health care

For transgender children, a frantic race for treatment despite bans

For transgender children, a frantic race for treatment despite bans
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SALT LAKE CITY — As a third-grade student in Utah, mandolin-playing math expert Elle Palmer said out loud what she had only felt before, telling a friend she was planning to change schools the following year and hoped that her new classmates would see her as a girl.

Several northeastern states, Asher Wilcox-Broekemeier was listening to punk rock in his bedroom, eager to join the neighborhood’s shirtless boys playing in the South Dakota sun. It wasn’t until his period started and the disconnection with his body grew that he knew he was one of them.

The two children’s accomplishments set their families on a journey of years of doctors, therapists and other experts in transgender medicine.

Now teenagers, their journeys hit a snag.

Republican lawmakers across the country are banning gender-affirming care for minors. Restrictions went into effect in eight states this year – including conservative Utah and South Dakota – and are expected to be implemented in at least nine more by next year.

Those who oppose gender-affirming care raise concerns about the long-term effects of treatments on adolescents, argue that research is limited and focuses particularly on irreversible procedures such as genital surgery or mastectomies.

Yet these are rare. Doctors usually guide children to voice therapy or coaching long before medical intervention. At this point, puberty blockers, anti-androgens that block the effects of testosterone, and hormone treatments are far more common than surgery. They have been available in the United States for over a decade and are standard treatments supported by major physician organizations, including the American Medical Association.

New laws force parents to scramble to get the care their children need. They worry about what will happen if they can’t get the drugs they have been prescribed, especially as their children enter puberty and their bodies change irreversibly.

“My body is basically this ticking time bomb, just sitting there waiting for it to explode,” said Asher Wilcox-Broekemeier, now 13. ___

She remembers her first day at school after her transfer. Before leaving, she came down in cowboy boots embroidered with rainbow sparkles that her mother feared would only spur bullies on. The taunts of children from Elle’s previous school drove her into such a deep depression that she had suicidal thoughts.

But that first day, a boy told Elle he loved her boots. Some children bullied her, but her classmates and teachers were much more supportive than at her previous school. She found new passions in hip hop and acting classes, and she settled into a new school and a truer version of herself. She began seeing a therapist as her uncertainty about her place on the gender spectrum grew more pressing.

She came out as a transgender girl in fifth grade. Now in seventh grade, she planned to start hormone therapy this summer so that potential side effects wouldn’t interfere with her life during the school year, especially her team’s extracurricular math competitions.

But then Republican Utah Gov. Spencer Cox signed a gender-affirming care ban in January. In a compromise, the law allowed children to continue taking medication if they were already taking it. So Elle’s mother rushed to get her treatment months ahead of schedule, as did other parents.

The waiting list at a clinic in Utah has grown to six months. Doctors faced tough decisions about who to take to appointments.

Elle’s medication arrived in the mail just before the Utah law went into effect. A small stick implanted in Elle’s forearm blocks slow-release hormones to prevent the effects of male puberty from taking hold. Eventually, she may be prescribed estrogen, and she and her parents will have to navigate the next steps and whether they will find doctors to continue her care.

At least for now, they have a reprieve.

“It feels like we can breathe again now,” said Cat Palmer. ___

There’s no relief for Asher Wilcox-Broekemeier’s family — not yet.

When Asher started menstruating, he felt a terrifying disconnect between the way his body was changing on the outside and what he was feeling on the inside.

Elizabeth began researching online to figure out what was going on with her son, while Asher’s father, Brian, turned to doctors for expertise. On the recommendation of his longtime pediatrician, Asher met with therapists and doctors who helped him explore his life story, personality, and feelings.

Almost two years ago, doctors prescribed puberty blockers and contraceptives to slow breast development, regulate menstruation and reduce the pressure of her disconnection with her body.

He’s 13 now and finds solace in music to ground him in a world of occasional bullying and constantly mispronouns. He practices Blink-182’s “All the Small Things” on guitar, plays trumpet in the school band, and rehearses various singing roles for the school musical Cinderella. When he’s not thinking about testosterone to lower his voice or possibly undergoing surgery, he looks forward to playing in the high school marching band next year.

Asher still struggles with moments of gender dysphoria. Friendships that were once strong crumbled after Asher came out as transgender. The parents disinvited him from their home for fear that he would be a “bad influence”.

But her parents noticed that her emotions were stabilizing thanks to her treatment.

“From a parent’s perspective, I see him as being able to be authentically himself, which is wonderful for him,” Elizabeth said.

Now he and his parents are worried about having to start over.

In February, Republican South Dakota Governor Kristi Noem signed legislation banning the drugs and procedures doctors are increasingly prescribing to transgender teens.

Asher’s current doctors in South Dakota won’t be able to prescribe her medication, so the family seeks a new doctor in neighboring Minnesota, where the Democratic governor signed an executive order explicitly protecting gender-affirming care for minors. . They hope to find a clinic close enough so they can drive to their appointments and not have to pay for hotel stays.

Planning took time. Logistical questions to their current doctors in South Dakota for referrals went unanswered. They want to beat any onslaught of patients from other states enacting similar bans Minnesota providers will bring, but also want to maintain as much normality for Asher as possible.

Sudden twists in Asher’s path make him wonder why his health care is on the minds of politicians.

“Even though trans people aren’t a big percentage of the population, that doesn’t mean we aren’t among them yet,” Asher said. ___

The full consequences of bans on the care of minors are not yet clear.

Dr. Nikki Mihalopoulos, an adolescent doctor at a Salt Lake City clinic specializing with transgender teens, worries that new laws will make families too scared to seek help and doctors too scared of losing their license to provide services. care.

In the middle are children like Elle and Asher.

Several studies have shown that transgender youth are more likely to consider or attempt suicide and less at risk for depression and suicidal behaviors when they can access gender-affirming care.

Both sets of parents are trying to protect their children from the stress and anxiety caused by recent changes in the laws.

After years of worrying about their children’s safety and sanity, they still fear what might happen if they don’t find the medication they were prescribed.

“My child is doing well is my number one priority. I know the suicide rate. I don’t want my child to be a statistic,” Cat Palmer said of Elle.

___

Biraben reported from Pierre, South Dakota.

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