Since 2021, interest-group backed Republican lawmakers in Arkansas, Tennessee and Texas have attempted to effectively ban gender-affirming health care for transgender and nonbinary youth. Most recently, in April, Alabama Gov. Kay Ivey signed into law the Vulnerable Child Compassion and Protection Act, making it a felony for doctors to prescribe hormone medication or transition surgeries to anyone younger than 19.

Parents of transgender youth and major medical organizations oppose such laws, saying gender-affirming care is necessary, sometimes lifesaving. Ivey said the law was designed to “protect” children from “radical, life-altering drugs and surgeries.”

The law was in effect for about one week in May, before a federal judge blocked the ban on hormone medication, leaving in place the ban on gender-affirming surgeries on minors. In his ruling, U.S. District Judge Liles Burke explained his opinion that the law discriminates on the basis of sex and thereby violates constitutional rights; that Alabama’s claims that hormone medication is “experimental” was unfounded, considering the established opinions of 22 major medical organizations including the American Medical Association and American Academy of Pediatrics that have endorsed the treatment; and that the law interfered with parents’ medical decisions for their children. Alabama attorneys have said they disagree and plan to appeal the ruling.

“A lot of the hateful anti-trans rhetoric that permeates society is linked to how the elected officials talk about transgender people and the fact that they honestly don’t know what gender-affirming health care looks like,” says Sy Bernabei, executive director of the nonprofit Gender Justice Nevada, which focuses on education about LGBTQ issues.

Bernabei, who identifies as queer and has been active in the LGBTQ community for more than two decades, draws a link between suicide and gender dysphoria—psychological distress surrounding one’s gender that can interfere severely with daily activities, mental health and well-being. According to the Mayo Clinic, anxiety, depression, self-harm, eating disorders, substance abuse and other problems can occur. In a 2022 study of transgender youth published in the National Library of Medicine, 56% reported a previous suicide attempt and 86% reported suicidality (the risk of suicide).

“When trans kids are forced to detransition, it immediately undoes the progress they made in their mental health when their gender dysphoria was being treated,” Bernabei says.

The LGBTQ-focused Huntridge Family Clinic provides referrals for counseling, medication management for hormone therapy and referrals for gender-affirming surgery for hundreds of local patients, including youth. Clinic founder Rob Phoenix, an advanced practice registered nurse, says providing gender-affirming health care is critical in helping parentscurb the damaging effects of gender dysphoria.

“One of the benefits of starting a transition earlier is, we can prevent the biologic puberty from setting in, or delay its onset,” Phoenix says. “If we have an adolescent and get them on Lupron, which is a puberty suppressing agent, we’re going to stop or prevent the onset of those secondary sex characteristics—breast development, hair growth, onset of menstruation, growth of the genitalia and those things that they typically are experiencing the dysphoria around.”

Huntridge Family Clinic also assists with “social transitioning,” supporting transgender patientswho are getting used to preferred pronouns, new clothing and other outward gender presentations. Phoenix says that, despite the Human Rights Campaign ranking Nevada highly in terms of LGBTQ equality, there are “too many” providers in town who don’t know how to deal with gender-affirming care.

“They don’t want to talk about the transition; they don’t want to manage the hormones; they’re not comfortable with managing the hormones; they’re not comfortable with having conversations with patients or parents around adolescence and sexual health,” he says, adding that patients who are misgendered or disrespected are likely to disengage not just from transition care but also primary and preventive care.

A law Nevada’s Legislature passed in 2021 should help with that, Phoenix explains. It requires medical providers to receive at least two hours of “evidence-based suicide prevention and awareness” training related to different cultural backgrounds, including LGBTQ, every two years.

Another obstacle to gender-affirming care: health insurance companies covering gender transition. But Phoenix says that has improved in recent years. In 2015, Nevada became the 10th state to prohibit insurance companies from discriminating against or excluding transgender patients in state exchange health plans.

“Now, I would say probably 95% of the insurances have some gender coverage for their covered lives,” Phoenix says. “There’s a few plans that still exclude stuff, and that’s largely employer-based.”

Availability and accessibility to top and bottom surgery also can be improved, he says. Huntridge Family Clinic works with a small “handful” of surgeons who will perform top surgeries. “We don’t have anyone in the state that does male phalloplasty, the creation of a male penis,” Phoenix says, adding that he knows of only one surgeon in Southern Nevada who accepts Medicaid for gender-affirming surgeries.

As Nevada advances in gender-affirming health care, other states’ efforts to ban it continue mounting, along with legal challenges.

After Texas Attorney General Ken Paxton in February released a non-binding legal opinion labeling gender-affirming treatments for minors “child abuse,” Texas Gov. Greg Abbott ordered the Texas Department of Family and Protective Services to investigate such instances as abuse, punishable by law. Less than two weeks later, Texas Children’s Hospital, the state’s largest pediatric medical center, announced that it was halting gender-affirming therapies to “safeguard our health care professionals and impacted families from potential criminal legal ramifications.”

The Texas Supreme Court in May affirmed Gov. Abbott’s order, allowing the investigations to proceed. Many transgender youth in the state must now forgo transition treatments, or their parents must be willing and have the means to travel to different states to get treatment. And those parents might still be subject to investigation and child abuse charges in Texas.

Bernabei says the recent attacks on the transgender community are “nothing new,” adding that there’s a resolve among the community to keep moving forward.

“Our rights are at stake with this election and every election. … We are not the generation that will cower from society and be fearful like the generation before us,” Bernabei says. “We will protect and affirm the younger people in our community from the harm we had to endure decades ago. We are not going to be quiet and idly sit by as hateful lawmakers determine how we live our authentic lives as trans, non-binary, and gender non-conforming people.”

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