(logo whooshes) - [Stan] Coming up on Impact.

Some treatments for transgender youth are now outlawed in Montana.

- [John] The state has a vested interest in protecting children.

- [Stan] But some families say they depend on this care.

- Feel just so much better.

- [Stan] We'll examine the issue.

(logo whooshes) And last year's devastating floods swept through this Red Lodge neighborhood.

This year, the town is ready for anything - So we would just rather be prepared this year.

- [Stan] We'll head there to check in on residents and first responders.

(logo whooshes) That's next on Impact.

- [Announcer] Production of Impact is made possible with support from the Otto Bremer Trust.

Investing in people, places, and opportunities in our region.

Online at ottobremer.org.

The Greater Montana Foundation.

Encouraging communication on issues, trends, and values of importance to Montanans.

And viewers like you who are friends of Montana PBS.

Thank you.

(logo whooshes) - Welcome to Impact, our continuing series, dedicated to in-depth reporting on issues important to Montanans.

I'm Stan Parker.

A new Montana law bans the use of certain medical treatments for minors with gender dysphoria, the psychological distress that can come from a disconnect between one's sex and gender identity.

The Republican lawmakers behind this effort say it's all about protecting children.

But opponents say the law is discriminatory, dangerous, and unethical.

Now, families and medical providers are coming to grips with the new law.

Montana PBS's Joe Lesar has the story.

(woman chuckles) - [Sid] I'm a disgrace the cooking world 'cause I put rice and I put corn in my fried rice.

- [Joe] It's 17-year-old Sid Beardslee's turn to cook dinner.

- [Sid] It's good.

- All good?

- [Sid] Mm-hmm.

- Okay.

Come get up.

- Yeah.

- [Jessy] Okay.

- Eventually, like I think it was when I was 12 I hit the point where my brain just like, I don't really feel like a female.

Like it's awkward, but I just don't feel like one.

And so, I kinda push myself a little further and then once I hit 14, I kind of hit the point of like, no, I'm definitely not a female.

Like I just don't look right, I don't feel right.

I'm not confident in myself.

- [Joe] Sid identifies as non-binary trans-masculine.

Born female, Sid neither identifies as a boy or a girl but feels a connection to masculinity.

- Like they've never been perfection of any type of child, they've been every kid.

They've been a monkey-climbing trees, they've been my Rapunzel princess wearing the dress and the beautiful long flowing hair.

- It wasn't really a surprise when Sid came out.

I mean I kind of always knew they were a little different but.

- [Joe] While they weren't exactly surprised when Sid came out, it did take some time to adjust.

- [Jessy] It's definitely scary for five seconds 'cause you say, what does that mean?

- [Joe] For the Beardslees, that meant getting treatment to affirm Sid's gender identity.

At 14, Sid started taking puberty blockers and at 17 began hormone therapy.

The Beardslees firmly feel that this was the right choice for Sid.

- It's basically just grown my confidence.

It's made me a lot happier and I actually feel like I have a future.

I can grow up, be an adult like (chuckles) I'm ready to exist on this planet.

- [Joe] Sid turns 18 later this year and will then be able to make their own medical decisions.

But when Senate Bill 99 takes effect on October 1st, families seeking the same care that help Sid will no longer be able to do so.

Montana is one of 18 states that have passed similar laws.

Montana's bill bans puberty blockers, hormones, and surgeries to treat minors with gender dysphoria.

Healthcare providers would be hit with a one year suspension for providing the treatments.

Supporters of the bill call the treatments mutilation while opponents call it lifesaving.

- If you vote yes on this bill and yes on these amendments, I hope the next time there's an invocation, when you bow your heads in prayer, you see the blood on your hands.

- [Joe] That remark made by Democratic Representative Zooey Zephyr, the state's first openly transgender lawmaker, brought a crackdown from Republican leadership drawing national and international attention.

The contention on the house floor echoed the emotionally charged public testimony delivered at committee hearings.

- So why, as a responsible parent, would you subject your child to these drugs?

This is child abuse.

- If I and other trans people never have to hear you speak again, it will be far too soon.

- [Joe] Republican Senator John Fuller carried the bill.

He carried a similar bill last session that failed.

Fuller says his motivation is to protect children from the poorly understood long-term effects and the irreversibility of some of the treatments.

- Children live under the guidance and guardianship of adults precisely because they lack the maturity, prudence, and experience to make safe and responsible decisions for themselves.

- [Joe] Gender dysphoria is the clinically significant distress.

It comes from a disconnect between one's sex and the gender they identify with.

The long-term side effects and efficacy of puberty blockers in hormone therapy are not fully understood.

Researchers are currently studying how they impact brain development and fertility.

However, the treatments have been shown to reduce depression and suicidal thoughts.

In major medical groups in the US, including the American Medical Association, the American Academy of Pediatrics, and the US Department of Health and Human Services support these treatments and deem them medically necessary.

- We wouldn't see all of the medical associations in the US providing support for this care without an evidence base.

- That's the same medical authorities that said that lobotomies were best practices for manic depression and schizophrenia well within my lifetime.

So, I'm not impressed by their arguments.

- [Joe] The unknowns and an increasing number of gender dysphoria diagnoses have several European countries questioning the blockers and hormones.

Sweden has limited hormone therapy to research or exceptional circumstances saying that the risks currently outweigh the possible benefits.

However, none of these countries have banned the treatments.

Dr. Lauren Wilson is the President of the Montana Chapter of the American Academy of Pediatrics.

She says she's seen the benefits of this care firsthand and believes the ban is a step backward.

- The response that we're seeing where people ban care completely is the antithesis of what we need to do in medicine which is to study and improve care as we go.

- [Joe] Puberty blockers have been used for decades to treat children whose bodies start puberty too early.

Dr. Wilson says their effects are reversible.

The effects of hormones are considered partially reversible.

Gender reaffirming surgeries on minors are rare and Dr. Wilson says bottom surgeries are not performed anywhere in Montana on minors.

Opponents pointed to increased rates of depression and suicide among transgender youth.

Child and adolescent psychiatrist, Dr. Heather Zaluski says that part of the cause comes from external stigma.

- It's not the fact that they're gender diverse, it's the fact that they have to live in silence, they have to live in shame, they have to deal with the stigma.

- [Joe] Sid can attest.

When they began expressing their gender identity, they were mocked in public by random people and bullied at school.

- Yes, I struggled a lot with suicidal thoughts.

I didn't have an idea of who I could possibly be in the future.

No real goal, no real like job for my brain to wanna focus on.

- [Joe] Zaluski says, for some children, waiting until they're 18 to start care is too great of a risk.

- Well, first of all, they could die.

And then they're not gonna be 18.

So I think that we have to think in those terms.

I mean, that's really what is at stake here.

- [Joe] The bill also bans public school employees from promoting what's known as social transitioning.

Things like wearing different clothes or using a different name.

Dr. Emily Sallee with the Montana School Counselor's Association says the effect of that rule will look different depending on a school's administration.

- So some are saying, no, absolutely no conversations with students.

You can't at all engage in that conversation around gender identity.

You know, shut it down, talk to parents.

Whereas others are saying if it's student-led and student initiated, you can certainly create that space and have those conversations.

- [Joe] Dr. Sallee says she's concerned about the kids who don't have a supportive home and need advocates at school.

- So I think in large part when we're talking about shutting off that opportunity for kids to talk to school counselors when maybe they don't feel comfortable talking to parents, we're just increasing that risk for suicidality and self-harm and other.

- When the medical community is so quick to automatically assume that if we don't do this, this child is going to do that.

I'm not persuaded.

- [Joe] The number of transgender children age 13 to 17 has doubled since 2017.

In Dr. Zaluski's opinion, increased awareness of gender variance has made children more comfortable in expressing their identities.

- I think it's probably multifactorial and I don't think we understand all of the components but a lot of it is I feel like it's the reduction of, a reduction in stigma and a greater acceptance societally about people being gender diverse.

- [Joe] Proponents of the ban argue that that same awareness mixed with social media and the impressionability of minors has created a fad.

They also point to cases where adults come to regret their care and are now re-identifying as their birth sex, a process called detransitioning.

Some feel they were rushed into treatment or not given adequate mental health screening beforehand.

Dr. Zaluski says that these stories are important and will play a role in improving the field.

- I really feel for them and I feel like the interventions they received have also contributed to their trauma, and that's tragic.

So I would never want to criticize those people.

I think they're very brave for sharing their stories.

- [Joe] Once again, data in this area varies but studies suggest rates of regret and detransition are low, and that external factors like family and societal pressure often play a role.

Zaluski says regret is common in many medical procedures but in Fuller's eyes, the stakes with these treatments are too high and that it's lawmakers' responsibility to shield children from the possibility of regret.

- [Group] Liberty and justice for all.

- We protect children from all kinds of things.

We don't allow them to consume alcohol.

We don't allow them to consume tobacco products.

- [Joe] Fuller says the new law falls within the vested interest the state has in managing the welfare of children.

But opponents argue it's an overreach by the government into the personal decisions of families.

A push for parents' rights grew out of the pandemic.

A bill expanding parents' rights in education is currently on the governor's desk.

but Jessy and Brandon say their rights are being stripped.

- And now to be told like, "Oh you're not doing a very good job as a parent."

Like (sighs) it's a parent's worst nightmare.

- The biggest thing that I see is taking away our ability to make an informed decision.

I mean, a decision that's taken five years to make is not taken lightly.

- Right.

- [Joe] Dr. Wilson says that medical providers don't take these decisions lightly either.

- And so, oftentimes families would like to start the therapy right away and it's the medical team that is making sure that all of the evaluations are in place and that we followed the patient over time.

A diagnosis of gender dysphoria, for example, requires at least six months.

- [Joe] Dr. Wilson says that medical providers look for insistent, consistent, and persistent expression of a child's gender identity before considering medical interventions.

- It's not as if someone comes in and just says, "This is who I am today," and everyone panics and runs to the doctor.

This is a process.

- [Joe] Supporters of the ban worry that adolescents aren't mature enough to understand the risks.

The Beardslee say the risks were well-communicated to them by their medical providers.

They also say the process was difficult and time-consuming.

- This has not been butterflies and rainbows for us, you know?

So we have to have pediatrician sign off to go to the endocrinologist, endocrinologist sign off to go to a therapist.

Therapist has a sign off to say that they- - A therapist had to go and had to actually evaluate Sid over a period of time.

- Right.

- It's not like I'm just getting it off the street.

No, I have to go to doctors.

I have to get diagnosises.

- [Joe] One of the few agreements in the debate over Senate Bill 99 was that Montana's transgender minors need care and compassion.

But whose hands should the decisions about how best to provide that be in, families and medical providers or lawmakers?

When it comes to gender affirming care in Montana, our legislature has spoken.

For Impact, I'm Joe Lesar.

- A legal fight against the law is already underway.

A group of families and caregivers has asked a state court judge in Missoula to find the law violates fundamental rights enshrined in the Montana Constitution.

Summer is right around the corner and Montana waterways are beginning their yearly rise.

In Red Lodge, memories of this time last year are all too fresh when record-breaking floodwaters tore straight down main street and rushed through a quiet neighborhood.

A year later we checked back in to see what recovery and resilience look like.

There's a cool drizzle here on this Saturday morning in Red Lodge but that didn't stop these volunteers from showing up to fill sandbags.

- It was pouring down rain at 8:00 and we were wondering what the turnout was gonna be like and the rain didn't keep anybody away.

So, it seems like everybody's here and anxious to help.

- [Stan] Micah Hoffman is a Red Lodge resident who helped organize this effort.

There's a lot of bags to fill but everyone here hopes they won't actually need them.

- [Micah] The goal is to make about 5,000 sandbags 'cause we don't wanna be caught off guard again like we were last year.

(gentle music) - [Stan] This was the scene in this neighborhood a year ago.

Heavy rains soaked a blanket of warm, late season snow sending a torrent of combined rainfall and snow melt rushing from the mountains faster than anything in memory.

On the Yellowstone, floodwaters washed out roads severing access to Yellowstone National Park.

Entire structures were swept away in the current, and here in Red Lodge, Rock Creek got pinched at 19th Street Bridge, took a left turn and headed straight down Broadway.

Amazingly, no one was hurt.

(rattling) In the days after the June 2022 flood, the rocks, trees and debris left behind was a clear reminder that nature does what it wants.

Its will to reclaim should not be underestimated but neither should the will of humans to roll up their sleeves and get to work, and to come to the aid of their neighbors.

- We're just taking care of the people and see whatever needs that we can hopefully meet for them.

- [Stan] Sarah Ewald, an EMT with Red Lodge Fire Rescue, went out with her colleagues to assess what people needed.

In some cases, just a hug or a good laugh.

- No, man.

- I think if you back it up it'll work.

(group laughing) - [Stan] What they found at Matt Martin's house, a yard full of soggy possessions dredged up from the basement and a lot of helpers.

- Oh, look at your stairs.

- There may be different shoes and stuff.

- Last skirts.

- That's growth.

- Yeah.

- People just showed up.

People like knew, barely knew, didn't know it all just came in and just started helping.

It was a pretty amazing response.

I mean, every house had a bunch of people in it helping them out.

Community is amazing.

The place is just crawling with quality people that are stepping up to help out.

- [Stan] For Red Lodge residents, the flood also brought a sense of whiplash.

Exactly a year prior, a close by wildfire forced evacuations and kicked off a treacherous fire season.

- I think the community was starting to heal again and then this is obviously just opens the, opens the wound back up in a very different way.

I mean, you know, we're used to fires here.

Flooding is more unusual.

It's something that we don't, we don't know how to train for really and we just, you just sort of guess and you hope.

You hope that you can guess right.

(rattling) - [Stan] It's been a year now and construction continues along Rock Creek as the spring runoff begins anew.

There's a sense of cautious optimism here for a fun and normal recreation season.

EMT Amy Hyfield is the volunteer coordinator and public information officer at Red Lodge Fire Rescue.

- Hoping to have fun this summer and not have another thing happen.

And also meeting that with a little bit of humor, you know?

I definitely have heard of some polls about people like what's gonna be the disaster this year?

(laughs) Locust or alien invasion or an earthquake.

- [Stan] Jokes aside, being prepared for anything is an important way to build resilience to natural disasters.

With climate experts warning that droughts, floods, and fires will become more common.

preparation and strong community bonds are key.

Hyfield says Red Lodge Fire Rescue has done more training on flood response, such as practicing community evacuation notices.

And they've also looked into ways to incorporate help from the community.

- There's a lot of other people in the community that wanna help out whenever a tragedy like that arises.

And so, how can we help out with the training and understanding that we have in organizing and helping make sure that they're able to be effective in a safe way.

- [Stan] The number of folks out here to fill sandbags shows just how many people in this community are ready to defend their homes and those of their neighbors should the need come.

Matt Martin is out here today too.

- [Matt] We've had experts come in and consult with a lot of the homeowners and say, okay, this is how you protect your house.

Trying to be strategic about where we place sandbags so that it doesn't come into our house.

- [Stan] Now his once flooded basement is clean and dry, thanks to the help of countless volunteers.

Down to bare studs, it's not a bad spot for his workshop.

And even in light of what's happened last year, it hasn't soured his feelings about this special place.

- They say the river's changed and it obviously has and we need to just be prepared for things.

But I like being here.

This is a great location and we're happy here.

- Experts say that as our climate changes, we can expect severe weather events like droughts and floods to happen more often.

What does that mean for those who live along Montana's waterways?

Dr. Susan Gilbertz teaches about sustainability in the Yellowstone River Valley at Montana State University Billings.

I sat down with her to learn more about the shifting balance between humans and our natural home.

I know that your research has consisted of hundreds of interviews with people who have lived all along the Yellowstone, and I'm sure you've found that people love this place, have you not?

- Oh, yes.

And they're poetic in how they talk about it.

That's another thing I really love about it.

- We're about to experience the first spring runoff after what they called a 500-year flood.

Even if we get a normal spring runoff volume of water what kind of changes can people expect from this year's spring runoff?

- Well, that's a great question because a flood that happened last year, the flood that happened last year in this area moved a lot of material.

And that material as the waters receded just kind of sat down.

But that doesn't mean that it's in place.

And so, as high water comes through this year we should expect more material than we normally would see moving and changing because I heard someone describe it last week, the little sands that are sitting under all the big rocks right now are like little ball bearings.

And once we get those moving again there's gonna be kind of some wholesale changes again.

What we know about the system of the river is that it won't immediately decide this is the new me.

(chuckles) It's now in a process of change that's gonna take a few seasons for it to figure out where it's going to be satisfied.

I don't know if rivers are happy.

I like to think of it as a happy river when it gets to do what it wants to do.

- When we think about the pain that last year's floods caused a lot of people are asking questions about whether or not this is gonna happen again and how do we prepare for it?

- I can guarantee you it will happen again.

I don't know when.

(chuckles) Those things are hard to know.

What we can think about is how to prepare for that.

Is there a way to make our communities resilient to these events?

And that's kind of a new word in sustainability studies, we talk about community resilience.

In some of these calculations about what is the river going to do, we actually recalibrate after an event like last year because we say, oh, we didn't really think that was gonna happen in our lifetime, but it did.

So now how do we recalibrate what we consider a normal possibility?

So I really think that helping people understand the river and know about the river helps them make choices for the long run.

If we take someone who's never seen the river and we take them out there and we say, "Isn't this beautiful and this little piece is for sale."

Boy, they wanna build their house right on the edge of that and they say, "Well, this river's been here a long time.

I can put my house right here."

Maybe.

- What are some of the things that people often do to protect themselves from the waterways that can actually be detrimental in the long run?

- Well, there are a number of things.

In general, we call it bank stabilization.

They want their river bank to stay where it is.

And it's a very understandable motive, right?

That's where my property ends, this is the beginning of my property.

I don't want to lose property to the river.

- And of course there's a cumulative effect to everyone doing this too, right?

- Right.

How many of these can we do and still have a healthy river?

And there are some limits and we know that very clearly now because there are areas along the river where we have put the armament in or the stabilization in on both sides for some measure of distance.

And we know that in those stretches we don't have good fish habitat.

We certainly don't have any spawning going on.

We don't have any of the things that we need when the river can move.

- Thank you so much for your time and sharing your thoughts.

Is there anything else that you think is important to add to this discussion about resilience?

- I just hope that the community as a whole wants to talk about it.

I think there are some hard discussions to be had in the future but maybe we could start some of those now.

If you can imagine that you could be in a very bad situation and make some decisions ahead of time about what will we do, let's do it before everybody's upset.

- Gilbertz notes that while last year's flood was deemed a 500-year event, it doesn't mean the next one is 500 years away.

She points to the Yellowstone River floods of 1996 and 1997, years with two back to back 100-year floods.

That's it for this episode of Impact from all of us here at Montana PBS, thanks for watching.

We'll see you next time.

(gentle music) (gentle music continues) (gentle music continues) (gentle music continues) - [Announcer] Production of Impact is made possible with support from the Otto Bremer Trust.

Investing in people, places, and opportunities in our region.

Online at ottobremer.org.

The Greater Montana Foundation.

Encouraging communication on issues, trends, and values of importance to Montanans.

And viewers like you who are friends of Montana PBS.

Thank you.

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