Here & Now

Bill Keeton on Delivering Gender-affirming Care in Wisconsin

Frederica Freyberg:

Impassioned testimony at the Capitol in recent weeks culminated in heated Assembly floor debate over legislation targeting transgender children. One of the bills prohibits minors from receiving gender-affirming medical care in the form of hormone treatments or surgery. The Republican-authored legislation sparked these words from Assembly Speaker Robin Vos.

Robin Vos:

So just because some people in science today say that this is settled that we are going to mutilate children before we allow them to get a tattoo, before they decide on many things that we say as a society they cannot decide. And for all of you who have sponsored the bill to say we need to have 17-year-olds treated as children because they can’t be admitted to adult court because their brains aren’t formulated, give me a break! So you say that kids aren’t old enough to know right and wrong when they commit a crime, but somehow permanent bodily changes, that, when you’re three years old, you’ve got it all figured out. This is baloney!

Frederica Freyberg:

To hear from a medical point of view, we speak with Bill Keeton, chief advocacy officer at Vivent Health, a clinic that focuses on serving LGBTQ clients. Bill, thanks very much for being here.

Bill Keeton:

Thank you for having me.

Frederica Freyberg:

So as to the speaker’s comment that children as young as three are undergoing permanent bodily changes, is that accurate?

Bill Keeton:

To the best of my knowledge, Ive not heard of any instances where someone that young has been in a position where they’ve had, whether it’s gender reassignment surgery or taking things like hormones or puberty blockers to treat gender dysphoria like what’s being discussed today.

Frederica Freyberg:

What does medically recognized gender-affirming care involve for children under the age of 18?

Bill Keeton:

It involves a lot of different components. Probably first and foremost is the really intentional engagement of that individual’s parents with a team of providers who are really looking at what is in the best interest of the health and well-being of that child. That’s going to include things like talk therapy and traditional mental health. It might include things like psychiatry. And if the team comes together, the parent or parents in this case come together with the team of providers and their child to determine that something like gender reassignment surgery is necessary, then that’s the course of treatment that’s going to be followed and sought out. There’s going to be a lot of consultation, a lot of discussion, a lot of education of the parent and the child about what this is going to mean for that individual for the rest of their lives and it’s not the standard course. I shouldn’t say it’s not the standard course. It’s not the only course. There are a number of different approaches to helping support folks who are living with — not feeling like their physical body matches how they feel about themselves.

Frederica Freyberg:

But in terms of that gender reassignment surgery, I mean, is that something that happens, you know, in young teenagers? Or even older ones? Or is it generally something that would be when they are adults?

Bill Keeton:

The research I’ve seen on this and the literature Ive seen on this really lends itself to the understanding that this is something that happens later on in an individual’s life. I think the medical community, providers in this space really recognize that they are taking a significant step with this patient and they want to make sure that they’re in a position to make that decision fully from a well-informed position.

Frederica Freyberg:

But this kind of care would include puberty-blocking drugs or hormones, and if so, at what age and under, again, what conditions would these be afforded?

Bill Keeton:

There’s a number of different approaches. It’s individualized for each one of the patients. There’s no standard on this day, after this many rounds of treatment, we’re going to start treatment “x,” “y,” or “z.” So is it the same in every case? The answer is no. This sort of care is very naturally tailored and individualized for the individual who is seeking it.

Frederica Freyberg:

Because what kind of care and caution do healthcare providers enter into with children and their parents as they go through this course of treatment?

Bill Keeton:

There are a lot of conversations that need to happen, meaningful conversations about what does this mean for the patient. The initiation of things like puberty blockers or hormone therapy, those are not necessarily permanent approaches. They will change the individual’s physiology in some ways so that it more closely represents how that individual experiences their gender, which is an internal, almost psychological sort of thing. And if that changes the ability to withdraw or stop receiving that, will have the impact of bringing that person’s gender expression back towards their physiological.

Frederica Freyberg:

And so in other words, those kinds of drugs are reversible.

Bill Keeton:

Correct.

Frederica Freyberg:

Why does your healthcare practice and others believe that it is injurious to prohibit gender-affirming care for children and for them to wait until they’re 18 to get that kind of care?

Bill Keeton:

Well, I think if we look at something like gender dysphoria and the folks who are seeking this out, it’s not a cosmetic, it’s not an esthetic sort of approach. It’s not a tattoo. This is recognized treatment, developed with protocols, developed by leading providers in this space, the American Psychiatric Association, the American Medical Association, and others, and the idea that someone is experiencing a condition that has treatments available for it that have been rigorously studied and proven to be effective and safe for that individual, to withhold that because of someone’s age seems to be cruel to me in some ways. That’s where the injury comes in. We basically other-ize and stigmatize folks and push them further to the margins of society.

Frederica Freyberg:

Bill Keeton, thanks very much.

Bill Keeton:

Thank you for having me.

Frederica Freyberg:

Governor Tony Evers says he will veto this bill and two others related to transgender sports restrictions.