How bans on gender-affirming care affect trans minors in Kentucky and across the country

Amber Duke isn’t new to politics in the Bluegrass State. The executive director of the ACLU in Kentucky has spent a decade involved with legislation at the Capitol in Frankfort. But the recent efforts to push through a ban on gender-affirming care for transgender minors resulted in what she called "far and away the most difficult legislative session myself, my team and our volunteers have experienced."

It’s an ordeal that advocates for trans care are confronting across the country as more states look to pass similar restrictions.

The new Kentucky law bans youth treatment for gender dysphoria, a condition in which a person’s gender identity conflicts with the biological sex they were assigned at birth. The Republican-controlled Legislature passed the bill, but it was originally vetoed by Democratic Gov. Andy Beshear on March 24, who said it allowed "too much government interference in personal health care issues and rips away the freedom of parents to make medical decisions for their children." Five days later, amid protests that led to 19 arrests, the Legislature voted to override the veto.

"I've seen a lot of pain at our Capitol," Duke told Yahoo News. "I've seen a lot of frustration and I've seen angry people, but just [to] be there to bear witness to trans Kentuckians crying, begging, pleading with legislators to hear them, to see them, to understand their experiences and really just begging them not to move forward with this legislation because [of] the impacts that it will cause, and to see those cries and pleas fall on deaf ears, to see the cruelty from legislators to kind of just shrug their shoulders in the face of some of this, was really, really difficult."

Republican supporters of the bill said they were protecting minors from decisions they would regret decades later.

"I have great compassion for the children, parents and their families who are in this situation," testified Republican state Rep. Jennifer Decker, one of the bill’s sponsors. "However, ultimately, it is our obligation to protect children from irreparable harm. The state has a compelling interest in protecting children from decisions that cause irreparable harm."

The bill is part of a broader national effort from Republican legislators against the LGBTQ community, including a focus on books about gender and sexuality and on drag shows. It also continues a trend in the Kentucky Legislature, which last year passed a ban preventing a single trans teenager from playing field hockey and this year failed in an attempt to restrict drag performances. In addition to banning gender-affirming treatment for trans youth, the bill bans conversations about sexual orientation or gender for students of all grades, restricts bathroom use and allows teachers to refuse to use a student's preferred pronouns.

Dr. Christopher Bolling, a pediatrician who testified against the bill as a representative of the Kentucky Medical Association and the state chapter of the American Academy of Pediatrics, told Yahoo News there could be serious consequences for affected patients.

"Our biggest concern is we know that these kids who have persistent gender dysphoria continue to feel isolated and ostracized and different, and they wind up with much higher rates of anxiety, depression, suicide attempts, all sorts of stuff — it's really bad for their mental health," Bolling said.

"These kids are a pretty small minority," he added. "And I think that they're being used by legislators and politicians and by adults … and I don't quite understand it. I think it's really disturbing."

Jeri Hahn is the spokesperson for Trans Parent Lex, a decade-old support group for parents of trans children based in Lexington. She told Yahoo News that "some of the moms can't even form words" as they try to process what this means for their children’s treatment.

"They just look at you and say, ‘What am I gonna do? I don't want to move. I love my city, I love my state, I love being near my family,'" said Hahn, whose now-adult daughter transitioned as a minor. "They're scrambling."

Hahn said that while the intricacies of the bill and legal challenges are being evaluated, families are attempting to figure out if they can stretch medications to make them last longer. A Kentucky doctor who treats trans minors told Yahoo News that their patients were "terrified" and discussing “fleeing the state." As far as moving is concerned, neighboring states have already passed similar bans, as in Indiana — where Republican Gov. Eric Holcomb signed a ban into law Wednesday — and Tennessee, or are considering them, as Ohio is.

If the Kentucky law goes into effect as planned, minors taking medication for gender dysphoria whose families remain in the state will be cut off from their treatments in June, causing potential calamitous effects on mental health as they stop the transition.

"There will be major depression and anxiety and fear and so many kids, their parents don't accept them," Hahn said, noting that the law’s changes on how schools treat trans kids will lead to more negativity there as well. "They're going to get bullied everywhere. And kids will die. The suicide rate is definitely going to go up."

The Trevor Project, a suicide prevention and crisis intervention program for LGBTQ youth, found last year that youth who identify as transgender or nonbinary were more likely to consider suicide than other LGBTQ youth. (Anti-trans activists attacked the Trevor Project last year, baselessly accusing it of being a front for sexual abusers.) A 2020 study found that trans youth had a higher rate of suicide risk versus the general trans population, while a Washington Post-KFF poll conducted last month found that most trans people said they had lacked a trusted adult to talk to while growing up.

The case from supporters of the Kentucky bill and others like it across the nation is that minors are being sped through a process of untested medication and dangerous surgery — by an American health care system that is accessible, affordable and expedient — as soon as they have any questions about their gender.

The reality is that the process to fully transition takes years, starting with counseling and numerous consultations, then puberty blockers, then cross-sex hormones like estrogen and testosterone. If the patient wishes to continue, the option of surgery is available. Many of the treatments are decades old and are backed by organizations like the American Medical Association, the American Association of Clinical Endocrinology and the American Academy of Pediatrics.

The New York Times — which has faced criticism for its coverage of transgender youth, with hundreds of contributors signing a February letter asking the newspaper to reconsider its approach — provided an example of this dichotomy in a November story about youth transition. An attempt to show both sides of the issue meant putting medical professionals and anti-trans politicians on the same footing. "Doctors who treat transgender patients typically describe the use of puberty blockers as a safe, reversible way to press pause. Republican politicians and other critics say the treatment is dangerous, even likening it to child abuse," stated a Times piece explaining that reporting.

Bolling said there are differences of opinion, murky areas and controversies, but the medical community is aligned on best practices.

"I'm a pediatrician," Bolling said. "We can sit in a room and argue about ear infection treatment for four hours. Will there be differences of opinions [on trans care for minors]? Should we continue to ask questions? Yes. Is the science ever completely settled? No. But when you look at the vast majority of the organizations that are out there, it's pretty uniform. With parental consent and the ongoing counseling guidelines that are pretty stringent, they're pretty accepted across all these major organizations."

Duke claimed that Republicans pushing the bill have emphasized certain procedures that don't even occur in the state.

"There’s been a lot of talk from supporters of this bill, particularly around gender-affirming surgeries for young people that are not the standard of care and that are not happening in Kentucky," Duke said. "Legislators and supporters of this bill have been in the media saying things about cutting off healthy body parts of children that just simply aren't true. They're not happening. It's very frustrating when people who have the positions and power that folks in the General Assembly have continue to spread misinformation."

Prominent Kentucky Republicans aggressively attacked the veto by Beshear, who is up for reelection this fall. State Attorney General Daniel Cameron, considered the frontrunner for the GOP nomination to face Beshear, said in a statement that he “absolutely” would have signed the bill, called the treatments "chemical castration" and pledged to "protect our youth from dangerous ideologies."

Kelly Craft, a former ambassador to the United Nations during the Trump administration who is also in contention, called Beshear's veto "politically motivated" and “out of step” with Kentuckians. Craft’s running mate, state Sen. Max Wise, was a primary sponsor of the legislation.

"This movement across the nation to impose radical gender ideology on our kids instead of improving reading, writing and math skills, is wrong," Craft said in a statement, adding, "As Governor, I will fight any attempt to sexualize our children and rob them of their futures."

In recent elections, anti-transgender policies have not proved an effective platform for Republican candidates, including in a key Wisconsin Supreme Court race this week. After Democrats scored historic victories in Michigan in last year’s midterms, Michigan GOP chief of staff Paul Cordes blasted the focus on the issue by his party's gubernatorial nominee, Tudor Dixon, in a postmortem memo, writing, "There were more ads on transgender sports than inflation, gas prices and bread and butter issues that could have swayed independent voters."

The ACLU is currently seeking families who are affected by the bill to join a lawsuit it intends to file before the portion of the bill banning gender-affirming care goes into effect in June. Until then, families of trans children, their doctors and allies will prepare for difficult choices and the continued legal and political battles.

"I'm going to keep fighting," Hahn said. "I’m not going to give up, it'll just take us a little bit. I’m going to be out telling every 18-year-old to please vote in November."