The proposed legislation would require health care providers to compel their staff to complete “evidence-based cultural competency training” for the purpose of providing “trans-inclusive” health care to patients who identify as transgender, gender nonconforming, and intersex (TGI).
A woman who once identified as a transgender male and lost her singing voice to cross-sex hormones spoke in opposition to the bill, telling the Senate Health Committee “it’s impossible for humans to literally change sex” at the hearing in Sacramento.
The woman, a self-described detransitioner who goes by the pseudonym Cat Cattinson to protect herself and her family, told the committee that proposed legislation “would deny health care providers the opportunity to recommend treatments that are in the best interest of the patients.”
“Humans can’t change sex, and by telling them that they can and leading them down this path is harming a lot of people, and so I just want to bring some attention to that side of the issue,” Cattinson said at the April 6 hearing.
“Gender-affirming care has not been proven to alleviate gender dysphoria,” she said. “Consider how this legislation will prevent vulnerable groups such as young people and those with comorbid mental illnesses from getting the proper therapeutic and medical care they actually need.”
Eight Democrats on the committee voted in favor of SB 923, including Sen. Scott Wiener (D-San Francisco) who introduced the legislation. The two Republicans on the committee Sen. Melissa Melendez (R-Lake Elsinore) and Sen. Shannon Grove (R-Bakersfield) voted against the bill.
Dozens of California parents of gender dysphoric teens, as well as multiple associations representing medical professionals, also opposed the bill. The legislation would apply to all staff and contractors working for health care providers, including health insurers, Medi-Cal, and PACE (Program of All-Inclusive Care for the Elderly) organizations.
Cattinson testified that testosterone, prescribed to her by a Planned Parenthood doctor after a half-hour phone conversation, made it painful for her to speak and sing.
“I was a semi-professional singer at this time. Hormones but not therapy were covered by my health insurance. A second Planned Parenthood doctor wrote me an approval letter for a double mastectomy, also without any in person meeting or recommendation that I address my other mental health issues first,” she told the committee.
“After four months of injecting testosterone, I suffered health side effects including heart palpitations, stabbing pain in my right side, nausea, vomiting, and edema. I acquired a vocal disability that made it painful to speak or sing,” Cattinson said.
Though her health has improved since she stopped transitioning, she still has trouble projecting her voice and can no longer sing at live performances.
“I’m one of a quickly growing number of detransitioners—individuals for whom transition not only failed to improve but worsened their situation. Gender Dysphoria is a symptom and often temporary. In contrast, transgender body modification is permanent, known to cause negative health effects,” she said.
Many other detransitioners who went further with transitioning deeply regret having body parts removed or feel devastated they will never be able to have children, she said.
“There’s currently no proof it improves mental health in the long term. After spending over a year healing from my transition experience, I have come to accept my biological sex. I am a woman, an adult human female, and this can never be changed,” Cattinson said.
One of the bill’s opponents said at the meeting that more than 100 people tried to call in to oppose the bill but were told the conference was full.
Rev. Bonita Ramsey, who testified over the phone in support of the bill, said she was refused treatment at a local medical office because of gender identity issues.
“They advertised that they served all in a caring environment, so I took my chances,” Ramsey said.
“Everything was uneventful until the doctor asked me to unbutton my shirt to check my vitals. I opened my shirt, and the doctor asked, ‘What is that?’ as he pointed to my wrapped chest area. I muttered, ‘It’s a binder, sir.’ Before I could utter another word, he said, ‘I don’t get this. Can you not afford a bra? What is this contraction supposed to do for you? Are you trying to become a man? I don’t support nor will I treat whatever this is. This is just a phase. You need to be who God made you to be and stop pretending.’ He said excuse me and walked out,” Ramsey said.
Ramsey claimed the staff talked loudly about the situation so that other patients in the lobby could hear, and described the humiliating experience.
“I heard a voice say, ‘What is that in Room 2? Why do people force their sexuality on us without warning? I will not serve that patient. Please give them a referral to get fitted for a bra and then sanitize the room,’” Ramsey said.
“Pain and fear came over me. I rushed to my car and began ripping off my binder with the sharpest thing I could find,” Ramsey said.
Five years later, in January, Ramsey began wearing the binder again. “I can now hold my head up high re-entering the world in my non-binary shell just as I am,” Ramsey said. “This is why SB 923 is important.”
Erin Pollard, a licensed Marriage and Family Therapist Licensed Professional Clinical Counselor and manager of student equity at Irvine Valley College in Irvine, Calif., also supported the bill.
As a therapist who has “specialized in gender-affirming mental health care in support of transgender non-binary and intersex patients for the past 14 years,” she said, training on how to provide appropriate care and treatment to “gender diverse patients” is difficult to find and as a result there is a scarcity of properly trained clinicians.
“Without this training, clinicians often provide misguided treatment that in fact is harmful to our TGI patients. This harm often results in a significant increase with depression, anxiety, gender dysphoria, and suicidality,” Pollard said.
Molly Robson of Planned Parenthood Affiliates of California, LGBT advocacy group Equality California and a group representing California social workers, among several others supported the legislation.
Melendez asked Cattinson whether she had received psychiatric counseling before the Planned Parenthood doctor prescribed testosterone.
“No, there are no appointments with a psychologist or psychiatrist required,” Cattinson said. “And I just want to add that this is the informed consent model, which is what trans activists are pushing for. This is what they want everywhere. They want you to just be able to … get the hormones and surgery on your first appointment.”
Melendez questioned Wiener about who would provide the gender-affirming care training sessions to health care providers and if they would be medically trained.
According to the bill, the government would be required to provide grants “to TGI-serving organizations” to facilitate the training and create educational materials.
Both Sen. Richard Pan (D-Sacramento) and Wiener said the state Medical Board’s Continuing Medical Education branch would oversee the training. Neither Pan nor Wiener specified if the trainers would be medical professionals or not.
Meanwhile, opponents of SB 923 claimed that trans activists and lobby groups would be paid by the state to provide the training.
During the hearing, Wiener criticized policies endorsed by red-state governors on everything from transgender bathrooms and sports to COVID-19 mask and vaccine mandates, as well as abortion, gun control, and the border crisis.
“It’s absolutely terrifying what states like Texas and Idaho and other states are doing right now to trans youth and to trans people in general,” Wiener said. “We have states in this country right now—and spreading like wildfire—that are literally classifying gender-affirming care as child abuse, and threatening to take trans children away from their parents and put them in foster care and then put the parents in prison simply because those parents are supporting their transgender children.”
Wiener claimed some states are “simply banning” health care for trans children and “criminalizing physicians” for providing that care.
“We have states that are prohibiting trans people from using the restroom that corresponds to their gender identity or banning trans youth from playing sports, and the list goes on and on and on. The message that that sends to trans people, particularly to trans youth, is horrific, and it’s no wonder that rates of self-harm are higher among trans kids,” he said. “There’s nothing inherent there. It’s because of the message that they’re receiving from society.”
Wiener said the bill would send a “strong message to the contrary” in support of the LGBT community.
Sen. Susan Talamantes Eggman (D-Stockton) asked Wiener if patients must first be diagnosed with gender dysphoria before getting cross-sex hormones.
“So Sen. Wiener, my understanding right now … is in order for someone to receive medication, or to begin any kind of transitioning process, they have to first have a diagnosis of gender dysphoria. …So someone who went to Planned Parenthood and received medications already had to have an evaluation to be given a diagnosis of gender dysphoria. Is that as you understand it?
Wieners stated that while he’s not a medical professional, “there are all sorts of protocols and different kinds of evaluations that people receive when they are considering transitioning.”
He said the bill does not define what medical care is, and it focuses on training and cultural competency.
“I know and represent a huge number of transgender people. I know an enormous number of transgender people who are extremely happy that they now have the correct gender identity that forms to who they are. And so, this whole notion that trans is fake and everyone is unhappy is just not true. I also know in San Francisco, we were blessed to have medical providers who provide excellent care,” said Wiener.
Planned Parenthood in Sacramento advertises “gender affirming hormone therapy” prominently on its website, and states that as part of its LBGTQ Services at B Street Health Center, potential patients can get cross-sex hormones on their first visit.
“In most cases your clinician will be able to prescribe hormones the same day as your first visit. No letter from a mental health provider is required,” Planned Parenthood states.
Patients under 18 can get the treatment with parental consent, Planned Parenthood states.
Planned Parenthood of California Central Coast also states on its website that no therapy is required to receive gender-affirming hormone therapy.
“We are committed to improving the way transgender people receive health care in our community, including eliminating barriers to that care,” Planned Parenthood states.
“We offer hormone therapy for patients 18 years and older at all of our 6 health centers. Patients do not need to participate in therapy or provide information from a mental health provider to receive care at one of our locations.”
The website states the initial appointment will include a review of the patient’s complete medical history, a thorough review of the patient’s transition goals, weight and blood pressure check, blood work, other routine evaluations, a discussion of how to take the hormones, and a prescription that the patient can take to a pharmacy.
Bill Moves Forward
SB 923 will be amended before it moves forward to the Senate Appropriations Committee.
“It’s no longer going to be a standalone mandated multi-hour training for every health care provider. Instead, it’s going to be woven into the existing continuing education,” Wiener said.