Anxiety rises for Georgia’s trans minors as state law barring hormone treatment starts July 1

By: - June 13, 2023 1:46 pm
Illustration of the transgender flag.

Transgender minors in Georgia will face new restrictions on health care when a new law goes into effect July 1. Getty Images

At midnight on June 30, transgender minors in Georgia who are not already receiving hormone treatments will be barred from starting due to a controversial law passed by the state Legislature along party lines this March.

One transgender teacher at an organization that works with queer youth said the kids she works with are very aware of the deadline.

“Overall, we’re seeing distress,” said the teacher, who asked the Georgia Recorder not to publish her name or the name of her organization because of a recent uptick in threats. “None of our students have left the state, but we do have friends who have trans kids who are a little bit younger who have left the state. And our parents and other people in our wider community with trans kids are talking about, like, well, when do we leave?”

The teacher said children were keeping up with debate over the bill during the session, and they have been tracking laws in other states as well.

“I want them to be informed, but I also want them to have some feelings of safety. Even if it’s an illusion of safety, they are kids, and I think that would still be healthy for them to have.”

Georgia governors typically wait until after the legislative session to sign bills, but Gov. Brian Kemp, a Republican, approved Senate Bill 140 in March, days after it received final Senate approval.

“As Georgians, parents and elected leaders, it is our highest responsibility to safeguard the bright, promising futures of our kids – and SB 140 takes an important step in fulfilling that mission,” he said, echoing the arguments of the bill’s Republican backers, who said the law will prevent minors from making irreversible medical decisions before they are mature enough to do so.

Dozens of transgender minors, family members and doctors say they see things differently. So does the teacher, who spoke with the Recorder as Georgia students were getting ready for summer break. She said it’s unusual for her program to have many new enrollees at the end of the semester, but that’s just what she’s been seeing.

She said every one of her students has been called slurs in school and lost friends or family members through transitioning.

“It’s weird for us to get kids at the end of a school year, because it’s a strange time to transition, but it seems like either it’s just adding up over the course of the year and the kids, it’s like culminating, and this is like a long part of the school year and they finally are breaking down, or the bill and the rhetoric around it has increased harassment at schools.”

The teacher said she is confident all of her current students who want to be on hormone therapy will be able to before the deadline.

“But we’re getting new students now, and I’m not sure about them yet, and I’m not sure if that’s care that they want to access,” she added. “Not every kid wants to access that care, even if they are trans, because trans can mean a lot of things, and medical transitioning is just part of that.”

“The next wave of students that we have, it’s going to be different conversations with them,” she added.

Treating patients

The bill is also creating uncertainty for medical providers who serve transgender youths, said Dr. Izzy Lowell, whose Atlanta-based practice QueerMed provides gender-affirming care to minors and adults. Doctors who violate Georgia’s law could lose their licenses and potentially be subject to civil or criminal action, but Lowell and her team will be doing everything they can within the letter of the law.

“Everyone’s agreed, everyone’s offered to stay up until midnight on June 30, seeing new patients if we have to, to get people in,” Lowell said.

Unlike other states that have banned gender-affirming care for minors, Georgia’s law allows for hormone blockers, which lawmakers said was a compromise designed to let transgender children put off puberty and delay deciding whether to transition until they turn 18.

Lowell said that scenario is not medically possible because puberty blockers were originally developed for the treatment of something called precocious puberty, which is when a child begins puberty way too early.

“They were meant to be used to stop puberty for a year or maybe two years to get you to 9 or 8, which is a normal time to start puberty,” she said. “They were never meant to be used long term or after typical ages of puberty. So what we’re talking about here, if somebody comes in at age 10 and it starts puberty, we can’t put them on puberty blockers for eight years. It’s medically unsafe, absolutely contraindicated to use it for that long.”

During House debate over the bill, Atlanta Democratic Rep. Park Cannon held up a box of hormones and warned that Republicans could drive children to try to manage their own care without the supervision of a doctor.

Lowell said she has concerns about people using internet-bought hormones, sometimes called DIY. She said she understands why people turn to these products, but she strongly recommends against using them, as they are not FDA approved and could lead to serious medical problems.

“I have a lot of patients come to us after having done DIY for some period of time, and I tell patients, ‘A lot of people do this. I get it. It’s really hard to access. So I understand that you had to do that. And thank you for coming to us. Thank you for telling me that you did that. Now we’re going to do it more safely and get you what you need in a safe manner.’”

Crossing state lines

QueerMed offers care to patients in 25 states, including some that already have bans similar to Georgia’s.

“Basically, the way the laws work, we can see patients in any of the 25 states we cover,” she said. “So a patient in Florida, for example, where a ban went into effect, would have to drive out of Florida, so they could drive into Georgia or South Carolina, where we have licenses, and then we could see them legally if they are physically located outside of the state of Florida in a state where we’re licensed.”

Transitioning requires many appointments, Lowell said. After the initial diagnosis of gender dysphoria, she will talk to a patient about what hormone therapy entails and perform a series of tests of hormone levels and organ functions to make sure the patient’s body can handle the hormones.

If the tests are positive, which they usually are, especially for young people, the patient will need parental approval to begin, and QueerMed strongly recommends they connect with a therapist if one is available in their area.

Minor patients begin on a low dose of testosterone or estrogen and must check in every three months to make sure everything is going smoothly before increasing the dose.

“I do that in part to make sure that that’s the right thing for the person,” Lowell said. “They could say, ‘Actually, I thought I wanted estrogen, but it doesn’t feel right. I think I’m going to stop.’ And it would be completely reversible. That never happens. But it’s reassuring to patients and families especially to have this window where we’re not causing permanent changes.”

After two or three years increasing the dosage, the appointments decrease to every six months, and once the patient is an adult, they only need to come in once a year for a checkup.

Lowell said some Georgia patients had been planning on taking regular trips to Alabama, where a federal judge has temporarily blocked a ban on gender-affirming care, though that’s a tough fit for many family budgets and work schedules. North Florida may soon be another option for medical tourism, after a similar ban was temporarily blocked there last week.

Carl Charles, senior attorney with Lambda Legal, an LGBTQ legal advocacy group, said Florida’s law is not dissimilar to Georgia’s, and he’s hopeful Georgia’s law will also be paused before it takes effect.

“This is definitely a step in the right direction, but Georgia’s law has to be challenged as well, and unfortunately, it’s just a reality that we can’t assume from this great ruling that a judge will find the same thing,” he said. “But it is certainly a reason to have hope and expect that federal courts can and do take these issues seriously and understand what’s at stake.”

Georgia Recorder is part of States Newsroom, a national nonprofit news organization.


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