Sam Edelman felt like a girl for as long as he could remember, his dad said. As Sam's 18th birthday approached, and after years of researching hormone treatments, the high school senior scheduled an appointment with a doctor who treats transgender people.
It was a big step for Sam, a musician, a runner, a snowboarder and a taekwondo black belt who still identified as a boy at that point and had shared his secret only with his family and closest confidants.
The doctor said Sam was too young and thought it unlikely that any doctor would treat the Bozeman, Montana, teen for the same reason. Ten months later, on Feb. 20, 2016, Sam died by suicide.
"Sam was devastated," said Adam Edelman, Sam's father, recalling that visit with the doctor. "He lost hope."
As legislatures meet across the U.S. to write new laws, at least 16 states are considering measures that would affect transgender athletes or those seeking treatment for gender dysphoria — the persistent and distressing feeling that one's gender is different from the sex noted on the person's birth certificate.
This wave of state legislation follows 79 anti-transgender measures introduced in statehouses last year. Nearly all were defeated.
Adam Edelman was motivated to tell Sam's story as Montana lawmakers considered two proposals: criminalizing doctors who treat transgender minors and banning transgender student-athletes from competing under their self-identified sex. One Montana bill would have fined doctors who provided treatment with medicines like puberty blockers to anyone under age 18 up to $5,000; even a referral to another medical expert could threaten a doctor's medical license. That bill was narrowly defeated in the Montana House of Representatives in January, 51-49.
The House passed a separate measure that would ban transgender athletes from competing on teams that don't align with their sex at birth. The state Senate is considering the proposed ban, though opponents of the measure say there are no existing conflicts or disputes in schools that would make a ban necessary.
At least 10 states besides Montana are considering similar bills restricting transgender student-athletes this session: Connecticut, Hawaii, Iowa, Kentucky, Mississippi, New Hampshire, North Dakota, Oklahoma, Tennessee and Texas.
Montana's bill to criminalize doctors for medically treating transgender children — which can still be revived with enough votes — is similar to bills being considered in at least 10 other states this year: Alabama, Iowa, Indiana, Mississippi, Missouri, Oklahoma, South Carolina, Tennessee, Texas and Utah.
This push across the U.S. is happening despite a decision by President Joe Biden shortly after his inauguration to lift LGBTQ restrictions in the military by executive order. It also comes after North Carolina lost an estimated $3.76 billion to boycotts following a 2016 law requiring people to use the bathroom that matches their birth gender. That law has since been repealed.
Laura Haynes, a retired faith-based clinical psychologist, is a major advocate of bills to ban medical intervention for transgender youth. Traveling from her home in California to testify before a Montana House committee hearing, she argued that social influences and media glamorization have led to a huge increase in youth identifying as transgender.
Most would eventually embrace their birth sex if adults just "watched and waited," said Haynes, who also supports conversion therapy for gays and lesbians.
She and proponents of the measures raise the specter of children undergoing dangerous and irreversible treatment.
"Experimental treatment affirming gender identity leads to puberty blockers, toxic wrong-sex hormones, organs devoid of function or pleasure, and potential mutilation of sex organs," said Haynes.
But the treatments are not experimental, and surgeries are not approved for youths under age 18, said Dr. Colleen Wood, one of four pediatric endocrinologists in Montana.
Medical association protocols call for no medical intervention before puberty. If youths persist in feeling distressed about their bodies once puberty begins, an arduous process commences.
If both parents consent and a mental health professional agrees, a teen might be approved for a puberty blocker prescription. Blockers have been used for 40 years to treat children with early onset of puberty and are reversible, said Dr. Lauren Wilson, vice president of Montana's chapter of the American Academy of Pediatrics.
Blockers are typically taken for five years before hormone therapy is considered. After teens have lived as the gender they embrace and undergone a comprehensive mental health assessment, they might be prescribed estrogen or testosterone.
If the hormones are stopped, the results are largely reversible, although some breast tissue may remain from estrogen, and a deepening of the voice and clitoris enlargement might be permanent from testosterone, said Wood. Infertility is a possible outcome.
A Cornell University review of 55 peer-reviewed studies found that 93% showed gender transition improved the overall well-being of transgender people, while 7% found mixed results or no differences.
Of the bills involving transgender people that were considered last year in states — including medical treatment bans, sports bans and hurdles to changing sex designations on documents like driver's licenses — all failed except a sports ban in Idaho. A federal district court later ruled the Idaho law unconstitutional and issued an injunction. The case is now before the 9th Circuit Court of Appeals.
The sports bans run counter to NCAA rules, which state that transgender females who were born male may compete on female teams if they have been taking hormones for one year. Laws that don't follow NCAA rules could result in those states being banned from hosting championship games.
Montana Republican Rep. Braxton Mitchell, a 20-year-old freshman lawmaker and supporter of the Montana measure, was dismissive of potential consequences. "My House district is nearly 1,800 miles and a 27-hour drive from the NCAA" headquarters in Indianapolis, he said. "We will hold our own."
Without legislative action, Mitchell said, he worried that women's sports in the state will be ruined.
"Someone can wake up one morning and say, 'I'm a man today,' or 'I'm a woman today,' as a tactic to win in sports," Mitchell said.
That's not how it works, said Jaime Gabrielli, the mother of a child born female who identified as a boy as a toddler. When taken to the store to choose "big kid pants" during potty training, he ran to the boys' section and chose SpongeBob SquarePants briefs. At age 4, he begged for a boy's haircut and instead was given a pageboy with bangs. He "fixed" it by cutting off his own hair.
Presenting himself to the world as a boy transformed his life, said Gabrielli. For the first time, he didn't dread school, didn't avoid going to movies and social events, and didn't experience as much extreme anxiety.
If the bills pass, civil rights groups have vowed to challenge them on constitutional grounds and as a violation of other legal protections. In addition to the equality issues these bills raise, civil liberty advocates questioned their practicality.
"It is unclear what would happen in Montana if someone disputes whether a person is in the ‘correct' category," said Alex Rate, legal director of the Montana ACLU.
Then there are the changing attitudes about children who question their gender. A father from rural Montana said in an anonymous letter to the Montana legislature that five years ago he would have supported both bills.
Those were the years he had tried to prevent his child, born a boy, from expressing identity as a girl.
"After I found my 12-year-old sitting in the dark with a handgun one night, I realized I need to learn from my daughter who she was, instead of me trying to tell her who I thought she was," the man wrote.
Treatment, he added, saved her life. And he no longer supports bills like the ones before the Montana Legislature.
This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.