As Nebraska's new law restricting gender-affirming care for minors goes into effect this weekend, families with transgender children and the doctors who treat them are steeling themselves for change. But exactly what and how much change is anyone’s guess.
A key aspect of the law is a set of treatment guidelines that has yet to be created. Affected families, doctors and even lawmakers say they have largely gotten no response from health officials on when they can expect the new rules, which should lay out how and when transgender minors can be treated with puberty blockers and hormones.
Many of them fear Republican officials and their appointees in charge of administering the rules are slow-walking the regulations as a way to block treatment for new transgender patients under 19, the age of adulthood under Nebraska law.
“There has been no communication,” said 42-year-old Lincoln resident Heather Rhea, who has a 17-year-old transgender daughter. “There's been no press release. There's nothing on the website about where they are in the process or a timeline for when we'll know when kids can get gender-affirming care."
“I know several, several people who've reached out for information and gotten zero response,” she said.
The new law, which goes into effect Sunday, bans gender-affirming surgery for anyone under 19 and restricts who in that age group can receive nonsurgical treatment. Minors who already receive puberty blockers or hormones are allowed to continue the treatment, but new patients who are minors are largely banned from starting.
The American Academy of Pediatrics recommends gender-affirming care for people under 18, citing an increased risk of suicide for transgender teens.
Only those minors who have shown “a long-lasting and intense pattern of gender nonconformity or gender dysphoria” would be allowed to start puberty blocking or hormone treatment, and only under a set of guidelines to be drafted by the state’s newly appointed chief medical officer, Dr. Timothy Tesmer.
Tesmer is an ear, nose and throat surgeon and political appointee of Republican Gov. Jim Pillen. The governor has leaned hard into a swell of anti-transgender legislation in Republican-led statehouses across the country.
During the signing ceremony for the new law, Pillen suggested children and their parents who seek gender-affirming treatment are being “duped,” adding, “that is absolutely Lucifer at its finest.”
Last month, Pillen issued an executive order strictly defining a person’s sex and ordering state agencies to define “female” and “male” as a person’s sex assigned at birth.
Omaha state Sen. John Cavanaugh is among those who said he is been unable to get answers from the Nebraska Department of Health and Human Services, even as his office fields multiple calls daily from the public seeking answers.
“There's a huge amount of concern about what's going to happen to trans folks,” Cavanaugh said. “They feel like the governor has put a target on their back for political gain. And they're frightened about what happens next.”
Some are not waiting to find out.
Heather Rhea's daughter, 17-year-old Nola Rhea, is a high school senior in Lincoln. Once she graduates in May, the National Merit Scholarship finalist plans to leave Nebraska for college in Minnesota, which enacted protections for gender-affirming care earlier this year. At the time, Nebraska lawmakers were locked in a contentious battle over the proposed transgender health care ban, which touched off an epic filibuster that slowed the session to a crawl.
The passage of the bill, which survived the filibuster attempt by a single vote, altered Rhea's longtime assumption she would attend the University of Nebraska.
“It makes you feel like you're not wanted here,” she said of the new law.
Rhea recounted she had contemplated suicide years earlier as her body began to change during puberty. When she came out to her family at age 14, their acceptance and the medical treatment she received, including puberty blockers and later hormones, “saved my life.”
She has since enjoyed the support of her school, teachers and peers. She entered high school thinking society had turned a corner on acceptance of the transgender community.
“And then this year happened,” she said.
She's concerned for those teens in the future who won't be able to get gender-affirming care.
“I worry especially because I don't think it's going to get better; I think things are going to get worse,” she said. As for the law's supporters, “I think they're going to push harder. I think they're going to push to try to make it illegal to be trans. Period.”
Dr. Alex Dworak, an Omaha family physician who has treated transgender patients for more than 10 years at OneWorld Community Health Centers, said he has heard the same concerns Rhea has from dozens of people since debate on the Nebraska law began.
Five of his trans patients have already left the state, he said.
“They don’t feel safe here,” Dworak said. “Which, again, seems like that’s precisely the point, or at least that it lines up nicely with the stated goals of the people advocating for this legislation.”
Dworak said he has spoken about developing the regulations with Tesmer, whom he described as collegial and respected in his field. Tesmer was hopeful earlier this week about launching a set of emergency regulations by Oct. 1 until the permanent set could be adopted, Dworak said.
As of Friday, no such emergency rules had been announced.
Tesmer did not respond to several interview requests from The Associated Press about where he is in the process of drafting the regulations, for whom he has consulted, or when they are likely to be made public.
A Department of Health and Human Services spokesperson also declined to answer those questions, referring the AP to a document addressing frequently asked questions about the new law.
That document says the health agency hopes to hold a public hearing on the regulations before the end of the year. A public notice of such a hearing, which is required by law to be published at least 30 days before such a hearing, has not yet been published.
The department “will attempt to minimize” the time between the law taking affect and enactment of interim emergency regulations, according to the document.
At least 22 states have enacted laws restricting or banning gender-affirming medical care for transgender minors, and most of those states face lawsuits. An Arkansas ban mirroring Nebraska’s was struck down by a federal judge in June as unconstitutional and will be appealed to the 8th U.S. Circuit Court, which also oversees Nebraska cases.
