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Transgender youth, families adjust to gender-affirming care ban
After ‘lifesaving care’ is outlawed, families seek out-of-state options
IOWA CITY — As 14-year-old Ridley looked in the dressing room mirror at Von Maur in 2020, they felt sick to their stomach.
After years of praying to a higher power, the usually non-religious teenager was painfully confronted at every corner with the thing they prayed would not happen — from the reflection of school windows to the mirrors at home. With each glimpse, they got shaky and nauseated witnessing something that didn’t look right.
A swimsuit in a department store laid bare Ridley’s reality: the flat chest they prayed for since childhood had not been delivered with the onset of puberty — quite the opposite. The body they saw in the mirror was a stranger who accosted them any time they looked.
“It almost felt like one of those dreams where you … go to school without pants on,” Ridley analogized the feeling to. “I would see myself in my mirror … and fall into this hole. I would obsess about how I looked. It didn’t feel right.”
From the outside, their cisgender mother thought the tears and pain she saw were the same insecurities she struggled with as a teenager.
But many therapy sessions, medications and doctor’s appointments later, medical and mental health professionals confirmed that Ridley’s body dysmorphia as a gender nonbinary person was more than skin deep.
The Iowa City teenager started to withdraw from life, spending their days hunkered in their bedroom. They pulled out of tennis, dance and the activities they loved doing. After a pediatrician and mental health provider discovered disordered eating, therapeutic conversations followed to uncover the root of it all.
“As we continued to listen and have patience, Ridley was able to articulate very clearly the heart of it around their identity, and very specifically, the growth of their breasts that was making them painfully uncomfortable in their body,” said Ridley’s mother, Karen Butler.
Ridley, now 17, tried different things to make it all click together — the way their body looked and their own conviction of who they were. They tried on their older brother’s clothes, played around with makeup styles and used masculine pronouns.
After years of wearing a chest binder, receiving therapy, having extensive conversations with doctors and getting signoffs from multiple specialists, they were referred to a surgeon at the University of Iowa. In November, Ridley was one of a very small number of minors in Iowa to receive top surgery to remove both of their breasts.
Just days later, for the first time, the tears Ridley cried seeing their own body found new meaning: joy. After years of medication and therapy, the surgical solution was able to treat the symptoms of gender dysphoria in a way their antidepressants couldn’t.
“I felt both physically and metaphorically like a giant weight had been lifted off my chest,” Ridley said. “Surgery was the only solution for that.”
No part of their treatment regimen has been, in itself, a magic bullet. But since November, the results have been decisive.
Ridley is fully confident in the way they carry their body. Their personality is visibly lighter, buoyed by many more smiles than before.
“It’s been incredibly freeing and comforting,” said Butler.
Had they waited five more months to schedule surgery, the care recommended after years of reflection, treatment and careful deliberation between the family and their medical professionals would have been denied.
For other transgender youth like Ridley, Senate File 538 signed into law by Gov. Kim Reynolds Wednesday means the gender-affirming care that makes living in their own bodies bearable is now illegal.
“This is not plastic surgery. This is not vanity. This is health care. They’re removing our right to get health care.” — Jonathan Turner, father of transgender child.
What is gender-affirming care?
Gender-affirming care for transgender and nonbinary youth doesn’t usually start with or include surgery. For many youth coming to terms with who they are, treatment options give them breathing room to process how they’re feeling while putting a pause on body changes.
“(Legislators are) making it sound like a 14-year-old walks into a clinic on Monday and has surgery on Friday,” said Butler. “It just doesn’t happen that way.”
For 14-year-old Willa Turner, a trans girl in Mount Vernon, it means starting on puberty blockers after socially transitioning with a different name and pronouns.
Puberty blockers are shots or tiny arm implants that dissolve over time, giving children the time they need to process their feelings and receive therapy to understand who they are. Approved by the U.S. Food and Drug Administration for use in children since 1993, they put a pause on rapid body changes like height growth, breast growth, menstruation, voice deepening and facial hair — all of which can be detrimental to the mental health of teenagers who feel like aliens in their own body.
Puberty blockers are reversible, but changes made to the body by puberty are not.
“Having to plead for our humanity, it’s a lot. It takes a toll.” — Lindsey Ellicksen, mother of transgender child
Gender-affirming treatments for children — even with the parental permission that was already required by medical providers — will be prohibited immediately. Doctors with patients currently receiving now-banned treatments will have until Sept. 18 to discontinue treatment.
Dr. Katie Imborek, a family medicine physician who operates the University of Iowa’s LGBTQ Clinic in Iowa City, said the law prohibits health care providers in Iowa from prescribing or administering puberty blockers or hormone therapy, or performing gender-affirming surgeries for people under 18.
This goes against the recommendations of every major U.S. medical and mental health organization, all of which support access to age-appropriate, gender-affirming care for youth and adults, Imborek said. This includes the American Medical Association, the American Academy of Pediatrics and the American Psychiatric Association.
“For Willa to let her natural body course develop into something looking like my husband is going to be detrimental for her in years to come,” said mother Whitney Turner as she looked at her burly, 6-foot-4 husband. “If you started this process the day she turned 18, it would be closer to 20 by the time she could start (medications.)”
In the last year, the Iowa City clinic has served 211 patients under the age of 18.
Physicians at UnityPoint Health, one of the largest health care systems in the state, prescribed puberty blockers to 28 children in Iowa last year. Only eight patients were prescribed hormone therapy.
“The shackles this (law) puts on people with such potential is unthinkable,” said Butler. “This is lifesaving — no exaggeration.”
After an often long and arduous road for gender-affirming care to help children live normal lives, parents of transgender children are growing increasingly frustrated with new state laws and a multitude of unpassed bills each year targeting them.
“This is not plastic surgery. This is not vanity. This is health care,” said Jonathan Turner, Willa’s father. “They’re removing our right to get health care.”
Last year, about a week after Willa Turner tried out to run girls track at Mount Vernon Middle School, Reynolds signed the bill banning transgender girls from playing sports with cisgender girls at school.
Now, just weeks away from starting puberty blockers, she won’t be able to get the medical care she needs, either. As Senate File 482 went into effect Thursday, banning Willa’s ability to use the girls restroom at Mount Vernon High School, her mother and school administrators had to quickly figure out how to comply with the law.
Before signing the bills, Reynolds said the gender-affirming care ban was “in the best interest of the kids.”
“I don't know what children she is protecting,” said Whitney, a special-education teacher. “It feels like state-sanctioned bullying.”
Before Willa can continue using the single-stall restroom she has already been using for two years to avoid confrontations, she’ll need her mother to sign a permission slip.
“She’s just trying to get to physics on time,” Whitney said.
The two new laws passed are part of more than 400 anti-LGBTQ bills introduced across the nation this year alone, according to One Iowa. For a subset of children who experience disproportionately high rates of depression, anxiety and suicide, each new restriction has high stakes.
“We expect the attack on trans youth to continue. It is part of a national strategy to make it a wedge issue in the current political climate,” said Courtney Reyes, executive director of the LGBTQ advocacy nonprofit. “These pieces of legislation will kill transgender youth.”
Lori Ampey, director of the Tanager Place LGBTQ+ Youth Center in Cedar Rapids, said banning gender-affirming care will “triple” the mental health toll on kids in the community.
“It’s really devastating that we’re so close,” said Lindsey Ellickson, whose 12-year-old, Remy, was set to start seeing specialists for care in April. “Having to plead for our humanity, it’s a lot. It takes a toll.”
Where they’ll go next
Transgender patients and their families still have the ability to seek care out of state, Imborek said. While Iowa law now limits gender-affirming care options, the LGBTQ Clinic will remain to care for transgender patients and their families in whatever way they can.
Multiple families with trans children surveyed by The Gazette said they intend to seek care in Minnesota, Wisconsin and Illinois, where clinics have wait times upward of a year for an appointment, if they are even accepting new patients. For transgender teenagers with rapidly changing bodies, getting medical care quickly is now a fight against the clock in which they can’t afford to wait.
This will require parents and children to take days off from work and school and drive multiple hours each way. Because of it, some families are considering leaving the state.
For those without supportive parents, organizations like Tanager Place may be a last line of defense in providing support groups and teaching life skills.
“It’s going to save lives. It’s a place kids can go to be safe and have support,” said Ampey. “I think it’s a misconception that every kid has that support at home. I see their sadness and determination to fight and make sure their voices are heard.”
In response to the new law, One Iowa has created a resource page on gender-affirming care, which will be updated frequently.
In the mean time, Ridley, Willa, Remy and others will continue to live their lives in the ways not prohibited by law.
Ridley will continue to play tennis at school, crochet and prepare applications to study computer science or physics at the University of California. With a 4.8 GPA, they have high hopes for UC Berkeley.
Willa will continue to play the clarinet and compose orchestral arrangements for Mount Vernon High School — one of her favorite things to do. With hopes to study music in college, she’s looking mostly at schools outside of Iowa.
She wants state legislators to listen to their experiences and know they’re human beings, too. But given what she sees and hears, she doesn’t think they’re receptive to their truth.
Butler said her family’s journey is not a sad one — just one made disheartening by Republicans in the legislature.
“We don’t live our lives in a different way. We live similar to them,” Ridley said. “We just aren’t treated similarly.”
Grace King and Tom Barton of The Gazette contributed to this report.
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