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Nicole Pajer

Nicole Pajer is a freelance writer published in The New York Times, Parade, AARP, Woman's Day, Men's Journal and beyond.

When she's not writing, she's checking exotic travel destinations off her bucket list, attempting to wear out her 71-pound Doberman's boundless energy and teaching people how to properly pronounce her last name ("It's Pager, just like the beeper!"). Keep up with her adventures on Twitter @NicolePajer.

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Transgender Children’s Rights Are Under Attack

An explosion of bills threatening health care for trans youth have recently been drafted

Your Body

Five years ago, Lisa Stanton's now 10-year-old daughter, Maya, socially transitioned to her affirmed gender. (A person's affirmed gender is the one that reflects their gender identity, as opposed to the gender assigned to them at birth.) The duo has been fighting against laws challenging transgender rights within their home state of Texas, ever since. They started with speaking against legislation that restricts people from accessing bathrooms that coincide with the gender they identify with and forces them to use bathrooms that match the genders they were assigned at birth. Recently, they have been fighting for trans children to have access to local gender-affirming medical services.

"My daughter has verbally stated that she would rather die than go through puberty as a boy," Stanton, 40, said. "I get emotional when I say it, but it's how she feels. As a parent, it's my job to make sure she's happy and healthy, and that means having access to trans-affirming care."

A rise in anti-transgender laws

2021 has been a record-setting year for anti-transgender legislation, with more than 100 bills drafted across the United States, 70 in Texas alone. In addition to preventing transgender children from playing sports in their affirmed genders, these bills are trying to deny transgender health care for minors. Some are threatening to revoke medical licenses of doctors who perform gender-affirming services and others will charge parents of trans children, like Stanton, who help children transition, as child abusers.

"With over 28 million residents and being the second largest State in the country, what happens in Texas reverberates through the U.S.," explained Fiona Dawson, an award-winning filmmaker and LGBTQ and diversity, equity and inclusion expert. Seventy percent of Texans believe that discriminating against LGBTQ people is wrong, but many of these laws are politically charged. "So what we're seeing is a tug of war between those who appreciate the spectrum of how human beings are made and those who are using ignorance as a political lightning rod," Dawson said.

What Dawson finds most alarming is these bills don't reflect the science and data on the appropriate and critical health care needed by transgender children. "The American Medical Association, American Psychiatric Association, American Academy of Pediatrics, American Academy of Child & Adolescent Psychiatry and others all support gender-affirming health care for trans children," she said.

Making an already difficult journey more difficult

When transgender children come out to their families as identifying as another sex, many of those parents connect with physicians, like Dr. John Turco, an endocrinologist who works with transgender patients at Dartmouth-Hitchcock Medical Center. He then typically places the children on medications to suppress puberty. "If you have strong and persistent dysphoria [distress a person feels from a mismatch between the gender they align with and the gender they were assigned at birth] that started at 3, 4 or 5 and it's still there and maybe more intense at 8, 9 or 10, then the imminent onset of puberty is a big issue," he said. "It's a simple medical thing to do, but fairly costly, running as much as $10,000 to $20,000 per year." Not all insurance companies cover puberty blockers, but some are starting to.

If children are denied access to these medications and puberty runs its course, they often end up with severe depression and can become suicidal. In a 2018 American Academy of Pediatrics survey, 41.8% of nonbinary youth revealed they'd attempted suicide. "When those medical services are not available, then you're basically kicking the can down the road. The kid will have more and more dysphoric feelings, which is eventually going to lead to more psychopathology and danger," Turco said. A 2020 study from the American Academy of Pediatrics found an inverse relationship between puberty blockers and suicidal ideation.

Counseling can help families work through a transition, and down the line, hormone therapy and surgeries like breast reduction or augmentation, facial feminization surgery and vaginoplasty can also help. "For the overwhelming majority of transgender individuals and families, it becomes cost prohibitive without insurance," Turco said. While insurance is starting to cover more of these procedures, such as the cost of prescriptions and, in some cases, surgery, these bills threaten to limit care to the children of affluent parents who can afford to pay for them out of pocket.

Transgender prejudice doesn’t just affect the children

Anti-trans debates and laws affect the physical, emotional, and psychological health of transgender children as well as their families, making an already difficult journey even more distressing. And some parents even have to move their families to other states. Stanton and her husband have considered relocating to the East Coast. In addition to regular sessions, the Texas governor has been calling special sessions on these bills, which makes campaigning against them an almost full-time job for the Stantons and other families like them.

"We've been fighting this current legislation for 10 months and have been back and forth to Austin, a three-hour drive each way, many times staying in hotels overnight," Stanton shared. "One of the last times, we weren't called to testify until 1 a.m. So our kids are staying up all night just so they can tell their stories."

For the time being, Stanton feels compelled to stay put and move forward. "Right now we are focused on staying and fighting in Texas for our daughter and for other trans kids," she said.

Aside from the consequences of the laws, the mere drafting of them is negatively impacting transgender children. "My daughter has developed a tic, which she's now taking medication for," Stanton said. The Stantons saw a neurologist who told them there was a direct correlation between the tic and the stress Maya was experiencing from all the anti-trans bills that were filed. The stress is affecting the families as well. "I have a rash that I can't get rid of from stress, my hair is falling out and I'm now an insomniac," Stanton said.

This legislation also affects physicians who have a passion for helping trans youth live authentic lives. "I can just imagine how frustrated transgender physicians and medical providers caring for transgender kids in a state like Arkansas are feeling at this time," Turco said, referring to the Arkansas House Bill 1570, banning access to trans-affirming care, including puberty blockers and hormones. The law was set to go into effect July 28 but was blocked in federal court when the ACLU sued the state against it.

"Most people do not realize there are no federal laws protecting LGBTQ+ people in the United States, and yet the majority of the country agrees that LGBTQ+ people should not be discriminated against," Dawson said. She's hopeful we'll eventually see the Equality Act passed in the Senate, which would amend the Civil Rights Act of 1964 to protect LGBTQ individuals from discrimination.

Although the journey has been hard, Stanton and her family plan to continue on in their advocacy. "We won't give up, and we will keep fighting not just for Maya's rights but for the rights of all trans kids in Texas," she said.

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