Beaufort's Elizabeth Foster speaks at the Statehouse in March about difficulties faced by her transgender brother.
COLUMBIA — Rebecca and David Bell sat together in the front row, her hand on his knee. They burst into tears as they watched a legislative committee vote to begin ripping away essential therapy from their transgender daughter.
They are among dozens, if not hundreds, of families in South Carolina that could be forced to leave the state to continue the care their children rely on as they transition. Their pleas and those of doctors have failed to stop legislation that barreled through the House of Representatives along party lines. It now is poised for debate on the Senate floor starting April 30 — days before the session ends.
If passed, all treatment and therapy for transgender youth would be legally barred in South Carolina.
The Bells and others have become reluctant public figures in the battle to continue care backed by most major medical organizations. But some parents plan to take the fight a step further and run against lawmakers who refused to listen to them.
“This is my state and I’m not giving it up,” said Jessicka Spearman of Pelzer, who has a transgender son and is running for state Senate against one of the main proponents of the ban on gender-affirming care for minors.
Rebecca Bell shops at H&M with her daughter, Mia, at the Tanger Outlets in North Charleston on March 9.
Energized for the fight
That ban, primarily on medications such as puberty blockers and cross-sex hormones, would be the second blow state lawmakers have dealt the Bells’ 15-year-old daughter, Mia. In 2022, a budget amendment essentially cut off her care at the Medical University of South Carolina. The Bells were among 150 families left to suddenly scramble for essential therapy with no warning from the clinic.
But the Bells eventually found another in-state provider Mia could see via telehealth. Things began to return to normal. Mia is taking an estrogen pill and a testosterone-blocking drug, which is also used to treat metastatic prostate cancer in men. Gone are the days when they had to schedule shots and use estrogen patches that sometimes fell off.
“The pills are so much easier,” David said in late December as he and Rebecca sat at the kitchen table in their West Ashley home. The family Christmas stockings hung on a nearby wall.
More important is the transformation Mia has made in the last year. Before she began gender-affirming therapy, there were “hours and hours of tantrums and just fighting us. Fight, fight, fight about everything,” David said. Now, Mia sat at the table and ate dinner with strangers, something she would never have voluntarily done before.
“She may have been quiet, but that is her way of participating,” Rebecca said. “She’s present. She’s listening. She’s there.”
David and Rebecca Bell speak during a rally after a state Senate subcommittee voted to move a bill that would ban gender-affirming health care for transgender youth on Feb. 14 at the Statehouse in Columbia.
Mia looks different, as well.
“That kid has grown so much,” David said. “She has blossomed. She’s definitely matured quite a bit. She’s responsible. She’s loving. She’s empathetic.”
She has two close friends, and the three girls are almost inseparable. Over the summer, Mia and David attended a camp where about half of the kids were LGBTQ. After struggling a bit at first, Mia wound up enjoying herself. It wasn’t until the end that she revealed she was trans, which came as a surprise to many other campers.
“At the end of the day, that’s what we want,” Rebecca said — for Mia to be accepted for who she is, as a girl without an asterisk.
“She’s grown so much in the last two years,” David said, fighting back tears. “It would be horrible if she were to never get the medication again.”
David testified last year at a legislative committee on a similar ban and he said it was emotionally overwhelming.
“If you would have asked me in July, I would have said I’m out, I’m not dealing with this any more,” he said.
But now, with everything going well, David is more energized for the fight. This time, Rebecca will come with him.
House debate
No one is exactly sure how many transgender adolescents there are in South Carolina. Dr. Elizabeth Mack, president of the South Carolina chapter of the American Academy of Pediatrics, was pressed for a number by legislators. Probably less than 2,000, she said.
Dr. Elizabeth Mack (left) and Rebecca Bell embrace after testifying at a Senate subcommittee hearing at the Statehouse in Columbia on Feb. 14.
The Post and Courier did its own analysis. Using an estimate from the Centers for Disease Control and Prevention that 0.7 percent of kids ages 12 to 17 are transgender, and using 2021 census figures for kids that age in South Carolina, that would be 2,816 transgender adolescents.
The bill, H. 4624, to ban gender transition therapy for those under age 18 was one of the first items to be taken up on the first day of the new legislative session Jan. 9, just hours after it began. The opposition was ready, as well.
As the House subcommittee hearing began, the room was packed. Some had to sit in an overflow room to watch. Parents, grandparents, doctors and advocates came from across the state despite a violent thunderstorm most of that afternoon.
David and Rebecca were among the first to step up. He is a retired Navy chief petty officer. Even though his daughter showed from age 3 she was a girl, it was years before he would accept it.
“It took a lot of her convincing me it was the right path,” David said, and a lot of talking and reading and researching for him to come around. But Mia never wavered.
“She said, ‘I would rather die than be a boy’,” David said.
Years of mental health therapy was followed by more than three years of monitoring by an endocrinologist until she reached puberty, and only then did Mia start on medication.
That slow and sometimes agonizing process, for both parent and child, flies in the face of what opponents to gender-affirming therapy characterize as a fad, Rebecca said. It also shows how much it will mean to lose it.
“I ask you, as parents, think of your child as they are sitting there asking for help. And you can’t give it to them,” Rebecca said. “I am really hoping you will think hard about this and the lives this really does impact. Because as parents, we don’t choose this journey for her. Oh my goodness, this is a painful journey. This is the last thing we want. Please, I am begging you, do not pass this bill.”
Rebecca Bell plays cards with her daughter, Mia, in West Ashley on March 9, 2024.
Wave after wave of families — mothers, sisters and brothers — expressed similar messages.
Elizabeth Foster of Beaufort could barely speak through her tears when talking about the change she saw in her brother Knox as he was able to transition.
“It didn’t make him more popular,” she said. “For the most part, he was alienated from his peers” and endured taunts and disrespect. Yet he was happy, finally openly living an identity he struggled with but had known for years.
“In a world that constantly insults, vilifies and invalidates young trans people, it is the absolute least you can do to ensure they are still respected and affirmed by their health care providers,” Foster said. But the legislation would deny them “the pure joy that comes from being able to live as one’s true self. This joy is not in any way harmful or dangerous to any one of you or any other South Carolinian.”
Jim Guilfoyle of Columbia stepped forward on behalf of his transgender granddaughter.
“There is nothing good in this bill for her and for the other youth of this state,” he said. And without that care “you leave them with some awful, awful options” that may drive some to suicide, he said.
It is not hyperbole. According to a 2023 survey by the Trevor Project advocacy group, transgender youth are more than four times as likely to attempt suicide, and 41 percent seriously considered it in the past year.
The legislation flies in the face of previous actions by the state to uphold parental rights, said advocate Phil Ford, who brought a large binder overstuffed with studies showing the care is safe and effective.
“We are South Carolina, y’all,” he said. “We’re supposed to be fighting for freedom. And we’re stripping that away from the Bells,” the Fosters and the other families testifying.
Of the 48 people who spoke, 47 were in opposition. The lone supporter was Matt Sharp, an attorney with the Arizona-based Alliance Defending Freedom, a well-funded conservative Christian legal group that took in $104 million in 2022 to oppose gender-affirming care, gay rights and abortion, among other issues.
Sharp appeared on a video call. He did not say from where.
“This bill protects children who deserve to experience a natural childhood, who are highly susceptible to peer pressure, social media and other negative influences,” Sharp said. “And who this Legislature has long protected from things we know are harmful and dangerous, like smoking, alcohol and even tanning beds.”
He pointed to Europe, where he said countries such as England, Finland and Sweden are turning away from this care, and have stopped using puberty blockers and hormones to treat gender dysphoria in adolescents.
That is partially true.
The United Kingdom’s National Health Service will not provide puberty blockers before age 16 but will provide gender-affirming hormones. In Finland, treatment is done on a case-by-case basis. Sweden has doubts whether the benefits outweigh the risk but also notes that “puberty-suppressing treatment can in some cases be considered to be of great benefit” to those who consistently show signs of gender dysphoria, a national advisory states.
In many of these countries, the provision of care was considered too laissez faire early on, without the proper confirmation and counseling. The recent guidelines are an attempt to rein that in.
In none of these countries is the care for adolescents banned.
But it is in 24 states in the U.S., including every state surrounding South Carolina. Nearly four in 10 transgender youth currently live in a state with a ban on care, according to the Kaiser Family Foundation. Many South Carolina legislators are eager for Palmetto State families to join them.
The ban flew through the House subcommittee, the full committee and, a week later, through the full House of Representatives, largely on party lines, becoming one of the first major pieces of legislation passed in the current session.
‘I know who I am’
Still, the Bells and other families were unbowed and prepared to return to testify Feb. 14 — Valentine’s Day — before the Senate subcommittee weighing the House-passed bill. But the night before they headed up, Mia gave her parents a message for the legislators pushing the bill.
“You are all trying to save the world, but instead you are making it worse,” she told her mother. “You are like high school bullies. I’m frustrated that this is about me, but nobody has talked to me. How many transgender people did you speak with? I am sad and angry that other kids get to grow up being who they are, but I am not being given a fair chance to be who I am. Why won’t people believe me? I know who I am.”
But Dr. Miriam Grossman would disagree with her.
David Bell holds a package of Tic Tac mints after a House subcommittee meeting at the Statehouse in Columbia on Jan. 10, 2024. The looming possibility of his daughter’s gender-affirming care being taken away, partnered with the persistent stress of nearly weekly appearances and testimonies at the Statehouse, has caused a lot of anxiety for the Bells. “The legislators are putting excessive anxiety on parents, all for the benefit of their reelection campaign,” David Bell said. “They are scared they are going to lose to someone more extreme, so they create an issue out of something that should be between a parent, child and their doctors. If they did nothing, this burden placed on parents to find care would be gone and it would allow us to better care for our family and ourselves. But we neglect ourselves to make sure our kids are taken care of.”
As someone who has made a career out of opposing sex education and gender transition therapy, Grossman testified to the Senate subcommittee by video link. She again pointed to concerns in Europe and declared that “the evidence against gender-affirming care has become formidable.”
Grossman, whose practice is mostly in New York and California, said she was sympathetic to those South Carolina families.
“I acknowledge that many kids and their families are suffering,” she said. But “if they lived in Stockholm or Oslo or London, they wouldn’t be eligible for medical interventions” — which is actually not true.
Senate Minority Leader Brad Hutto, D-Orangeburg, pointed out that her position is contrary to that of the American Medical Association and the American Academy of Pediatrics, among others, who say gender-affirming therapy is safe and effective for those children.
True, Grossman said, but “the legacy medical organizations in this country, many of them, have been captured by dangerous ideology.”
After Grossman told him the American Academy of Pediatrics is no longer credible, Hutto asked, “So pediatricians in South Carolina should just call you?” Laughter broke out across the overflow room, where opponents of the bill filled every seat.
Mack, who heads up the pediatrician group in South Carolina, has a different take. She said those who treat transgender adolescents in South Carolina carefully monitor the care and it “happens thoughtfully and not rapidly. Each step involves parents who know their child best.”
And Mack brought studies to back up why that care makes a difference.
In one study published in 2022 of 104 transgender adolescents, those who got puberty blockers and transgender hormones had a 73 percent reduction in suicidal thoughts and a 60 percent decrease in depression compared to those who had not gotten the medications.
In a larger study of nearly 22,000 who wanted to transition, those who received gender-affirming care had much lower rates of suicidal thoughts as adults compared to those who never accessed care. And those who got that care in early adolescence, as young as age 13, got a greater benefit than those who got the care as adults.
But in the Senate committee, opponents to the care raised a well-worn specter to explain why kids in South Carolina wanted to transition: social contagion, or the idea that they were influenced to think they are transgender.
Dianne Mitchell of Greenville County Republican Women, one of several Republican women’s groups to testify in favor of the bill, said there has been an astronomical increase in the number of children identifying as transgender in recent years, particularly girls.
“This is primarily driven by social contagion,” she said, an argument echoed by others.
Sen. Richard Cash, R-Anderson, who is a strong proponent of the bill, said he also has an idea of where it is happening, a place where parents may not know it is taking place.
“The social contagion is going on at the public schools,” he said.
They appeared to be referencing a theory known as “rapid-onset gender dysphoria,” which is from a 2018 study in which many parents reported that their children were suddenly identifying as transgender, and that it was predominantly adolescent or young adult females. The study noted that these children had peers who identified as such and that their social media use had increased.
The publisher of that study later issued a long correction where the authors conceded that:
- “Rapid-onset gender dysphoria” should not be used as a mental health diagnosis.
- It was a survey of 256 parents and not the children themselves.
- At least two of the main sites used to recruit the parents are openly opposed to gender-affirming care. One, a UK-based group called Transgender Trend
- Prominently features the motto, “No child is born into the wrong body.”
A 2022 study in the journal Pediatrics also debunked the idea that the number of transgender children is increasing, noting that a CDC national survey found that the number self-identifying as transgender declined from 2.4 percent in 2017 to 1.6 percent in 2019. The Williams Institute at UCLA, using the same data but from 2017-20, found that 1.4 percent of those ages 13-17 identify as transgender.
Some parents of transgender children find the idea that their kids were pressured into it absurd. Julia, now 14, of Anderson showed early signs that she did not consider herself a boy, said her mother, Elizabeth.
“By 5 or 6, we had some idea that she had some definite feminine preferences and that’s all we knew,” she said.
That progressed to the point that at age 11, Julia told them she was a girl. Julia had been home-schooled the entire time, but they met with other families regularly. Knowing the more-conservative tendencies of that group, however, the family cut ties. Having been raised in a very conservative Presbyterian church, Elizabeth and her family sought out a more-accepting one in First Baptist Church of Greenville.
Julia had by then transitioned to living as a girl, having started on puberty blockers a little more than two years ago and hormones about a year ago after extensive consultations with a therapist and pediatrician. Hers is a “stealth” transition for the most part, her mother said.
“Very few people in her life know she’s transgender, unless she tells them,” Elizabeth said.
Spearman, who has a 15-year-old transgender son, Ray, also finds that contagion theory puzzling.
“My kid was never around trans people, did not read books about being trans, none of those things,” she said.
Still the ban on various justifications has moved forward through the state Senate. And the families that will feel the brunt of it wait, with it dangling over their heads, and try to plan for the future to get their children the care they need.
Kristen French’s transgender daughter, 16-year-old Beatrice, has already been through that once. By the time she told her parents and they began looking for a provider, MUSC had already abandoned its program. The family eventually found someone in the Charleston area, but that could end with the ban.
“It’s really hard to plan for all of the contingencies,” said French, a former member of the Charleston County School Board.
Spearman of Pelzer agreed.
“It’s an anxious place to be: trying to coordinate care, trying to balance advocating for your family and other people’s families because not everyone is in that position that we are in,” she said.
Her husband, Eric Childs, a combat veteran, has already gone viral in a video where he shoots guns with their transgender son on a practice range and advocates for trans rights.
Spearman joked they have contingency plans “A, B, C, D, E, F and G” if a ban goes through.
“No matter what, we know by whatever means we have to, our kid is still going to get that health care,” she said.
One thing the families said they are not going to do is give up quietly.
“We will not disappear,” French told the Senate subcommittee. “We are going to stay. We are going to fight.”
Spearman is challenging Cash for the Senate District 3 seat. Childs, her husband, is running in House District 6. Another advocate for trans rights, Ford, is vying to represent House District 93.
David Bell wears a Navy pin and a rainbow pin with transgender flag colors while at the Statehouse in Columbia on Feb. 14, 2024. Bell served as a chief petty officer in the Navy.
Despite the easy journey for the ban in the heavily Republican state Legislature, the families don’t believe that represents the views of the state on the issue. And they might be right: A poll released in late March by advocacy group AFFA Action found 71 percent of respondents said the government should not intervene if parents are seeking gender-affirming care for their minor child, while only 21 percent supported it.
And because they have had to come out and protest, have had to speak out against the legislation, the transgender families have made connections and reached out to support one another.
“We all know each other now,” Spearman said.
Where once it was just them and a few others like French speaking out publicly, the Bells can now stand in front of a throng of people filling the Statehouse steps in Columbia, many sporting the pink and blue colors of transgender awareness, and know their family is not alone.
At one time, the Bells contemplated different arrangements for Mia to continue receiving the care that has made such a difference in her life. And for now, David is keeping their plans vague. It might involve stockpiling, using telehealth, seeing a provider in another state.
He, like many other parents of transgender youth in South Carolina, worries about the recent action the Texas attorney general took in trying to get patient records about gender-affirming care in other states, and whether others will try, as well.
But the Bells also have a recent victory in getting a court to change Mia’s gender on official state documents. That means when she gets a state ID card or her driver’s license, she can continue to be who she is.
Because Mia is staying in South Carolina.
“It’s where she was born,” her father said. “Why should she move?”
