Dozens of transgender Nebraskans, LGBTQ+ rights advocates, parents of trans youths, medical professionals, religious leaders and concerned residents at large lodged opposition to the state's proposed gender-affirming care restrictions for minors at a 12-hour public hearing at the Lancaster Event Center on Tuesday.
Nebraska Chief Medical Officer Timothy Tesmer after the state’s Legislature in May voted 33-15 to pass LB574, further restricting access to abortion in the state, banning gender-affirming surgeries for minors and turning the power to regulate the use of puberty blockers and hormone therapy in youth patients over to Tesmer.
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The — which aren’t yet state law but closely mirror the temporary regulations that took effect Oct. 1 and can remain in place for up to 90 days — require that patients under 19 undergo at least 40 hours of therapy and wait another seven days after having their prescription approved before receiving any puberty blocking or hormone medication.
Patients also must have lived six consecutive months as their preferred gender before being eligible for a prescription and, if the medication comes through an injection, the proposed regulations call for it to be administered by a credentialed professional in the prescribed practitioner's office or by the patient's primary care provider.
The regulations also require prescriptions for hormones or puberty blockers to “identify the drugs being prescribed are for the treatment of gender nonconformity or gender dysphoria,†among other rules laid out in Tesmer’s six-page proposal.
Those restrictions — and the Legislature's targeting of trans youths at large — came under fire at Tuesday’s marathon hearing, where more than 60 people lined up to oppose the regulations, largely casting them as overly burdensome on trans youths and their families, arbitrary, countered to best practice and potentially dangerous for children in dire need of gender-affirming care.
“I want my child to live and grow,†said Tobi White, a pastor at a Lutheran church in Lincoln and the mother of a trans child, who took aim at the “Let Them Grow Act,†the legislation that prompted Tesmer’s regulations and Tuesday’s hearing.
“I want them to live freely without government officials telling them who they are, what bathroom to use, which doctors they can see, what care they can receive. I want my child to live, rather than hide in shame in a body that is not theirs. You say, ‘Let them grow.’ I say, ‘Gender-affirming care is lifesaving care.’â€
From 7 a.m. to 7 p.m. Tuesday, White and others filed into the Lancaster Event Center to give at times tearful testimony to Tesmer, an ear, nose and throat doctor who could alter the regulations — or not — prior to sending them onto the State Board of Health for review before the Nebraska Department of Health and Human Services formally adopts the regulations.
But Tesmer — who is required to review and evaluate all public comments on the regulations — didn’t attend Tuesday’s hearing. An HHS spokesman said Tesmer was undergoing a previously scheduled surgery and will review all comments, which were recorded and accepted in writing, at a later date. He could decide whether to amend the regulations or adopt them as is by the end of December, the spokesman said.
A vast majority of those who did speak at Tuesday’s hearing — 74 of 77 testifiers who took the mic — showed up to oppose Tesmer’s drafted regulations, taking particular issue with the requirement that trans youths undergo at least 40 hours of therapy before being prescribed hormones or puberty blockers.
Even if patients undergo an hour of therapy each week — which testifiers said was unrealistic given that counselors generally don’t offer full hourlong sessions and because the state is already facing a shortage of mental health care professionals with availability — that requirement could delay treatment by up to 10 months.
And, advocates said, the out-of-pocket cost for such treatment could run north of $6,000 or more.
Dr. Alex Dworak, an Omaha-based family medicine physician, was among dozens of speakers who called on HHS to toss the 40-hour requirement, which he said is not “a national practice standard (of care), nor is it supported by the medical literature.â€
A 12-year-old trans boy who testified later offered a starker view of that requirement:
“We will probably kill ourselves before we receive care,†he said, adding: “These regulations will kill us.â€
Dworak, like others, also took issue with the requirement that all therapeutic hours be “clinically objective and non-biased†— a requirement that he said is unnecessary and disrespectful to the state’s practicing medical professionals.
“All proper and good-faith care is clinically neutral,†he said.
Jacob Lozier, a Lincoln-based therapist and a member of the LGBTQ+ community who spoke Tuesday on behalf of himself and his employer, Kindred Psychology, said the 40-hour requirement “just isn’t how it works†and the neutrality clause “raises more questions than it can answer.â€
“It’s problematic for the state to intervene in evidence-based treatments, which are sought about by individuals and offered by specifically, specially trained medical providers,†he said, pleading with hearing officers, in lieu of Tesmer, not to overstep agreed-upon professional standards.
Under the proposed regulations, patients who do have a prescription approved have to wait an additional week before receiving any puberty-blocking or hormone medication — a shorter timeline relative to the therapy requirements but one that nonetheless drew the ire of speakers at Tuesday’s hearing.
“I can find no other example in Nebraska state law where drugs have a waiting period,†said Robert Way, a Lincoln man who cast that final barrier as one that Tesmer offered “out of nowhere†and without justification.
Advocates, too, raised concerns about what the 40-hour therapy requirement and in-person hormone or blocker injections could mean for trans youths who live in rural parts of the state, where such care is harder to access than in Lincoln and Omaha, the state’s two largest cities.
Groups including OutNebraska, the ACLU of Nebraska, the Women's Fund of Omaha and Nebraska Appleseed also sent representatives to oppose Tesmer’s regulations, which no one explicitly supported at Tuesday’ hearing.
Three speakers — including Caroline Epp, Marilyn Asher of the conservative political group Nebraskans For Founders’ Values, and State Board of Education Member Sherry Jones — spoke out in opposition against trans youths at large but did not specifically weigh in on the proposed regulations.
Asher compared gender-affirming care such as hormone therapy to inmates getting face tattoos in prison, indicating that transitioning is a decision that youth would later come to regret. Epp, meanwhile, compared allowing trans youths to seek gender-affirming care to letting a young child drive a car before extending the analogy to an airplane.
“Bringing puberty blockers into all this — letting kids decide — is like allowing an untrained passenger to take over the jet,†she said.
But most opponents of gender-affirming care for minors stayed home Tuesday, including Omaha Sen. Kathleen Kauth, who championed the bill that led to Tuesday’s hearing, and Sen. Ben Hansen of Blair, the chair of the Legislature’s Health and Human Services Committee who offered the amendment that combined Kauth’s bill with one that restricted abortion access.
Their absence — along with Tesmer’s — came as a disappointment to Omaha Sen. Machaela Cavanaugh, who led opposition to LB574 in the Legislature last session and who spent several hours at Tuesday’s hearing.
“He should be here,†Cavanaugh said of Tesmer. “And Kathleen Kauth should be here. And Ben Hansen should be here, to listen to the people who are impacted by the legislation and the rules and regulations that they have collectively put forward and how they are impacting Nebraskans’ lives. They should all three be here.â€
Kauth, in an email, said “the legislative part of this bill is done.â€
“Now it sits in the executive branch to be enacted,†she wrote. “This is all part of the well-established administrative process.â€
Reached by phone, Hansen, a chiropractor, said he missed Tuesday’s hearing for work but sent staff members to the hearing. He said he plans to review written testimony, too, adding that he was “glad people showed up and had their voices heard.â€
But it’s not the first time they have shown up, Cavanaugh said.
They crowded hearing rooms at the state Capitol during the 90-day session earlier this year, she said. They tracked down their representatives in their offices or in the Rotunda and pleaded with them not to advance the legislation that led to Tuesday’s hearing.
“These people called their senators and sent letters and begged and pleaded to be listened to,†she said. “And they never were."