Republican State Sen. Bryant Richardson (R-Seaford) files legislation to ban gender-affirming care for minors following an executive order from President Donald Trump signaling similar efforts at the federal level.
In late January, the president signed an executive order that says the federal government will not “fund, sponsor, promote, assist or support” gender-affirming care for those under the age of 19.
That order has been temporarily restrained by two federal judges as the merits of cases brought against the mandate are reviewed.
Delaware Attorney General Kathy Jennings also joined 14 other attorneys general in issuing a joint statement on protecting access to gender-affirming care within days of President Trump's executive order.
Sen. Richardson’s bill, titled the Delaware Save Adolescents From Experimentation (SAFE) Act, would prohibit healthcare providers from administering puberty blockers, cross-sex hormones and gender transition surgeries to minors.
The legislation would also ban "non-genital gender reassignment surgeries," which includes liposuction, lipofilling, voice surgery and hair reconstruction and would prohibit public funds from being issued to any entity that provides gender-affirming care to children.
The legislation does provide exceptions for intersex individuals.
Although the bill does not clarify an age range for which the ban would be instilled upon, Sen. Richardson says the legislation is intended for those 18 and under.
He cites concerns over the long-term effects of such treatments and the potential for regret among young individuals, as well as the intentions of gender-affirming care providers.
“I just question if they're really concerned about the patient or if they're concerned about the profits," he said.
But State Rep. DeShanna Neal (D-Wilmington), Delaware's first nonbinary elected official and a parent of two transgender children, argues there are only two providers in the First State who offer top surgery to minors and no providers that offer bottom surgery.
“I think there may be one or two top surgeons in the state of Delaware — one or two. And when I say top surgery, these are for usually [transmasculine] or gender nonconforming people who get the top surgery done. It's majority 18-year-olds or older," Rep. Neal explains.
According to Rep. Neal and TransHealthCare's directory of gender surgeons, there are no providers in Delaware who offer phalloplasties or vaginoplasties — also referred to as bottom surgery.
Neal has hands-on experience with minors experiencing gender dysphoria, not only with their own children, but as a professional mental health provider for at-risk youth.
They explain not only are permanent gender-affirming care procedures for minors extremely rare in Delaware, but there is great attention given to any child seeking to transition often through therapy or puberty blockers first.
"It's not just a kid wakes up one day and says, 'I'm trans,' and then tomorrow they get surgery. That's that's not how it works — that's never how it worked. It's a long, long road — a very long road, and sometimes it actually doesn't even happen," Rep. Neal said. "The purpose of having gender-affirming care, especially puberty blockers, is to give time to understand and time to know if this is what we want."
Puberty blockers, whose use would be banned for children under Sen. Richardson's bill, can be used to delay the changes of puberty in transgender and gender-diverse youth who have started puberty. The medicines most often used for this purpose are called gonadotropin-releasing hormone (GnRH) analogues.
According to the Mayo Clinic, GnRH analogues don't cause permanent physical changes, they only temporarily stop the body from making sex hormones — testosterone and estrogen. When a person stops taking GnRH analogues, puberty starts again.
The Mayo Clinic and the Murdoch Children's Research Institute do report reductions in bone density and fertility and changes in adult height as potential side effects, but research consensus also shows significant reduction in anxiety, depression and suicidal thoughts among gender-dysphoric youth who are prescribed puberty blockers.
Sen. Richardson notes one of the reasons he brought the bill forward was the United Kingdom's decision to indefinitely ban puberty blockers two months ago. The country intends to conduct clinical trials on the safety of the medication this year and revisit the ban in 2027.
Rep. Neal argues these decisions should continue to be left to parents, children and their doctors.
"If it's medically necessary, and it has been properly discussed — all the pros and cons, the dangers, the risks, all of that which we expect our doctors to do. If all this happens and the family and the child are like, 'This is what we really want to do,' then that is between them," Rep. Neal said. "The same crowd that says, 'My parental rights — don't tell me how to raise my children,' that extends to parents like me. My parental right is that I chose to love my daughter as my daughter because she's my daughter. You don't get to tell me how to raise her if you don't want me telling you how to raise yours."
Sen. Richardson believes without gender-affirming care, gender-dysphoric youth would be more inclined to accept their gender assigned at birth.
"I think eventually, the high percentage of youth will accept their sexual identities at birth — a very high percentage — if nothing's done, if none of these procedures are done. Why risk that? Why put young people through that? I think we should be encouraging young people to to accept themselves the way they are and feel good about it," Sen. Richardson said.
A recent study published by the Journal of the American Medical Association found that in a survey of 220 children who are several years into taking either puberty blockers or cross-sex hormones, only 4% expressed regret with some aspect of their care, while over 50% rated their satisfaction at the highest possible level.
Additionally, when the researchers asked more about these regrets, children often expressed wishing they hadn't done puberty blockers and gone straight to hormone treatment or had a negative side effect related to the blockers.
Of the nine children who expressed some form of regret, four continued their treatments while four more chose to stop all gender-affirming medical care and one stated that they plan to stop.
"We need to just believe in the science. We need to believe in the fact that our doctors— they are not just doing it for a paycheck. They're doing it because they want to help. I truly believe that. I mean, my daughter is here. She'll be 22 this year, and she socially transitioned when she was four. So we've got two more years, and it will be 20 years of her being her, and never once has she wavered. She has not said, 'I changed my mind.' None of this has happened. She always knew. And on the flip side of that, my 14-year-old, who's nonbinary and trans, didn't want puberty blockers and didn't want hormones and have not had anything. So one, it's a personal journey, and two, you communicate with a therapist, you communicate with a doctor and you make those decisions together," Rep. Neal said.
Sen. Richardson says that although he knows the bill is not likely to be supported in the General Assembly with Democratic majorities in both chambers, he still believes it's worth pushing for.
"As with any legislation, I think you just need to have your facts lined up and just overwhelm the discussion with the information that helps support your bill," he said. "I think the people that will oppose it are the people that profit from it, and we just need to overwhelm them with the evidence and then to dispel any of the information they have as not being factual."
There are currently 26 states with some type of legislative ban on gender-affirming care for minors — those laws in Arkansas and Montana have been blocked by court decisions while litigation is ongoing in 13 other states.
Last year, Rep. Neal introduced a bill to provide legal protections for healthcare professionals who provide gender-affirming care, which would build upon codified legal protections for providers of contraceptive, abortion and fertility services in Delaware.
While that piece of legislation was voted out of committee, it did not make it to the full House agenda.
Rep. Neal says similar legislation to provide protections for healthcare providers will be reintroduced this year.
Sen. Richardson's bill awaits a committee hearing in the Senate Health & Social Services Committee.
