Nebraska governor approves regulations to allow gender-affirming care for minors

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Slimshandy
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There’s nothing in the bill that says anything about needing an opposing opinion…. The only specification is “ Gender-identity -focused” therapy.


Which is exactly the kind of therapy that would be needed…
You still pick your own therapist.



023
2023
(4) This section does not apply to nonsurgical gender-altering procedures when such procedures are provided in compliance with the rules and regulations adopted and promulgated pursuant to section 18 of this act.
Sec. 18. (1) The chief medical officer as designated in section 81-3115 shall adopt and promulgate such rules and regulations as are necessary to provide for nonsurgical gender-altering procedures for individuals younger than nineteen years of age, such as puberty-blocking drugs, cross-S*x hormones, or both. Such rules and regulations shall be consistent with the Let Them Grow Act and, at a minimum, include the following:
(a) Specify that a health care practitioner may prescribe approved puberty-blocking drugs, cross-S*x hormones, or both to an individual younger than nineteen years of age if such individual has a long-lasting and intense pattern of gender nonconformity or gender dysphoria which began or worsened at the start of puberty;
(b) Specific criteria, obligations, or conditions regulating the administration, prescribing, delivery, sale, or use of puberty-blocking drugs, cross-S*x hormones, or both involving an individual younger than nineteen years of age in accordance with subdivision (1)(a) of this section, which shall, at a minimum, set forth the following:
(i) The minimum number of gender-identity-focused therapeutic hours required prior to an individual receiving puberty-blocking drugs, cross-S*x hormones, or both;
(ii) Patient advisory requirements necessary for a health care practitioner to obtain informed patient consent;
(iii) Patient medical record documentation requirements to ensure compliance with the act; and
(iv) A minimum waiting period between the time the health care practitioner obtains informed patient consent and the administration, prescribing, or delivery of puberty-blocking drugs, cross-S*x hormones, or both to such patient; and
(c) Specify that section 17 of this act does not apply to nonsurgical gender-altering procedures when such procedures are provided in compliance with the rules and regulations adopted and promulgated pursuant to this section.
(2) The Department of Health and Human Services may adopt and promulgate rules and regulations not inconsistent with the rules and regulations adopted and promulgated by the chief medical officer that are necessary to carry out the Let Them Grow Act.
Sec. 19. State funds shall not be directly or indirectly used, granted, paid, or distributed to any entity, organization, or individual for providing gender-altering procedures to an individual younger than nineteen years of age in violation of the Let Them Grow Act and the rules and regulations adopted and promulgated pursuant to the act.
Sec. 20. An individual that received a gender-altering procedure in violation of section 17 of this act after the operative date of this section and while such individual was younger than nineteen years of age, or the parent or guardian of such an individual, may bring a civil action for appropriate relief against the health care practitioner who performed the gender-altering procedure. Appropriate relief in an action under this section includes actual damages and reasonable attorney's fees. An action under this section shall be brought within two years after discovery of damages.
jessilin0113 wrote: Sun Mar 17, 2024 1:28 pm What other condition do we require people to spend a significant amount of time getting an opposing opinion for before we treat them? Gender dysphoria is a clinical condition diagnosed with valid and reliable testing. It already requires a duration of six months before it can be diagnosed. The appropriate treatment is gender-affirming care, and making someone wait longer for it puts their literal life at risk. Gender-affirming treatment comes with lots of people involved, including PCP, endocrinologists, therapists, and family. They know better than the state ever will.
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Slimshandy wrote: Sun Mar 17, 2024 2:29 pm There’s nothing in the bill that says anything about needing an opposing opinion…. The only specification is “ Gender-identity -focused” therapy.


Which is exactly the kind of therapy that would be needed…
You still pick your own therapist.

Just curious why people think it is good for the state of Nebraska to determine the medical and therapeutic care for people's children? Why not allow the family and medical professionals to craft the care plan?
jessilin0113
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Slimshandy wrote: Sun Mar 17, 2024 2:29 pm There’s nothing in the bill that says anything about needing an opposing opinion…. The only specification is “ Gender-identity -focused” therapy.


Which is exactly the kind of therapy that would be needed…
You still pick your own therapist.



023
2023
(4) This section does not apply to nonsurgical gender-altering procedures when such procedures are provided in compliance with the rules and regulations adopted and promulgated pursuant to section 18 of this act.
Sec. 18. (1) The chief medical officer as designated in section 81-3115 shall adopt and promulgate such rules and regulations as are necessary to provide for nonsurgical gender-altering procedures for individuals younger than nineteen years of age, such as puberty-blocking drugs, cross-S*x hormones, or both. Such rules and regulations shall be consistent with the Let Them Grow Act and, at a minimum, include the following:
(a) Specify that a health care practitioner may prescribe approved puberty-blocking drugs, cross-S*x hormones, or both to an individual younger than nineteen years of age if such individual has a long-lasting and intense pattern of gender nonconformity or gender dysphoria which began or worsened at the start of puberty;
(b) Specific criteria, obligations, or conditions regulating the administration, prescribing, delivery, sale, or use of puberty-blocking drugs, cross-S*x hormones, or both involving an individual younger than nineteen years of age in accordance with subdivision (1)(a) of this section, which shall, at a minimum, set forth the following:
(i) The minimum number of gender-identity-focused therapeutic hours required prior to an individual receiving puberty-blocking drugs, cross-S*x hormones, or both;
(ii) Patient advisory requirements necessary for a health care practitioner to obtain informed patient consent;
(iii) Patient medical record documentation requirements to ensure compliance with the act; and
(iv) A minimum waiting period between the time the health care practitioner obtains informed patient consent and the administration, prescribing, or delivery of puberty-blocking drugs, cross-S*x hormones, or both to such patient; and
(c) Specify that section 17 of this act does not apply to nonsurgical gender-altering procedures when such procedures are provided in compliance with the rules and regulations adopted and promulgated pursuant to this section.
(2) The Department of Health and Human Services may adopt and promulgate rules and regulations not inconsistent with the rules and regulations adopted and promulgated by the chief medical officer that are necessary to carry out the Let Them Grow Act.
Sec. 19. State funds shall not be directly or indirectly used, granted, paid, or distributed to any entity, organization, or individual for providing gender-altering procedures to an individual younger than nineteen years of age in violation of the Let Them Grow Act and the rules and regulations adopted and promulgated pursuant to the act.
Sec. 20. An individual that received a gender-altering procedure in violation of section 17 of this act after the operative date of this section and while such individual was younger than nineteen years of age, or the parent or guardian of such an individual, may bring a civil action for appropriate relief against the health care practitioner who performed the gender-altering procedure. Appropriate relief in an action under this section includes actual damages and reasonable attorney's fees. An action under this section shall be brought within two years after discovery of damages.
jessilin0113 wrote: Sun Mar 17, 2024 1:28 pm What other condition do we require people to spend a significant amount of time getting an opposing opinion for before we treat them? Gender dysphoria is a clinical condition diagnosed with valid and reliable testing. It already requires a duration of six months before it can be diagnosed. The appropriate treatment is gender-affirming care, and making someone wait longer for it puts their literal life at risk. Gender-affirming treatment comes with lots of people involved, including PCP, endocrinologists, therapists, and family. They know better than the state ever will.
It was the "could push back on" phrasing in the OP. If that is not the case, then great. I still don't think the state has any business being involved. Most kids with gender dysphoria or gender identity issues are already in therapy.
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MonarchMom wrote: Sun Mar 17, 2024 2:36 pm
Slimshandy wrote: Sun Mar 17, 2024 2:29 pm There’s nothing in the bill that says anything about needing an opposing opinion…. The only specification is “ Gender-identity -focused” therapy.


Which is exactly the kind of therapy that would be needed…
You still pick your own therapist.

Just curious why people think it is good for the state of Nebraska to determine the medical and therapeutic care for people's children? Why not allow the family and medical professionals to craft the care plan?
Ideally it would be just the medical professionals and parents making the decisions…


My comments are based on “even within the medical community” this should be standard of care…
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jessilin0113 wrote: Sun Mar 17, 2024 2:37 pm
Slimshandy wrote: Sun Mar 17, 2024 2:29 pm There’s nothing in the bill that says anything about needing an opposing opinion…. The only specification is “ Gender-identity -focused” therapy.


Which is exactly the kind of therapy that would be needed…
You still pick your own therapist.



023
2023
(4) This section does not apply to nonsurgical gender-altering procedures when such procedures are provided in compliance with the rules and regulations adopted and promulgated pursuant to section 18 of this act.
Sec. 18. (1) The chief medical officer as designated in section 81-3115 shall adopt and promulgate such rules and regulations as are necessary to provide for nonsurgical gender-altering procedures for individuals younger than nineteen years of age, such as puberty-blocking drugs, cross-S*x hormones, or both. Such rules and regulations shall be consistent with the Let Them Grow Act and, at a minimum, include the following:
(a) Specify that a health care practitioner may prescribe approved puberty-blocking drugs, cross-S*x hormones, or both to an individual younger than nineteen years of age if such individual has a long-lasting and intense pattern of gender nonconformity or gender dysphoria which began or worsened at the start of puberty;
(b) Specific criteria, obligations, or conditions regulating the administration, prescribing, delivery, sale, or use of puberty-blocking drugs, cross-S*x hormones, or both involving an individual younger than nineteen years of age in accordance with subdivision (1)(a) of this section, which shall, at a minimum, set forth the following:
(i) The minimum number of gender-identity-focused therapeutic hours required prior to an individual receiving puberty-blocking drugs, cross-S*x hormones, or both;
(ii) Patient advisory requirements necessary for a health care practitioner to obtain informed patient consent;
(iii) Patient medical record documentation requirements to ensure compliance with the act; and
(iv) A minimum waiting period between the time the health care practitioner obtains informed patient consent and the administration, prescribing, or delivery of puberty-blocking drugs, cross-S*x hormones, or both to such patient; and
(c) Specify that section 17 of this act does not apply to nonsurgical gender-altering procedures when such procedures are provided in compliance with the rules and regulations adopted and promulgated pursuant to this section.
(2) The Department of Health and Human Services may adopt and promulgate rules and regulations not inconsistent with the rules and regulations adopted and promulgated by the chief medical officer that are necessary to carry out the Let Them Grow Act.
Sec. 19. State funds shall not be directly or indirectly used, granted, paid, or distributed to any entity, organization, or individual for providing gender-altering procedures to an individual younger than nineteen years of age in violation of the Let Them Grow Act and the rules and regulations adopted and promulgated pursuant to the act.
Sec. 20. An individual that received a gender-altering procedure in violation of section 17 of this act after the operative date of this section and while such individual was younger than nineteen years of age, or the parent or guardian of such an individual, may bring a civil action for appropriate relief against the health care practitioner who performed the gender-altering procedure. Appropriate relief in an action under this section includes actual damages and reasonable attorney's fees. An action under this section shall be brought within two years after discovery of damages.
jessilin0113 wrote: Sun Mar 17, 2024 1:28 pm What other condition do we require people to spend a significant amount of time getting an opposing opinion for before we treat them? Gender dysphoria is a clinical condition diagnosed with valid and reliable testing. It already requires a duration of six months before it can be diagnosed. The appropriate treatment is gender-affirming care, and making someone wait longer for it puts their literal life at risk. Gender-affirming treatment comes with lots of people involved, including PCP, endocrinologists, therapists, and family. They know better than the state ever will.
It was the "could push back on" phrasing in the OP. If that is not the case, then great. I still don't think the state has any business being involved. Most kids with gender dysphoria or gender identity issues are already in therapy.
I think the writer of the article tried to insert a bit of speculation on what was already specified just to add some drama to the story…



That’s exactly right, most of the kids are already in therapy… and this isn’t saying they have to change therapists or get an additional one, it’s just specifying that the therapy needs a gender identity aspect to it.
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It's not so much that we think that the state/government should be involved in the type/availability/access to medical care of any patient. But the reality is that the government IS involved, particularly one party over another. Therefore, having the state government legislate protections and guidelines, it allows for patients to hopefully have access to quality care without exception; especially in states where extreme conservative busy bodies are on the warpath to impose and expand their religious beliefs and erase the lines of separation of church and state.




MonarchMom wrote: Sun Mar 17, 2024 2:36 pm
Slimshandy wrote: Sun Mar 17, 2024 2:29 pm There’s nothing in the bill that says anything about needing an opposing opinion…. The only specification is “ Gender-identity -focused” therapy.


Which is exactly the kind of therapy that would be needed…
You still pick your own therapist.

Just curious why people think it is good for the state of Nebraska to determine the medical and therapeutic care for people's children? Why not allow the family and medical professionals to craft the care plan?
jessilin0113
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Slimshandy wrote: Sun Mar 17, 2024 2:44 pm
MonarchMom wrote: Sun Mar 17, 2024 2:36 pm
Slimshandy wrote: Sun Mar 17, 2024 2:29 pm There’s nothing in the bill that says anything about needing an opposing opinion…. The only specification is “ Gender-identity -focused” therapy.


Which is exactly the kind of therapy that would be needed…
You still pick your own therapist.

Just curious why people think it is good for the state of Nebraska to determine the medical and therapeutic care for people's children? Why not allow the family and medical professionals to craft the care plan?
Ideally it would be just the medical professionals and parents making the decisions…


My comments are based on “even within the medical community” this should be standard of care…
It already is the standard of care:
Children and adolescents require a multidisciplinary approach, which considers developmental stage, neurocognitive function, language skills; offers mental health support; discusses risks and benefits of social transition; and includes parental/guardian involvement in GAMST in almost all situations.
https://jamanetwork.com/journals/jama/f ... le/2805345

I wonder how many physicians are on the Nebraska Legislature...
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jessilin0113 wrote: Sun Mar 17, 2024 3:29 pm
Slimshandy wrote: Sun Mar 17, 2024 2:44 pm
MonarchMom wrote: Sun Mar 17, 2024 2:36 pm


Just curious why people think it is good for the state of Nebraska to determine the medical and therapeutic care for people's children? Why not allow the family and medical professionals to craft the care plan?
Ideally it would be just the medical professionals and parents making the decisions…


My comments are based on “even within the medical community” this should be standard of care…
It already is the standard of care:
Children and adolescents require a multidisciplinary approach, which considers developmental stage, neurocognitive function, language skills; offers mental health support; discusses risks and benefits of social transition; and includes parental/guardian involvement in GAMST in almost all situations.
https://jamanetwork.com/journals/jama/f ... le/2805345

I wonder how many physicians are on the Nebraska Legislature...
One of the authors of the amendments is a chiropractor. Does that count?

The concern from the psychiatric community is not only on the number of hours of therapy required but the language used that therapy must be gender-identity-focused and “clinically neutral and not in a gender-affirming or conversion context.”

https://nebraskaexaminer.com/2023/11/07 ... %20therapy.

And so no one is confused about the importance of puberty blockers as a legitimate part of gender affirming care: "In this prospective cohort of 104 TNB youths aged 13 to 20 years, receipt of gender-affirming care, including puberty blockers and gender-affirming hormones, was associated with 60% lower odds of moderate or severe depression and 73% lower odds of suicidality over a 12-month follow-up."
https://jamanetwork.com/journals/jamane ... le/2789423

My immediate concern is for the individuals who have already started puberty blockers or are scheduled to start in the near future. These strict regulations are confusing and as doctors and pharmacists are liable, they will and have already stopped prescribing. What does this mean for kids who are prescribed puberty blockers for precocious puberty? I imagine that parents of younger transgender kids will seek care outside of Nebraska.

For the last 3 years my cousin's daughter has had to move multiple times to continue her gender affirming care - basically couch surfing at various relatives' houses. She received better care when her family was living in Beijing. It's a sad situation but probably preferable to the states she has had to leave.
"The books that the world calls immoral are books that show its own shame." - Oscar Wilde
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If it’s already the standard of care, seeing it in a bill shouldn’t be upsetting.
jessilin0113 wrote: Sun Mar 17, 2024 3:29 pm
Slimshandy wrote: Sun Mar 17, 2024 2:44 pm
MonarchMom wrote: Sun Mar 17, 2024 2:36 pm


Just curious why people think it is good for the state of Nebraska to determine the medical and therapeutic care for people's children? Why not allow the family and medical professionals to craft the care plan?
Ideally it would be just the medical professionals and parents making the decisions…


My comments are based on “even within the medical community” this should be standard of care…
It already is the standard of care:
Children and adolescents require a multidisciplinary approach, which considers developmental stage, neurocognitive function, language skills; offers mental health support; discusses risks and benefits of social transition; and includes parental/guardian involvement in GAMST in almost all situations.
https://jamanetwork.com/journals/jama/f ... le/2805345

I wonder how many physicians are on the Nebraska Legislature...
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Slimshandy wrote: Mon Mar 18, 2024 10:07 am If it’s already the standard of care, seeing it in a bill shouldn’t be upsetting.
jessilin0113 wrote: Sun Mar 17, 2024 3:29 pm
Slimshandy wrote: Sun Mar 17, 2024 2:44 pm

Ideally it would be just the medical professionals and parents making the decisions…


My comments are based on “even within the medical community” this should be standard of care…
It already is the standard of care:
Children and adolescents require a multidisciplinary approach, which considers developmental stage, neurocognitive function, language skills; offers mental health support; discusses risks and benefits of social transition; and includes parental/guardian involvement in GAMST in almost all situations.
https://jamanetwork.com/journals/jama/f ... le/2805345

I wonder how many physicians are on the Nebraska Legislature...
It is the mandate imposed by the state that is objectionable. 40 hours of "therapy" will likely take a year, and at an average of $100 session $4000. Why? Where is the research done by state to determine this is needed, rather than the family deciding with the medical team that knows them best.
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