Nebraska now requires trans kids to undergo 18 weeks of non-affirming therapy

A new set of emergency regulations announced by the Nebraska Department of Health and Human Services requires trans kids to undergo 18 weeks of “clinically neutral” gender-identity-focused therapy before receiving gender-affirming medication, among other hurdles to receiving care.

A new state law, which went into effect Sunday, bans minors under the age of 19 from receiving gender-affirming surgery and restricts how and when they can receive other forms of gender-affirming care like puberty blockers and hormone therapy. While gender-affirming surgeries are rarely performed on minors, every major medical organization in the U.S. has recognized that gender-affirming healthcare — including puberty blockers and hormone therapy — is evidence-based, safe, effective, and can be medically necessary to treat gender dysphoria in young people.

Related: Nebraska reps’ historic filibuster comes to an end as GOP moves to ban trans health care & abortion

Conservatives combined gender-affirming care restrictions and a 12-week abortion ban into one bill.

Signed by Republican Gov. Jim Pillen earlier this year, the bill required Nebraska’s chief medical officer, Timothy Tesmer – a Pillen appointee who has voiced opposition to all forms of gender-affirming care for minors – to draft guidelines regulating the use of hormones therapy and puberty blockers for trans minors. As ABC News reported last week, doctors and families of trans kids had accused Republican officials of slow-walking the regulations in an effort to block new patients from receiving gender-affirming care.

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On Sunday, the Nebraska Department of Health and Human Services finally announced the emergency regulations, which will remain in place while the department takes public comments on permanent guidelines, according to the Associated Press.

Among the new rules is a requirement that trans minors undergo 40 hours of therapy before being prescribed gender-affirming medication. That includes an “initial assessment of up to four consecutive hours” followed by a maximum of two hours per week. The guidelines, which appeared on the Nebraska DHHS website Monday but have since been removed, state that “therapeutic hours must be clinically neutral and not in a gender-affirming or conversion context.” They also require doctors to determine whether “gender dysphoria is driving the patient’s distress and not other mental or physical health conditions.”

Journalist Erin Reed criticized the regulations for opening the door to “Gender Exploratory Therapy,” which she describes as a “new form of conversion therapy.”

The emergency regulations also require a seven-day waiting period between when trans young people are prescribed puberty blockers or hormone therapy and when they can receive their medication. Trans minors receiving gender-affirming care must also undergo a minimum of one hour of therapy every three months “to evaluate ongoing effects on a patient’s mental health.”

Grant Friedman, a legal fellow for the American Civil Liberties Union of Nebraska, described the state’s regulations as unnecessary, as doctors already follow international standards for treating trans youth. Friedman noted that the 40 hours of therapy required were particularly onerous given the lack of mental healthcare providers. “It just adds an additional barrier to existing care barriers that already exist in our health care system,” he said.

Following public comment on a permanent set of regulations, the Nebraska DHHS plans to release a final version at the end of the month. A public hearing on the proposed permanent rules is set for November 28.