Puberty blockers used widely in medicine. Will SC’s Help not Harm bill effect them?

Legislation to prevent minor’s gender transition in South Carolina has caused great concern among the medical community because it targets puberty blocking medications. The drug, used for gender transition periods, is also used for a wide variety of medical conditions.

The ‘Help not Harm’ bill, which would prohibit anyone under 18 from receiving gender transition procedures or using puberty blockers for transitioning, is in the Senate. Senators voted to give the bill priority status for consideration Thursday. It will be taken up before other contested legislation, most likely with debate starting Tuesday.

The legislation also asserts school employees may not withhold information from the minors parent or legal guardian if the minor’s perception of his or her gender is inconsistent with their sex.

Parents, medical professionals, researchers and community advocates have criticized the bill. But legislators defend it and say the drug restrictions only apply to limited circumstances

Michael O’Brien, a pediatrician in the Lowcountry, said the drugs used for gender transition procedures are called “pubital blockers,” and are often used for patients who are not wanting to transition.

Pubital blockers are a group of drugs that block the sex hormones that begin during adolescence, he said.

“I’ve never seen those drugs used for transgender kids. But I have seen them used numerous times for kids who have other conditions that are causing them to have puberty too early in life, that’s called precocious puberty. And for kids with certain types of tumors, because there are certain cancers that essentially are fueled by testosterone, estrogen, so you need to block those pathways,” O’Brien said.

O’Brien wondered if the state be auditing or investigating doctors who used these drugs if the bill passed.

“Who’s paying for that? What office would do the investigations? How much of a burden would this add to the doctors who already have so much work and documentation to do on these complex patients? It’s an unnecessary side effect of this ridiculous ban,” O’Brien said.

O’Brien said it’s important to note that this drug is only given to transgender or gender non-nonconforming kids after they start puberty, never before.

Also, the drugs are reversible, O’Brien said. The only major long-term side effect of these drug is having a short stature.

“You might not be as tall as you would otherwise,” O’Brien said. “It’s not super significant because puberty resumes either the moment you stop taking that drug, or once you start taking the hormones of the opposite sex.”

If the bill passes, minors will either have to forego treatment or leave the state to attempt to get it, he added.

“This whole debate for us is really about preserving the choice of families, children and their doctors, and keeping the government out of it,” O’Brien said. “The lose-lose here is for the kids. Our patients will not be fine. I’ve cared for numerous gender non-conforming and transgender kids in the Lowcountry at this point, who have attempted to take their lives, and they cite this legislation as part of the reasons why. They’re listening to what’s happening at the statehouse.”

One of the bills sponsors, Rep. John McCravy, R-Greenwood, said the law only applies to the medication when used in a transition period for minors.

McCravy said the drug’s labeled use is for cases where children undergo early puberty.

“It’s off-label use to give estrogen to a male or testosterone to a female. It would only prohibit that in a case of transition procedures,” he said.

Regardless, there will be a chilling effect in prescribing and using those drugs, Phillip Ford, a lobbyist running for House District 93, wrote via text, because doctors could be questioned and investigated.

Dr. Elizabeth Mac, a pediatric critical care physician and the President of South Carolina Chapter of the American Academy of Pediatrics, spoke on the bill at the House subcommittee Jan. 9. She urged lawmakers to not move the bill forward, and told them among many things, there isn’t even gender confirmation surgery occurring for minors in South Carolina.

“This is not a concern,” Mac said. “There are lots of things of concern with our youth, and that’s not one.”