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

[Slimshandy]

My son was diagnosed with ADHD at the age of 4 and I was really hesitant to put him on meds. He was in multiple therapies until the age of 9 when his behavior therapist asked me point blank what was I waiting for? I immediately put him on meds and the change was amazing. I call those first five years "the lost years" and I deeply regret them.

Parents can opt for therapy instead of meds, meds instead of therapy, or a combination of the two. My personal preference would be meds in conjunction with therapy but I certainly wouldn't want my personal preference to deny another parent of the ability to make another choice. This applies specifically to ADHD meds.

There is a battery of testing - both psychological and medical as well as a 6 month period before a diagnosis of gender dysphoria. I believe that this team of professionals is more qualified to identify the needs of the child than a Chiropractor on the Nebraska legislature. I would equate it to a school requiring all students with an IEP receive 40 hours of a mandated specific therapy before implementing accommodations in the classroom.

And in the glorious US where we have to pay for healthcare, cost is a factor. Therapy sessions run $100 to $200 per hour. If you're lucky, you are insured and "only" have to pay the co-pay. Medicaid in Nebraska does not cover the cost of gender transitional care so the uninsured or those on Medicaid would have to foot the $4000-$8000 bill. Believe it or not, for many families, this is cost prohibitive. Add that cost to the fact that Nebraska is experiencing a crisis of lack of mental health professionals, it's not rocket science to see how this therapeutic mandate is causing a lack of access to transgender youth.

And as I posted above, we are talking about care that "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." It is literally life-saving. Comparing it to breast augmentation is disingenuous.

As someone with a son who has ADD/ADHD, and has had an IEP since first grade… I’m well aware of what a child goes through with it…

I chose not to medicate him and instead keep him in CBT . I also made sure the school and every teacher he’s ever had are aware of this, and his IEP, and they are legally required to follow the IEP… meaning none of his years at school are “lost” they are modified to fit his specific needs.

He’s now in his last years of high school and has realized that his thought process is actually a strength… he has the ability to hyperfocus, which makes his ability to write code, create apps, and go as far as attempting to invent a new kind of camera is so much more than anyone he knows, including the robotics teachers at school. And if it happens that he gets a D+ in history, then so be it.., he’s not meant to be a history teacher. He’s meant to excel in the field of technology…



As a mother of a child who identified as transgender for two years, was put into therapy with a woman who is very much gender fluid herself and super supportive for the past four years, and now identifies as non-binary, I am also very aware of the importance of therapy and pinning down the reasons the child has want for that kind of change… immediately medicating should never even be discussed among the medical community or parents with children who are finding their identity.

If the decision is made to start hormonal therapy, you are right it can be helpful beyond words… but that still doesn’t mean it should be utilized before therapy. 6 months of therapy is what even the doctors who created the standard of care suggest.


If money is an issue, then work needs to be done in the state level to ensure mental health care availability for every resident. Which is actually the status quo at the moment if parents do not make enough to cover the cost. But money being an issue is not a good enough reason to disregard the importance of therapy.

I'm glad that therapy was a good choice for your son and that he was able to meet his educational goals. I'm glad that medication relieved my son's crippling anxiety and depression and enabled him to thrive. It just goes to show that there just isn't a one size fits all when it comes to treatment for ADHD.

A diagnosis of gender dysphoria requires an evaluation across multiple disciplines as it should. Symptoms of gender dysphoria must be exhibited for at least 6 months, as they should. Various therapies are recommended/required depending on each individual child, as they should. The state of Nebraska is now implementing rules that a specific type of therapy be required for a minimum of 40 sessions. Again, IMO, this is excessive. What was "broken" that the state needed to "fix"?

Money is an issue, at least in Nebraska who has decided that mental health care of children with gender dysphoria should not be covered. They are mandating hours of a specific therapy (whether determined that a child needs it or not) and stating that state funds are not going to pay for that therapy. That pisses me off. I don't say that because I dislike the idea of therapy - all three members of my family have been and currently are in therapy to address a variety of issues. I say this as someone who has always been free to choose the type of therapy that my child needs with advice from his "team" rather than having it dictated by the state.

For example, if my son were currently in the state of Nebraska, was diagnosed with gender dysphoria, and suffered from anxiety, it"s most likely that his team would recommend specific therapy to deal with anxiety. That would be appropriate. However, in Nebraska, treatment of anxiety due to gender dysphoria must be secondary to "gender-identity-focused" therapy so would not necessarily "count" toward the 40 hour requirement. Again, IMO, requiring therapists to determine how much time to spend on specific aspects of therapy is not good care nor is it individualized care which is what all children need, even those with gender dysphoria. Frankly, I believe that Nebraska has implemented this specialized therapy so that they don't have to pay. If my child were seeking therapy specifically for anxiety, regardless of the reasons, Nebraska medicaid would pay for it if I had no coverage or my insurance didn't pay. But if I'm seeking gender-identity-focused therapy, even if care for anxiety is included in that therapy, Nebraska won't pay. Leave it to the right to be calculating, and while framed as best interest of the child, it's not. It's in the best financial interest of Nebraska and screw the child, their parents, and their therapists simply because they are seen as being uugy.

I think you made great choices for your son, and I am fully supportive of the decisions you made even though they were different than mine, I think you should applaud yourself for getting through it, because it’s tough years.




But as for what the state of Nebraska would pay for- I question whether or not either one of us know the specifics because I would think that each individual child’s therapist would be chosen by them and it would be up to the therapist to say, yes- we spent a great deal of time on gender identity.

[MonarchMom]

I think you made great choices for your son, and I am fully supportive of the decisions you made even though they were different than mine, I think you should applaud yourself for getting through it, because it’s tough years.




But as for what the state of Nebraska would pay for- I question whether or not either one of us know the specifics because I would think that each individual child’s therapist would be chosen by them and it would be up to the therapist to say, yes- we spent a great deal of time on gender identity.

As per the legislation you posted it seems to be a requirement that the therapy be focused on the gender identity issue:

The minimum number of gender-identity-focused therapeutic hours required prior to an individual receiving puberty-blocking drugs, cross-S*x hormones, or both;

[jessilin0113]

It seems pretty clear that treatment for transgender kids is not just happening willy-nilly and with no oversight or inappropriate care. The question then needs to be asked again, what problem is this legislation trying to address? It seems like a solution in search of a problem. There is no evidence or anything to suggest that kids are being transitioned too quickly or without appropriate guidance, so this is just meaningless, cruel legislation aimed at a tiny portion of the population that already goes through enough. Law and legislation should do the least amount of harm, and this does not meet that basic rule of thumb. This will withhold or delay care that would otherwise prevent children from experiencing significant depression and/or suicidal ideation.

[Slimshandy]

I think you made great choices for your son, and I am fully supportive of the decisions you made even though they were different than mine, I think you should applaud yourself for getting through it, because it’s tough years.




But as for what the state of Nebraska would pay for- I question whether or not either one of us know the specifics because I would think that each individual child’s therapist would be chosen by them and it would be up to the therapist to say, yes- we spent a great deal of time on gender identity.

As per the legislation you posted it seems to be a requirement that the therapy be focused on the gender identity issue:

The minimum number of gender-identity-focused therapeutic hours required prior to an individual receiving puberty-blocking drugs, cross-S*x hormones, or both;

Yes that’s true, but I’m wondering if the verification of gender identity focused therapy comes down to the paperwork a therapist fills out.

[WellPreserved]

I think you made great choices for your son, and I am fully supportive of the decisions you made even though they were different than mine, I think you should applaud yourself for getting through it, because it’s tough years.




But as for what the state of Nebraska would pay for- I question whether or not either one of us know the specifics because I would think that each individual child’s therapist would be chosen by them and it would be up to the therapist to say, yes- we spent a great deal of time on gender identity.

As per the legislation you posted it seems to be a requirement that the therapy be focused on the gender identity issue:

The minimum number of gender-identity-focused therapeutic hours required prior to an individual receiving puberty-blocking drugs, cross-S*x hormones, or both;

Yes that’s true, but I’m wondering if the verification of gender identity focused therapy comes down to the paperwork a therapist fills out.

I think you're right but that is part of the problem. With this bill, therapists are monetary liable if they "do it wrong". What normally would be purely a judgment call, now brings in the prospect of civil liability. Therapists are going to be less likely to administer gender therapeutic care for worry of being open to liability which means less therapists available to deliver that care in a state that is already experiencing an extreme mental health provider shortage. I think this is the point of the legislation. It's the same playbook used in some anti-abortion legislation.

For example, can a gender identity focused therapy session focus on trauma that was experienced but unrelated to a patient's gender identity? From the wording of the legislation, it sounds as if it's a "no" but is that in the best interest of the child?

[WellPreserved]

As someone with a son who has ADD/ADHD, and has had an IEP since first grade… I’m well aware of what a child goes through with it…

I chose not to medicate him and instead keep him in CBT . I also made sure the school and every teacher he’s ever had are aware of this, and his IEP, and they are legally required to follow the IEP… meaning none of his years at school are “lost” they are modified to fit his specific needs.

He’s now in his last years of high school and has realized that his thought process is actually a strength… he has the ability to hyperfocus, which makes his ability to write code, create apps, and go as far as attempting to invent a new kind of camera is so much more than anyone he knows, including the robotics teachers at school. And if it happens that he gets a D+ in history, then so be it.., he’s not meant to be a history teacher. He’s meant to excel in the field of technology…



As a mother of a child who identified as transgender for two years, was put into therapy with a woman who is very much gender fluid herself and super supportive for the past four years, and now identifies as non-binary, I am also very aware of the importance of therapy and pinning down the reasons the child has want for that kind of change… immediately medicating should never even be discussed among the medical community or parents with children who are finding their identity.

If the decision is made to start hormonal therapy, you are right it can be helpful beyond words… but that still doesn’t mean it should be utilized before therapy. 6 months of therapy is what even the doctors who created the standard of care suggest.


If money is an issue, then work needs to be done in the state level to ensure mental health care availability for every resident. Which is actually the status quo at the moment if parents do not make enough to cover the cost. But money being an issue is not a good enough reason to disregard the importance of therapy.

I'm glad that therapy was a good choice for your son and that he was able to meet his educational goals. I'm glad that medication relieved my son's crippling anxiety and depression and enabled him to thrive. It just goes to show that there just isn't a one size fits all when it comes to treatment for ADHD.

A diagnosis of gender dysphoria requires an evaluation across multiple disciplines as it should. Symptoms of gender dysphoria must be exhibited for at least 6 months, as they should. Various therapies are recommended/required depending on each individual child, as they should. The state of Nebraska is now implementing rules that a specific type of therapy be required for a minimum of 40 sessions. Again, IMO, this is excessive. What was "broken" that the state needed to "fix"?

Money is an issue, at least in Nebraska who has decided that mental health care of children with gender dysphoria should not be covered. They are mandating hours of a specific therapy (whether determined that a child needs it or not) and stating that state funds are not going to pay for that therapy. That pisses me off. I don't say that because I dislike the idea of therapy - all three members of my family have been and currently are in therapy to address a variety of issues. I say this as someone who has always been free to choose the type of therapy that my child needs with advice from his "team" rather than having it dictated by the state.

For example, if my son were currently in the state of Nebraska, was diagnosed with gender dysphoria, and suffered from anxiety, it"s most likely that his team would recommend specific therapy to deal with anxiety. That would be appropriate. However, in Nebraska, treatment of anxiety due to gender dysphoria must be secondary to "gender-identity-focused" therapy so would not necessarily "count" toward the 40 hour requirement. Again, IMO, requiring therapists to determine how much time to spend on specific aspects of therapy is not good care nor is it individualized care which is what all children need, even those with gender dysphoria. Frankly, I believe that Nebraska has implemented this specialized therapy so that they don't have to pay. If my child were seeking therapy specifically for anxiety, regardless of the reasons, Nebraska medicaid would pay for it if I had no coverage or my insurance didn't pay. But if I'm seeking gender-identity-focused therapy, even if care for anxiety is included in that therapy, Nebraska won't pay. Leave it to the right to be calculating, and while framed as best interest of the child, it's not. It's in the best financial interest of Nebraska and screw the child, their parents, and their therapists simply because they are seen as being uugy.

I think you made great choices for your son, and I am fully supportive of the decisions you made even though they were different than mine, I think you should applaud yourself for getting through it, because it’s tough years.




But as for what the state of Nebraska would pay for- I question whether or not either one of us know the specifics because I would think that each individual child’s therapist would be chosen by them and it would be up to the therapist to say, yes- we spent a great deal of time on gender identity.

Thank you for those kind words.