. Endocr Pract. Feb 2015;21(2):199-204. doi:10.4158/ep14351.ra 


Rosenthal SM. Approach to the patient: transgender youth: endocrine considerations.J Clin Endocrinol Metab. Dec 2014;99(12):4379-89. doi:10.1210/jc.2014-1919


Heylens G, De Cuypere G, Zucker KJ, et al. Gender identity disorder in twins: a review of the case report literature. J Sex Med. Mar 2012;9(3):751-7. doi:10.1111/j.1743-6109.2011.02567.x


Dessens AB, Slijper FM, Drop SL. Gender dysphoria and gender change in chromosomal females with congenital adrenal hyperplasia. Arch Sex Behav Aug 2005;34(4):389-97. doi:10.1007/s10508-005-4338-5

3. Fact: In Montana, accessing health care is difficult, and accessing gender affirming care is even harder. 


Throughout Montana, access to healthcare is a common problem.  For those who are seeking gender affirming care, access is even more difficult.  For example, in the Flathead Valley there are very few providers who offer trans healthcare. Difficulty accessing medical care of any kind is not unique to the Flathead or Montana, and trans care providers are scarce in nearly all non-urban centers around the country.

This lack of providers is compounded by the myriad of barriers families face getting healthcare in general (cost, lack of insurance coverage, transportation, time off work for parents). Youth and their families also face tremendous social and emotional barriers when they come out come out as transgender.

From the medical standpoint, medical and mental health professionals follow national and international guidelines that lay out careful, methodical steps for identifying and caring for transgender and gender diverse people. They follow guidelines and standards of care from WPATH (World Professional Association of Transgender Health) and the Endocrine Society.

There are stringent standards of care, especially for youth.The standard of care for trans youth involves a multidisciplinary team that includes mental health professionals, primary care, and sometimes in the case of youth who have started puberty, pediatric endocrinologists. With transgender youth, no medication is used prior to puberty. 

When medical treatment is considered, parents are always involved and parental consent is required. Mental health professionals and medical professionals provide careful assessments before initiating any treatment.  Diagnoses are based on the systemic evaluation of signs of transgender or gender diverse identity that are persistent, consistent, and insistent, often starting in childhood, and often increasing as the trans adolescent approaches puberty.

Being a teenager is all about identity exploration. In today’s growing acceptance and visibility of trans people, and increased access to information, more youth have the language to understand what they are feeling, and they are coming forward as gender diverse.  That does not mean that all of them will continue to think of themselves as trans or nonbinary over time.  And it certainly does not mean that they all need hormone therapy.

This is where careful assessment by a team of mental health and medical health professionals is important. There is a difference between a teen that is thoughtfully questioning their identities and one that has had persistent and insistent transgender or gender diverse identity questions over sustained periods of time. Each child deserves to be listened to carefully and to have care tailored to their individual needs.

 

Sources
Nolan IT, Kuhner CJ, Dy GW. Demographic and temporal trends in transgender identities and gender confirming surgery. Transl Androl Urol. 2019 Jun;8(3):184-190. doi: 10.21037/tau.2019.04.09. PMID: 31380225; PMCID: PMC6626314.

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). American Psychiatric Association. 2022

American Academy of Pediatrics policy statement, October 1, 2018. Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents

Endocrine Society. Position Statement on Transgender Health 2022

American Psychiatric Association 2022.  A Guide to Working with Transgender and Gender Non Conforming Patients

American Psychiatric Association. What is Gender Dysphoria? 

4. When youth do not have access to healthcare that supports their gender identity, the outcomes are devastating. 


Critics paint a very misleading picture of easy access to sympathetic health care providers and medication. The truth is that most trans youth face multiple barriers to basic checkups, let alone gender affirming care. What we know very clearly is that NOT providing gender-affirming care is dangerous. Due to the intense bullying and shaming that transgender adolescents and adults receive, they have much higher rates of depression, anxiety, eating disorders, self-harm, and suicide than cisgender youth.

Fear of rejection and feelings of not fitting in take a huge toll on mental health and wellbeing. Suicidal ideation is twice as high for transgender and gender diverse youth than cis gender kids, and suicide attempts are 3 times as high. Fortunately, research confirms that when children have access to competent care and affirmation, their risk of depression, anxiety and other negative mental health outcomes are on par with their cisgender peers.

In March of 2021, 7 million youth-serving professionals from more than 1000 child welfare organizations released an open letter calling for lawmakers in states across the country to oppose dozens of bills that targeted LGBTQ people, and transgender children in particular.

They called on legislators to oppose bills that:

  • Ban or limit access to medically-necessary, gender affirming care

  • Forbid students from using the restroom at school consistent with their gender identity, and

  • >Prevent transgender youth from playing sports alongside their peers, because those measures are known to harm transgender youth.


For many transgender youth and adults, gender affirming care is not only medically necessary, but can also be life-saving.

Sources
Human Rights Campaign, March 2021. Major Health, Education, and Child Welfare Organizations Oppose Anti-LGBTQ State-Based Legislation

Olson, K. R., Durwood, L., DeMeules, M., & McLaughlin, K. A. (2016). Mental health of transgender children who are supported in their identities. Pediatrics, 137(3).

Turban, J. L., King, D., Carswell, J. M., & Keuroghlian, A. S. (2020). Pubertal suppression for transgender youth and risk of suicidal ideation. Pediatrics, 145(2).

Green, A. E., DeChants, J. P., Price, M. N., & Davis, C. K. (2022). Association of gender-affirming hormone therapy with depression, thoughts of suicide, and attempted suicide among transgender and nonbinary youth. Journal of Adolescent Health, 70(4), 643-649

5. Fact: Gender affirming care with hormones is slow and allows for pauses, adjustments, and reconsiderations as children mature emotionally.

 

Most physical changes that occur with gender-affirming hormones are reversible once hormones are stopped. While the vast majority of changes, especially those associated with delaying the onset of puberty such as “puberty blockers” are reversible, there are some changes associated with hormone therapy that may be permanent. 

 

Medical care experts take gender affirming care very seriously and every stage of medical treatment is done with informed consent.  A central tenent of transgender care is that patients and families have time and support over multiple checkups to thoroughly discuss the risks, benefits and alternatives to hormone therapy with their health care provider. Those seeking hormone therapy for themselves or their child are educated on which physical changes are permanent and which are reversible, should they stop hormone therapy.

 

Many transgender people do not seek medical intervention. For those who do, the process is long and cautious, allowing medical providers to evaluate incremental progress. Frequent checkups are required, and medical professionals ask questions at every stage in the process so they can adjust medication or treatment at any time.

 

Like any medical intervention, there is a cost benefit analysis to gender affirming care. That said, when an intervention (based on evidence) is known to be beneficial and withholding intervention (based on evidence) is known to be harmful, the practice is considered ethical and medically necessary. An analogy might be the use of insulin, which can be fatal, but is life saving for diabetics.  Or antibiotics, which carry the risk of anaphylactic shock and death, but are routinely used to treat infection and save lives.  Hormone treatment carries risks, but for those whom doctors and specialists determine it is an appropriate treatment, it is akin to any other medically necessary treatment. 

 

It is important to remember that there are youth and adults who receive hormone therapy and puberty blockers for reasons other than gender-affirming care.

6. Fact: As a rule, gender-affirming surgery is only available for people 18 years old and older. 


It is important to note that not every transgender person wants surgery. Every person’s transition path is unique, and for most, surgery is not part of the picture.

Except in very rare instances of top surgery, Montana’s youth are not getting reconstructive surgery. One of the requirements for surgery established by the WPATH standards of care is age of majority, which is 18 years old. 

Among adults, research published in JAMA Surgery in 2021 finds gender-affirming surgery is associated with improved mental health outcomes among transgender people. However, most transgender adults do not get surgery of any kind due to barriers associated with costs and a lack of available care providers. Gender affirming surgery is expensive and there are very few surgeons who practice gender affirming care.  In fact, there are no surgeons in Montana who perform bottom surgery. There are only a few surgeons in the entire U.S. who provide reconstructive bottom surgery. Even if more surgeons were available, surgery is often inaccessible to those who would choose it based on cost and lack of insurance coverage. 

Based on National Institute of Health Data, about 25% of transmen and women get top surgery which is less expensive and offered by more surgeons than bottom surgery. Only 5-13% of trans women have bottom surgery and fewer than 5% of trans men have bottom surgery.

In Montana, chest masculinization surgery is available for adults 18 and older after consultation, but most people are not able to access that care due to cost and loss of income during the recovery time. In Montana, this surgery has been performed on older teens in rare circumstances when the youth’s parents and a team of healthcare and mental health professionals determine it is the best course of action.

Transgender people who want bottom surgery must travel out of state because there are no surgeons in Montana who offer it. As a result, banning surgery for transgender minors within Montana is unnecessary, because it is exceptionally rare and could end up delaying or restricting care for children who need surgery for reasons beyond gender care, such as reconstructive or other corrective surgery. Nuanced and complicated decisions regarding surgery are best left to families and trained medical professionals who are using scientific evidence to inform their recommendations. 

Sources
World Professional Association for Transgender Health. (2012).
Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People [7th Version]. 

James, S., Herman, J., Rankin, S., Keisling, M., Mottet, L., & Anafi, M. A. (2016). The Report of The 2015 US Transgender Survey. Accessed November 7, 2020.

Anthony N. Almazan, BA, Alex S. Keuroghlian, MD, MPH. Association Between Gender-Affirming Surgeries and Mental Health Outcomes. JAMA Surg. 2021;156(7):611-618. doi:10.1001/jamasurg.2021.0952. 

 

 


The Montana Human Rights Network
PO Box 1509, Helena, MT 59624
(406) 442-5506
network@mhrn.org

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The Daily Inter Lake and John Fuller have done it again. As LGBTQ+ Montanans are experiencing legitimate fear and trauma after the shootings at Club Q in Colorado Springs, the Inter Lake and Representative Fuller have repeated harmful misinformation about LGBTQ+ people that enables verbal and physical violence and discrimination against our LGBTQ+ neighbors, friends, and relatives.  
 
In 2018, the Inter Lake published a guest editorial that criticized a support group for LGBTQ+ teens. That piece was full of character attacks and cruel stereotypes, and local residents responded by telling the Inter Lake that gross misrepresentations of LGBTQ+ teens and adults had no place in our valley.  
 
During the 2021 Montana Legislative Session, Fuller sponsored three bills designed to remove the rights of transgender youth to access medical care and participate in school sports. He used every stage of the legislative process as an opportunity to amplify misleading information meant to reinforce negative perceptions about LGBTQ+ people, and especially transgender people. MHRN knows that this misinformation comes directly from well-funded national groups that are promoting a slate of hate bills that target transgender youth and adults. 

Let’s be clear: Rep. Fuller’s actions are not designed to protect anyone. Since the passage of his misleadingly named “Save Women’s Sports” bill in 2021, he has shown no interest in taking actions that would truly support women’s sports, like advocating for funding or scholarships that close gaps in access to sports and athletics. Rep. Fuller’s actions exemplify the type of blatant lies and rhetoric that encourages violence against the LGBTQ community. 
 
 

While Rep. Fuller is free to have his completely unfounded opinions about transgender people, the Inter Lake and other media companies are not required to repeat slurs, false characterizations, and calculated cruelty that leads to very real harm toward our LGBTQ+ friends and neighbors. Transgender people belong in Montana; Rep. Fuller’s hateful rhetoric does not.


Please take time today to tell your local elected officials that you support equality for LGBTQ+ people in our valley and our state.  Click here to send an email to tell Fuller
that you support LGBTQ+ rights and Montanans. 

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We have received some questions asking if we expect to see voter suppression or intimidation tactics from armed militia members similar to what has been happening in Arizona. While it’s possible that radicalized individuals or groups could stage a presence at polling places, we’re not seeing a coordinated effort or major reason for concern at this time. Of course, anything is possible and, if you encounter such activity, please contact MHRN and call the Voter Protection Hotline at 406-888-VOTE (8683) with any voting-related irregularities you see or hear about.

Unfortunately, Montana is likely to see disruptions after ballots have been cast and while ballots are being counted. Missoula has been targeted by “election security” conspiracy theorists since the 2020 election, and MHRN knows of another group in Carbon County that has been trying to find errors in the voter file.

Another potential problem could come from so-called “constitutional sheriffs” in Montana. The national organization Protect America Now has been pushing for sheriffs to challenge legitimate elections under the guise of protecting “election integrity.” Depending on how some contested races go, right-wing extremists might lean on their local sheriffs to intervene. This fact sheet is a good overview about sheriffs and elections. “Constitutional sheriffs” don’t have the authority to determine elections, but that never seems to stop them from responding with misinformation and intimidation tactics.

MHRN will keep an eye on the situation and provide updates if needed.
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Raging Against the Rainbow: Extremism in Montana Series

A coordinated national attack on basic rights for transgender people started in Montana during the 2021 Montana Legislature and has filtered down to local libraries, schools, and businesses.

Attend this webinar featuring our own staff experts and find out what’s happening, who’s involved, and what you can do to make sure that the rights of transgender, nonbinary, and Two Spirit Montanans are protected. We’ll give you some insider information on recent incidents in Montana, too.

Get more information and register for the webinar here.


Montana Gender Alliance Campout

September 16-18, 2022 at Hauser Lake

The Montana Gender Alliance had so much fun camping together in June (even with the rain), so we’re doing it again!

This time we’re trying out a new group campsite on Hauser Lake which is located near Helena. Mark your calendars for September 16-18, we hope to see you there!

This event is intended for trans, nonbinary, Two Spirit, and gender diverse folks and their families.

Please email Shawn@mhrn.org for a registration form and more information.


Title IX Comments

The U.S. Education Department is suggesting a rule change that would amend Title IX’s nondiscrimination mandate, which could help LGBTQ+ students in public schools.

The public comment period is open! Please leave a message supporting this rule change. Click here for more information and talking points.
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