You You You You In passion 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 Voss. 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 are 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 got it all figured out. This is baloney. To hear from a medical point of view we speak with Bill Keaton, chief advocacy officer at Vivint Health, a clinic that focuses on serving LGBTQ clients. And Bill thanks very much for being here. Thank you for having me. So as to the speaker's comment that children as young as three are undergoing permanent bodily changes. Is that accurate? To the best of my knowledge I've 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 purely blockers to treat gender dysphoria like what's being discussed today. What does medically recognize gender affirming care involve for children under the age of 18? You know 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. But in terms of that gender reassignment surgery, I mean is that something that happens in young teenagers or even older ones or is it generally something that would be when they are adults? The research I've seen on this and the literature that I've seen on this really lends itself to the understanding that this is something that happens later on in individuals 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. But this kind of care would include puberty blocking drugs or hormones. And if so, at what age and again, what conditions would these be afforded? Well, there's a number of different approaches and 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 narrowly tailored and individualized for the individual who's seeking it. Because what kind of care and caution do health care providers enter into with children and their parents as they go through this course of treatment? 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 sort of 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. And so in other words, those kinds of drugs are reversible. Correct. Why does your health care 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? 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 aesthetic 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. And what that injury then leads to is further feelings of that person in terms of stigma, ostracization, discrimination, not feeling like they are fully accepted for who they are into society, which we know will then force them further away from not only the care for gender reassignment or gender affirming care, but all their primary health care and public health care needs. Folks won't engage with a system that makes them feel like they're less than a person, which means they're not going to get the routine screenings. They're not going to avail themselves to other treatments and preventative measures that can help keep themselves healthy. We basically otherwise instigmatize folks and push them further to the margins of society. Bill Keaton, thanks very much. Thank you for having me. No, no. I mean, not like that. Anything that was all right? It was really good. No, it was really good. All right. I tried not to make it all about stats and stuff like that. No, it was good. Yeah. Thank you. Appreciate it. Well, we'll give you a call the next time. Sounds good. I'd be happy to come on anytime and chat. Thank you. All right.