Currently, 15 bills have been introduced in the New Hampshire legislature to limit the rights of transgender people. House Bill 619, which outlines which genital reconstructive surgeries are allowed to be performed on minors and which are not, passed through the New Hampshire House of Representatives in January and is scheduled to reach the state Senate in March. This bill, sponsored by eight Republican senators, contains several inaccurate words when referring to transgender healthcare. The phrase “gender reassignment surgery” itself is considered outdated by the medical community, which uses the term “gender-affirming care” to describe the variety of mental and physical healthcare options available to transgender people. The bill also contains the word “genitalia” 21 times and the word “transgender” a grand total of zero times. This is not the first time that Republican policymakers have displayed a shameless obsession over the genitals of children to misrepresent the nuances of transgender experiences.
This anti-trans legislation endorses overt misconceptions about healthcare that distract policymakers from moving toward health equity. Dartmouth students have a civic responsibility to understand that these anti-trans policies being considered by the state are rooted in ignorance.
HB619 is a small portion of an original bill, titled the Protection Against Child Medical and Psychological Experimentation Act that was introduced in January of 2023 and was amended by the State House. The bill includes a section on “reassignment” surgery that admits that “surgeries are [already] generally not recommended for children.” Nonetheless, the original bill also seems to ban private insurance and the state’s Medicaid program from covering almost any gender-affirming healthcare, as well as banning clinicians from providing such services or referring patients to other clinicians. Healthcare for transgender youth generally includes access to inclusive doctors and OB/GYN, reproductive care that considers gender and sexual diversity, mental healthcare and hormone therapy. Instead of recognizing this, HB619 prioritizes a conservative political agenda above clinical practice and research. If the legislature passes this bill, policymakers will mislead the New Hampshire public on trans-inclusive health practices instead of pushing solutions for better care.
Right now, New Hampshire is perpetuating a wider legislative environment that attempts to prohibit genderqueer people from living freely and comfortably. Much of the original bill restricted education practices in New Hampshire schools, policing what name children go by in class and forbidding teachers to discuss nonbinary gender. According to Sarah Chant, a lecturer in the women, gender and sexuality studies program whose research investigates the language and context of anti-trans bills in the American South, “everything that was in the original unamended bill is the plan.” Many of these other goals are now outlined in additional bills still in committee hearings. The future of these bills, which include policy regulating admissions of higher education institutions and hiring practices, will be impacted if HB619 sets a precedent in favor of anti-trans law during this legislative cycle. If HB619’s proponents pass this bill without facing strong protest, they may be inspired to continue writing discrimination into law.
Policymakers are not clinicians. HB619 seeks to regulate best practices for transgender care but does not take into account the actual processes and norms of gender-affirming healthcare for adolescents and adults. Currently, gender dysphoria is named as a mental illness in the Diagnostic Statistical Manual of Mental Health to describe those experiencing a difference between their experienced gender and their gender assigned at birth. Despite the stigma that results from defining a person’s identity as a disorder, a formal DSM diagnosis of gender dysphoria is required before genital reconstructive surgery is covered by most insurance. This bill is built upon a misconception of the requirements already in place to receive gender-affirming healthcare.
Mental and physical healthcare that supports positive development for transgender kids is already difficult to offer even without misguided legislation like HB619. A formal diagnosis of gender dysphoria is required by many insurance plans before a person can receive any kind of gender-affirming healthcare, not just surgery. Many insurers already employ age limitations to restrict aspects of gender-affirming healthcare, such as hormone treatment. Therefore, health policies that achieve a high standard of care for transgender youth are more worthwhile than blanket prohibitions based on crude age limitations when the health system already takes great care to determine restrictions on its own.
The language used in this bill is incendiary and aggressive. HB619 proclaims gender-affirming procedures to be coercive, claiming that parents believe they must choose between “their child committing suicide or consenting to their child’s genital gender reassignment surgeries.” Policymakers hereby impose incorrect statements about a real safety issue to push a political agenda that scares the parents of vulnerable youth. I am appalled by the irresponsibility of policymakers who ignore the research on the high rates of suicidality among transgender youth, with one study from the National Institute of Health reporting that 40% of teens in the study had attempted suicide. Significant risk factors listed in the study include interpersonal microaggressions, school belonging, emotional neglect by family and internalized self-stigma, and not the impact of one specific surgery, as this bill suggests. All this bill does is exacerbate those real risk factors.
The narrative presented in HB619 oversimplifies transgender identity by placing genital reconstructive surgeries at the center of gender-affirming healthcare, which is far from the truth. The reality is that clinicians and clients determine the treatments and pacing of administered care based on the individualized needs of the patient and the informed consent of all involved parties. The language used in this bill imposes decisions about public health and education based on a binary, one-dimensional perspective on gender.
Additionally, the current bill effectively threatens punishment for families simply attempting to navigate the healthcare process to the best of their ability, as well as their clinicians, by allowing lawsuits “against any person who has committed or attempted or threatened to commit such violation [against actions defined within the bill] or any person who has aided or abetted the same.” The threat of legal action might steer parents and doctors away from openly and honestly discussing with adolescents what their healthcare options might look like once they reach adulthood. This bill will undeniably harm young people’s identity development and ability to plan for the future, which are undeniably deserving of more support.
For a campus that represents a broad variety of national and international identities, Dartmouth plays an important role in political activism in New Hampshire. The policies put in place during our time in New Hampshire directly affect Dartmouth’s campus and the lives of those within it. Dartmouth support staff work with genderqueer students under the age of 18, genderqueer faculty and staff and those who have genderqueer children. Hateful policy has a deeply personal impact on those implicated, and the way we respond to this bill is important to the community directly around us, to the future of anti-trans policy considerations in the state and to Governor Chris Sununu’s decision if the bill arrives at his desk this spring.
Dartmouth students can communicate to the state Senate that they oppose this bill with a single form linked here once the bill is added to the Senate’s calendar. As Angélique Bouthot, assistant director and LGBTQIA+ student advisor at Dartmouth’s Office of Pluralism and Leadership has told me, “No matter what happens, we are not going to stop supporting students.” Policymakers in New Hampshire should remember the fact that many Dartmouth students are New Hampshire voters.
OPAL and Dartmouth College Health Services are doing work to expand access to gender-affirming care at Dartmouth. Linked to this page are LGBTQIA+ resources that OPAL has compiled to help students navigate social and academic life, daily self-advocacy and healthcare in the Upper Valley.
Opinion articles represent the views of their author(s), which are not necessarily those of The Dartmouth.
