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N.H. House votes to ban gender-affirming genital surgeries for minors

Twelve Democrats joined the bulk of their Republican counterparts to pass a pared-down bill that critics said takes a dangerous approach to regulating health care

Members of the New Hampshire House of Representatives convened Wednesday, Jan. 3 2024, for the start of the 2024 session.Jonathan Wiggs/Globe Staff

With a bipartisan vote, the New Hampshire House of Representatives signed off Thursday on a scaled-back bill to ban gender-affirming genital surgeries for minors, amid a nationwide wave of anti-LGBTQ legislation.

As originally introduced, the proposal in New Hampshire would have prohibited a broad range of medical interventions for transgender minors, including puberty blockers, cross-sex hormones, and non-genital surgeries, such as mastectomies.

But the House adopted an amendment to House Bill 619 that significantly narrowed its scope and won the approval of 12 Democrats and almost all the Republicans in the 400-member House. The final vote was 199-175.

As amended, the bill would prohibit physicians from performing “genital gender reassignment surgery” on minors, and it would threaten professional disciplinary action for physicians who refer minors to other providers for such services.

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Representative Erica Layon, a Republican from Derry, who sponsored the amendment, said the legislation will protect children from unproven medical procedures.

“Despite experts telling parents that this surgery is safe and effective, it has not yet been studied in children. That means parents don’t have the information required to provide informed consent,” Layon said. “This law to wait until 18 protects parents and children from premature, irreversible surgeries.”

The bill’s prime sponsor, Republican Representative Terry Roy of Deerfield, said the bill would make New Hampshire the first state in the Northeast “to protect minors from gender experimentation and mutilation.”

Opponents, however, contend the legislation takes a dangerous approach, injecting lawmakers into a sensitive area of medical advice and decision-making.

Representative Gerri Cannon, a Democrat from Somersworth, who is transgender, said lawmakers didn’t hear about any persistent problems with gender-affirming care that New Hampshire residents are actually receiving that might justify legislative intervention on this topic. Nor is it reasonable to expect the legislature to continually monitor and refine this type of prohibition in response to emerging medical science, Cannon said, noting that minors are typically advised to hold off until adulthood for any gender-affirming surgeries.

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The stakeholders who spoke out against the bill included LGBTQ rights advocates, the New Hampshire Medical Society, New Hampshire Hospital Association, New Hampshire Psychological Association, National Alliance on Mental Illness in New Hampshire, and others.

Dr. Keith J. Loud, who serves as physician-in-chief for Dartmouth Health Children’s and chair of the pediatrics department, said HB 619′s passage serves to infringe the rights of parents and families to access health care for their children in consultation with health care professionals.

“While Dartmouth Health does not perform gender-affirming surgery on minors, we are concerned that the passage of HB 619 directly impedes equitable access to medical care for youth in New Hampshire,” Loud said.

The bill would still allow genital surgeries in cases of minors with sex development disorders, damaged or malformed genitalia, or the need for reconstruction “to correct malformation, malignancy, injury or physical disease.” Male circumcision would still be allowed as well.

The bill would authorize the New Hampshire Attorney General’s Office to enforce the law through litigation, and it would give minors and their parents the right to sue anyone who has violated the law, attempted or threatened to violate the law, or “aided or abetted” anyone in doing so.

Chris Erchull, an attorney with Boston-based GLBTQ Legal Advocates & Defenders (GLAD), said some states have sought to impose total bans on all forms of gender-affirming care for minors, so HB 619 is notably narrower than anti-trans bills in certain other states. But it’s still “cut from the same cloth” of the nationwide trend, he said.

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At least 22 states have enacted bans on gender-affirming care for minors, according to the Human Rights Campaign Foundation. That’s despite data showing gender-affirming genital surgeries are already extremely rare among teenagers. One study published by JAMA Network Open found an estimated 405 transition-related genital surgeries had been performed between 2016 and 2020 on patients between the ages of 12 and 18 anywhere in the United States.

Erchull said he spoke with the authors of that study and learned only 101 of those patients were under the age of 18 at the time of their surgery — which would mean only about 20 minors per year received gender-affirming genital surgeries anywhere in the country during that period.

These bills aren’t actually tailored to halt a certain number of surgeries, Erchull said.

“I see this as fear-mongering and opportunism that is just meant to target and play political volleyball with an extremely vulnerable group of people,” he said.

Erchull noted that HB 619 wasn’t the only anti-trans bill the New Hampshire House passed on Thursday. He pointed also to House Bill 396, which would allow public and private entities in New Hampshire to segregate multi-person bathrooms and locker rooms, athletic events and competitions, and jails and other detention facilities based on biological sex without fear of violating state nondiscrimination laws related to sex and gender identity. Three Democrats joined nearly all Republicans to pass HB 396 by a six-vote margin.

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Erchull said the New Hampshire Senate is likely to pass both HB 619 and HB 396, so Governor Chris Sununu ought to veto the two bills, much like Republican Governor Mike DeWine in Ohio recently vetoed a broader bill that would have prohibited gender-affirming care for minors.

Linds Jakows, co-founder of 603 Equality, noted Sununu signed New Hampshire’s trans-inclusive nondiscrimination bill into law in 2018.

A spokesperson for Sununu’s office did not respond to a request for comment Thursday about whether he would be open to vetoing either HB 619 or HB 396.

In addition to approving two anti-trans bills Thursday, the House rejected two measures that had been supported by LGBTQ rights advocates.

Representatives voted 190-185 to kill House Bill 368, which would have prohibited health care providers from releasing information about a patient’s gender-affirming health care to any civil action or foreign subpoena based on another state’s law.

Cannon, who spoke in support of the bill, noted that Texas Attorney General Ken Paxton recently asked a hospital in Seattle, Wash., for records related to gender-affirming treatments the hospital may have provided to kids from Texas. New Hampshire should pass a law to block the release of that type of information, she said.

Representative Lisa Mazur, a Republican from Goffstown, countered that HB 368 would make New Hampshire “a sanctuary state for gender transitions for children.” It’s not a good idea, she said, for New Hampshire to pass laws that seek to prevent other states from enforcing theirs.

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Representatives also voted 191-185 to kill House Bill 264, which would have simplified the process by which transgender individuals can update the gender listed on their birth records.

Courtney Reed, a policy advocate for the American Civil Liberties Union of New Hampshire, said Thursday was “an especially grim day” in New Hampshire.

“Our state has made clear time and again that LGBTQ+ people belong,” Reed said, “and after today’s shameful votes, it’s more important than ever to make the message louder and more clear than before that the Granite State respects the rights of LGBTQ+ people — and that our rights are not up for debate.”


Steven Porter can be reached at steven.porter@globe.com. Follow him @reporterporter.