Nebraska Regs Require 7-Day Waiting Period, 40 ‘Neutral’ Therapy Hours for Minor Gender Transition Drugs

The Nebraska Department of Health and Human Services (HHS) adopted emergency regulations Sunday to “govern the use of nonsurgical pharmaceutical gender altering treatments.” The Let Them Grow Act, enacted in May, took effect on October 1 and directed Chief Medical Officer (CMO) Dr. Timothy Tesmer to regulate the prescription of puberty blockers and cross-sex hormones for minors.

The regulations require practitioners who prescribe puberty blocking drugs to “determine or document” that the patient “has at least six consecutive months of living primarily as the preferred gender,” has received “a minimum of 40 gender-identity-focused contact hours of therapeutic treatment,” and has been screened for “other mental or physical health conditions” that are receiving proper treatment. The regulations also require “a minimum waiting period of seven calendar days” between the date a patient provides informed consent and the date that puberty blockers are prescribed.

In an undercover video released in April, a social worker at a transgender center in Texas said that “a prescription for puberty blockers might be appropriate after one” appointment because “it’s not something that we want to gatekeep.”

Of the 22 states with laws protecting children from gender transition procedures, the Nebraska Let Them Grow Act is among the more modest. It prohibited all gender transition surgeries for minors, but it allows gender transition hormone treatments that comply with health regulations it directed the CMO to create. The law directed the regulations to include a minimum number of “gender-identity-focused therapeutic hours” and minimum waiting period, as well as guidance on documentation and informed consent.

Nebraska State Sen. Michaela Cavanaugh (D) filibustered the entire legislative session over the Let Them Grow Act. “These bills are steppingstones in the eradication of trans Nebraskans, and voting for them is voting for a stepping stone in genocide,” said Cavanaugh.

Bill sponsor Nebraska Sen. Kathleen Kauth (R) had in January introduced a bill to fully protect minors from all gender transition procedures, but the final version was substantially different. The bill required the support of a supermajority (60%) to advance it in three separate votes over an unprecedented filibuster in the unicameral legislature. Republicans were one vote short of the required threshold, so each vote required the support of every Republican plus one pro-family Democrat, who supported the legislation. According to sources, moderate Republicans only agreed to vote for the bill if it was watered down.

The final hurdle Nebraska lawmakers cleared to pass the Let Them Grow Act was an attempt by pro-trans protestors to derail the vote. With only days left in the legislative session, protestors interrupted proceedings with loud chants from the gallery, throwing dirty tampons on the senators below. The legislature recessed until the galleries were cleared and several arrests made. At one point, protestors occupied the capitol rotunda, blocking the doors and prompting police to evacuate senators through a construction zone. “We had senators leaking where senators were evacuating to, so that the angry mob could go catch them there,” said state Senator Julie Slama (R).

The ACLU of Nebraska publicized a “rally for trans rights” at the Nebraska capitol on October 1, the day the law went into effect. Grant Friedman, a legal fellow for the American Civil Liberties Union of Nebraska, criticized the legislation as unnecessary, arguing that Nebraska practitioners already follow the international standards set for the World Professional Association for Transgender Health (WPATH), a pro-trans advocacy group. The ACLU sued to have the legislation declared unconstitutional and plans to appeal after a state court ruled against them in August.

In a complementary FAQ document, the Nebraska HHS explained that 40 hours would “allow for sufficient therapeutic treatment time and to develop a thorough understanding of a patient’s needs and determining appropriateness for treatment.” Additionally, “the 40 therapeutic hours would also allow adequate time to determine any additional co-occurring conditions,” added the document. “In addition, pharmaceutical treatment could produce life-altering changes to a minor’s body. It is important for minors to have ample time to consider these life-changing effects.” Similarly, the seven-day waiting period “is necessary to allow the patient and the patient's family enough time to weigh the risks and benefits of treatment.”

The regulations further require practitioners to complete a three-hour Category 1 Continuing Competency Education training produced by the American Medical Association, document “that there is no reasonable expectation of natural resolution of gender nonconformity,” document that the 40 hours of therapy is “clinically neutral and not in a gender affirming or conversion context,” and “ensure adequate familial support during and post treatment” of unemancipated minors.

A whistleblower from a Missouri transgender center described how staff would bully parents by misinforming them with scary hypotheticals. “A common tactic was for doctors to tell the parent of a [girl], ‘You can either have a living son or a dead daughter,’” she said.

To prescribe cross-sex hormones, practitioners must comply with largely the same requirements that pertain to puberty blockers. Additionally, they must “determine or document” that “puberty blocking treatment, if occurring, has been successful at reducing patient distress and discomfort.”

Practitioners may count “up to two hours per week” of contact therapy hours after “an initial assessment of up to four consecutive hours”; this means the 40-hour minimum requirement will take at least 19 weeks to complete. Practitioners must give a patient “at least one therapeutic contact hour every 90 days” while the patient is on puberty blockers or cross-sex hormones.

The regulation also provides guidelines for informed consent forms. These forms must include “all known side effects,” a “list of alternatives to treatment,” and “whether the medication is being prescribed for off-label use or otherwise not approved by the Food and Drug Administration.” Last year, the FDA placed a warning label on puberty blocking drugs that had caused symptoms such as brain tumors and blindness in several young girls.

“I appreciate the thorough work put in by Dr. Tesmer and his team to get the emergency regulations drafted and to me for approval on the effective date of the law,” remarked Nebraska Governor Jim Pillen (R). “These regulations provide the guidance necessary to ensure that Nebraska kids are protected from medical treatments and surgeries that could result in irreparable harm.”