Gov. Bill Lee delivers his State of the State address in Nashville, Tenn., on Monday, Feb. 6, 2023.
Gov. Bill Lee

Tennessee Gov. Bill Lee on Thursday signed into law a total ban on gender-affirming health care for transgender children, despite calls for him to veto the bill and threats of incoming litigation.

Lee also signed off on a new law to prohibit “adult-oriented” entertainment, including “male and female impersonators,” from public property and limit it to age-restricted venues. The legislation, filed after a flurry of drag show controversies in Tennessee, is not a total ban of drag, though opponents worry it could open the door to wider legal battles over the performance art.

The new health law bans medications such as puberty blockers and hormone treatments to treat any underlying gender dysphoria cause, affecting Tennessee children who identify as transgender and nonbinary. Surgeries, which were rare in Tennessee, are also banned.

Children who currently take the medications will have until March 31, 2024, to cycle off of treatment. The law, which was fast-tracked by the legislature’s Republican supermajority in this year’s legislative session, will officially go into effect this summer.

The American Civil Liberties Union plans to sue over the bill.

“We will not allow this dangerous law to stand. Certain politicians and Governor Lee have made no secret of their intent to discriminate against youth who are transgender or their willful ignorance about the life-saving health care they seek to ban,” the American Civil Liberties Union, the ACLU of Tennessee, and Lambda Legal said in a joint statement Thursday.

“Instead, they’ve chosen fearmongering, misrepresentations, intimidation and extremist politics over the rights of families and the lives of transgender youth in Tennessee. We are dedicated to overturning this unconstitutional law and are confident the state will find itself completely incapable of defending it in court. We want transgender youth to know they are not alone and this fight is not over.”

The law was narrowly tailored not to ban any one medication, but rather medical treatment of an underlying diagnosis: gender dysphoria, in addition to “gender identity disorder, gender incongruence, or any mental condition, disorder, disability, or abnormality.”

Lawmakers filed the legislation after a high-profile controversy in the fall over Vanderbilt University Medical Center offering gender-transition care. Conservative commentators seized on the issue and misinformation spread that doctors were performing genital surgeries on minors. Vanderbilt denied the claims, while stating they performed a very small number of gender-affirming procedures, chest surgeries, per year on patients 16 and older with full parental consent.

House Majority Leader William Lamberth, R-Portland, the House sponsor, said minors lack the maturity to make “life-altering” medical decisions before they become adults.

“These treatments and procedures have a lifetime of negative consequences that are irreversible,” he said.

Democrats argued the GOP’s position is inconsistent and targeted at trans and nonbinary youth, an already vulnerable population. The law still allows minors to seek cosmetic or gender-affirming surgeries such as breast reductions, as long as gender dysphoria or gender identity issues aren’t involved.

Major U.S. medical associations, such as the American Medical Association and the American Academy of Pediatrics, have supported gender transition health care as evidence-based medicine.

The Tennessee chapter of the American Academy of Pediatrics urged Lee last week not to sign the bill.

“This bill limits access to healthcare and interferes with the physician-patient relationship and parental choice,” the chapter said in a statement. “As pediatricians, we follow evidence-based medicine and clinical practice guidelines rather than politics. This law will significantly limit our ability to practice to the standard of care established by numerous national medical organizations. Comprehensive gender affirming care, conducted in a close, coordinated setting with doctors, mental health practitioners, and families is safe, effective, and can be lifesaving.”

Drag bill signed

The drag-related bill, Senate Bill 3, bans “adult-oriented performances that are harmful to minors,” as defined in Tennessee’s obscenity law, from public spaces or venues that aren’t age restricted.

The law will take affect on April 1.

Since the bill was filed, some Republicans have said it would not broadly affect drag shows, only those with material that fits under the state’s existing obscenity laws and under a strict obscenity test defined by the U.S. Supreme Court.

However, bill sponsor Rep. Chris Todd, R-Madison County, filed the legislation after he fought a public Pride drag show in Jackson, Tennessee. Todd at the time called the drag show “child abuse,” though he said he wasn’t aware of the actual content the show would contain. In a House floor debate in February, Todd again suggested the drag show was inherently inappropriate for minors.

“This is a common-sense, child safety bill, and I appreciate your support,” Todd said.

Democrats criticized the motivation behind the bill, pointing out that minors are already protected from “obscene” material under state law.

It’s unclear how exactly the law might be enforced, but it could open up another avenue to challenge drag show performances in court. Violation of the law are a Class A misdemeanor on first offense and a Class E felony on second or subsequent offenses.

Stella Yarbrough, ACLU of Tennessee legal director, said the group is “disappointed” Lee signed the bill.

“However, I want to be abundantly clear: the law that was just signed does not make it illegal to perform in drag in Tennessee. The law bans obscene performances, and drag performances are not inherently obscene,” Yarbrough said. “However, we are concerned that government officials could easily abuse this law to censor people based on their own subjective viewpoints of what they deem appropriate, chilling protected free speech and sending a message to LGBTQ Tennesseans that they are not welcome in our state.”

Drag shows across Tennessee have faced opposition from local governments in recent months, in addition to protests at recent drag performances at Diskin Cider in Nashville and other locations. In January, masked protestors brandished Nazi slogans and chanted anti-LGBTQ slurs outside a Cookeville event, WPLN reported.

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