Fair Wisconsin’s Testimony in Opposition to SB 405

Good morning to the members of the Senate Committee on Health. I am Abigail Swetz, my

pronouns are she/her, and I am the executive director of Fair Wisconsin, Wisconsin’s only

statewide LGBTQ+ civil rights and political advocacy organization. I am here to speak in

opposition to SB 405.

I am queer, and a leader in the LGBTQ+ community, but as a cisgender person, I have never

transitioned, and I have never detransitioned. At the same time, I do not need to understand

every detail and nuance of someone’s identity in order to believe them when they say they know

who they are and that they know what they need. I know trans kids deserve the freedom to be

themselves and receive the medical care they need. In fact, we should all be free from

politicians using our identities and our medical care to score political points.

 

I have prepared testimony, and it will be distributed to you, along with thousands of pages of

written testimony from Wisconsinites across our state who were not able to make it in-person

today. I hope you read it all because it explains the importance of this care and the need for its

continued access – and for a bill that claims to not be an attempt to ban this care, the way it’s

been referred to as “so-called care” and the fact that the medical provider who testified in

support of it says he would never provide it because he does not believe in it, it sure seems to

me that this bill is an attempt to ban the medically necessary care trans youth need just under a

different bill number.

 

I’m an educator who knows the value of research, investigation, and listening to the experts, but

I’m not a researcher myself. That is why I look to the scientists and professional associations

that do rigorous research. And that is why I’m going to spend my time using that research to

address the lies that have been presented as fact in this bill and in testimony from people before

me during today’s hearing.

There is the false claim that there has been a ”rapid” increase in gender dysphoria diagnoses

that is somehow explained as having been motivated by profit. In reality, as society has become

generally more accepting of gender diversity and the visibility of transgender people has

increased, we have seen this support mean that more transgender people are able to live

publicly as their authentic selves. That’s something to be celebrated, not weaponized.

Youth do not make these decisions about pursuing care alone – adolescents cannot and do not

access gender-affirming care without the involvement of and consent of parents/guardians, and

these decisions also involve skilled medical and behavioral health practitioners.

 

There is the false claim that these medications are dangerous and irreversible. First of all,

before puberty, there are no medical interventions for trans youth. The primary forms of support

for trans youth before puberty are purely social affirmation, such as using a different name,

changing hairstyles, dressing differently, and using different pronouns. At puberty, puberty

pausing medication can be a part of gender-affirming care. The medications provided to trans

adolescents are the same as those provided to adolescents who are not transgender without issue.

 

In fact, cisgender youth are often given access to this care at younger ages than trans

adolescents. Puberty pause medications are reversible. If stopped, puberty starts.

There is the false claim that these treatments are not effective. Gender-affirming care is safe

and effective The provision of this care to trans adolescents is guided by rigorous and

evidence-based standards of care, and provided by trained medical professionals prescribing

this care. Gender-affirming care is life-saving and medically necessary. Evidence shows this

care improves the mental health of trans youth; this care significantly reduces rates of anxiety,

suicidality, depression, and dysphoria that trans youth experience.

There is the false claim that these treatments are experimental. The field of pediatric

gender-affirming care has existed for well over 4 decades and has continued to be found safe

and effective for trans adolescents. This care has been and continues to be thoroughly studied.

The potential for adverse effects is very low and meets the FDA definition of a “safe” treatment.

Youth gender-affirming care is supported by broad medical consensus; the necessity and

benefits of this healthcare have the support of every legitimate professional association,

including the American Medical Association, the American Academy of Pediatrics, the American

Psychological Association, and the Endocrine Society. This care is evidence-based, life-saving,

and medically necessary. As I already said, evidence shows that gender-affirming care improves

the mental health of trans youth and significantly reduces the disproportionate rates of anxiety,

suicidality, depression, and distress trans youth experience. Again, this care is provided with

rigorously developed standards of care and under the expert guidance of trained clinicians.

I would like to also address the “notice” section of this bill, starting with the medical issues it has

due to disinformation it includes. I will take these point by point, and can follow-up with any

requests for citations. Concerning claims that social transitioning and initial medical treatment

“increases the likelihood that a child’s discordance would worsen.” In fact, by the time

adolescents seek care, it is after considerable reflection on their identity and consultation and

considerable reflection on potential forms of gender-affirming care.

 

Concerning the use of reports from the UK, Sweden, Finland, it is important to know that the UK

report, which is commonly referred to as the Cass Review, was not a rigorous or objective

review. It had too many methodological flaws, too many unsubstantiated conclusions, too many

unnamed authors, and too many contributors (of those we know of!) with biases against

transgender people. Even with these flaws, the UK report does not, in fact, recommend a

complete ban on gender-affirming care, despite what American politicians may claim. In fact,

there are other European and American reports – from France, Germany, Australia, Poland, and

even Utah – that are far more reputable and fully support the provision of this care.

 

Concerning the claim about death by suicide, I recognize that it is incredibly difficult to assess a

single reason that an individual takes their own life, and I know it is at least possible that suicide

completion based on gender dysphoria is low. It is also absolutely verifiable from surveys –

some of which were administered by our own federal and state and local governments – that

suicidal ideation, a child considering taking their own life, does increase when someone is

experiencing gender dysphoria. It is also true that suicidal thinking increases significantly when

met with rejection, or when met with harmful conversion practices. I would maintain, and I think

that we can all agree with this, that having a young person even contemplate leaving this life by

their own hand is tragic and we should do everything in our power to prevent that situation.

On a personal note, again, I understand that it is difficult to study the reason someone takes

their own life, and that people may feel it is reasonable to assert that there is not a higher rate of

death by suicide and that maybe the risk of suicide is not a reason to ensure access to medical

care for trans youth. But to those people, I want you to hear this: I have been to the funeral of a

young trans person who took his own life. You can claim gender dysphoria does not have

anything to do with suicide, and you can even put that statement in a bill and force doctors to

say it out loud. But you cannot change the fact that that funeral home’s lobby floor was covered

with backpacks because the mourners were all his classmates who had walked over when the

school bell had rung. Their experiences matter, too.

 

Concerning the claim about puberty blockers, puberty pause medication is approved for

pediatric use for precocious puberty (when a child begins puberty at a very young age). This

medication is used for the same population (minors) and for the same purpose (to pause

puberty development), and often at a far younger age than young people accessing them for

gender dysphoria, and with a lot less scrutiny.

 

Concerning off-label prescribing, this is very, very common in pediatric medical practice.

Off-label use is not cause for alarm, and this is another example of why leaving the provision of

medicine to medical providers instead of politicians is best practice.

 

Concerning the claims made about hormones, as the Utah report shows (and I have it here – I

will turn in all 1,000 pages of it so it can be a part of this bill record), the volume and quality of

evidence associated with gender-affirming care treatments likely actually exceeds what is typical

of many new pediatric uses of drugs approved by the FDA. In the Utah report, hormone

treatments were found to be safe. The average patient’s values remain within normal ranges for:

bone density, cardiovascular risk factors, metabolic changes, and cancer. This includes

long-term effects; no evidence of serious long-term adverse outcomes that would outweigh the

documented benefits to mental health and gender dysphoria.

 

Those were all just the issues with the “notice” in medical terms, but I also need to address its

legal issues as well. There is language that is essentially the same as what you find in this bill in

a Florida policy, and a federal judge said this when issuing an order in the Doe v Surgeon

General of Florida case, an order that maintained that the Florida ban on youth gender-affirming

care is unconstitutional: “The forms are untrue and misleading in substantial respects, omit any

discussion of benefits, address not only risks of treatments a patient will receive but also of

treatments the patient will not receive, include incomprehensible provisions no patient could be

expected to understand, and are plainly intended to dissuade patients from obtaining

gender-affirming care, not to ensure that patients are fully informed of the relevant risks and

benefits.

 

” There were also concerns raised about compelled speech when the judge noted “theobvious First Amendment issue inherent in compelling physicians to speak words they do not

believe” This case is still currently in litigation.

 

In addition to all of this, the fact is that Wisconsin already has a medical malpractice law, and

malpractice statutes have already determined when and how much patients can recover in

those situations. That law already includes a special provision to extend the time to bring a

lawsuit when the patient is a child. We do not need a new law here.

 

I am immeasurably lucky to have incredible trans people in my life, many of whom I have known

since they were children. It is difficult to see this legislature perpetually putting them in a position

of having to defend their own existence, the validity of their own identities, the necessity of their

own health care, and the value of their own lives. It is incredibly important that we listen to trans

people when we’re talking about their medically necessary health care. It is also incredibly

important that we stop debating their humanity, and that we stop using anyone’s individual

experience to score political points.

 

Gender-affirming care for transgender youth is medically necessary care, just like the kids who

receive it – and all kids – are necessary. It is age-appropriate, just as it is appropriate to believe

someone at any age when they tell you they know who they are and how they want to live, a

perspective backed by rigorous scientific evidence. It is individualized, just like the young people

who receive it are, themselves, unique individuals. And it is high-quality, just like the bright future

this state has ahead of us when all our children thrive. Young people and their families deserve

to know it is within their power to continue to access this medically necessary care without

anyone else – especially politicians – injecting themselves into their medical decisions.

 

The reality is this: we must protect access to youth gender-affirming care because this medically

necessary health care makes it possible for trans kids to grow into awesome adults. You’re

meeting some of them today, too – although I actually hope they are not here to hear that

language other people in this hearing are using about them. Wisconsin is a better, richer, more

beautiful place thanks to these amazing kids, and the least we can do is ensure they can grow

into thriving adults who will enrich our state. We should all be so lucky for them to continue to

call Wisconsin home.