Dr. Terence McAllister, a primary care pediatrician in Las Vegas, mostly treats kids’ ear infections, colds and other maladies.
But much of his time is spent building rapport with his clients, who range from babies to 21-year-olds. They talk about hobbies, favorite video games or books — topics that build trust and allow for deeper conversations about struggles with depression, stress, gender expression and sexuality.
“It’s not overwhelming yet, and I can guide them and help address those issues,” he said.
McAllister is one of about 300 pediatricians in the state, which has the second worst pediatrician to patient ratio in the country, only above neighboring Idaho.
As state officials and lawmakers seek to address the critical shortage, McAllister, the president of the Nevada Chapter of the American Academy of Pediatrics, said part of the solution involves protecting providers in the Silver State.
It’s why, earlier this month, he swapped his stethoscope for a lobbyist badge to talk with lawmakers about SB171, a measure proposed by Sen. James Ohrenschall (D-Las Vegas) that would protect health care providers licensed in Nevada who offer gender-affirming care to patients, including via telemedicine. Specifically, it would make it so another state could not sanction or prosecute a provider in Nevada offering legal, ethical and medically necessary gender-affirming care to patients.
The bill is scheduled for a hearing Friday in the Senate Committee on Commerce and Labor.
Ohrenschall said there’s fear in the health care field that providing medically necessary care to patients could open providers to criminal prosecution in other states. He said this has a chilling effect on providers practicing in Nevada or those who could come to the state.
In 2023, Ohrenschall proposed a similar measure that Gov. Joe Lombardo vetoed after it passed out of the Assembly and Senate along party lines with Republicans in opposition. Opposition focused on gender-affirming care and fears that minors would be making irreversible changes to their bodies — though the bill dealt with providers and does not change existing law around those receiving gender-affirming care.
In his veto message, Lombardo said he could not support the bill because it “inhibits the Executive Branch’s ability to be certain that all gender-affirming care related to minors comports with State law.” He also said the measure “decreases the Executive Branch’s authority to ensure the highest public health and child safety standards for Nevadans.”
This year, Ohrenschall said he carefully studied Lombardo’s veto message and removed overly broad language, making it more closely mirror the reproductive rights shield law Lombardo signed that Senate Majority Leader Nicole Cannizzaro (D-Las Vegas) proposed.
“I believe I’ve addressed the concerns he put in his veto message. I hope so, and I hope that if it gets back to his desk, this time he’ll consider signing it,” Ohrenschall said.
A spokesperson for Lombardo said the governor does not have a comment on the legislation but will evaluate the bill language if it arrives at his desk.
Through legislation or executive orders, 16 states, including neighboring Arizona, California, Oregon and New Mexico, have enacted protections for providers offering gender-affirming care.
McAllister said gender-affirming care is a broad spectrum. The American Academy of Pediatrics defines gender-affirming care as supporting a child’s gender expression and gender identity, he said, noting that’s medically, socially and mentally. McAllister said that can look like using the child’s preferred pronouns or referring families to counseling services.
Gender-affirming care for young people includes reversible social affirmation, reversible puberty blockers and partially reversible hormones. Gender-affirming surgeries are typically reserved for adults and on a case-by-case basis for adolescents.
Under existing law in Nevada, minors can access gender-affirming care, including hormone therapy and surgery, as long as it’s deemed medically necessary and follows established standards of care, with parental or guardian consent required for minors younger than 18.
Experts note, however, that surgery is not recommended for minors, with rare exceptions for those experiencing life-threatening effects of gender dysphoria — where an individual experiences discomfort or distress because of a mismatch between gender identity and assigned gender at birth.
“It’s really that social affirmation and the mental health care, because we do know that children who identify as transgender are at increased risk for depression, anxiety and, unfortunately, for suicide,” McAllister said. “Those are the fears that we as pediatricians have by not providing that appropriate care, that appropriate affirmation for them.”
He said if the law proposed by Ohrenschall passes, it would allow him to practice medicine as outlined within state law and his training without fear of retribution from other states — 27 states have enacted laws or policies limiting youth access to gender-affirming health care, and 24 states impose legal penalties on health care practitioners providing gender-affirming care to minors. He emphasized that the measure does not change how gender-affirming care is offered in Nevada, and parental consent is still required for minors accessing treatment.
McAllister’s fear follows Texas Attorney General Ken Paxton issuing investigative demands to out-of-state health care providers who offered gender-affirming care to youth in Texas who had received care from a Georgia telehealth clinic last year, along with related lawsuits.
This isn’t the first time McAllister has advocated for the legislation.
In 2023, he pushed for the legislation, writing in an op-ed that if a Nevada doctor helps a family that has traveled from another state to get the care they can’t at home, the doctor could face criminal charges.
“If we don’t pass this bill, politicians hundreds of miles away could undermine the integrity of our own state’s health care system,” McAllister wrote.
