Michael, now 17, is transgender, and he had recently begun taking testosterone to help him undergo the puberty for a teen boy. In the mirror that day, Michael was seeing a difference for the first time, a boy who looked like a boy.
The Atlanta Journal-Constitution is not identifying the families of transgender children, who said they are concerned for their safety.
Republican lawmakers in Georgia are trying to change the law to stop transgender minors like Michael from receiving hormone replacement therapy or having surgery to help them physically align with their gender identity.
From birth, Michael was raised as a girl. But Michael said he knew for years that he was a boy. The pain of living his life in a body that didn’t match his gender identity led him to self-harm and suicidal thoughts. He credits hormone treatment, in his case testosterone, with giving him a path to bringing his body and his identity into alignment.
Leading culture wars
Now, cases like Michael’s have exploded into the political consciousness as some conservatives voice concern that such treatments are hasty. Legislatures in red states across the nation are proposing bills to intervene. In Georgia, versions of the bill have passed both chambers. It would apply to anyone under 18 years of age.
The House on Thursday passed Senate Bill 140 largely on a party-line vote, with Republicans supporting the measure. Such party-line votes on the issue are the norm in the Republican-majority General Assembly. Since the bill was amended in the House, it will now go back to the Senate for its consideration.
It’s not the first time transgender children felt like they were political targets in Georgia.
Last year, lawmakers passed a bill that allows any athletic association to ban transgender girls from competing on girls teams. A month later, the Georgia High School Association voted to require athletes to compete based on their biological sex.
This year’s bill would ban health care professionals from giving hormones such as estrogen or testosterone to transgender minors. Doctors also would not be allowed to perform surgeries on children seeking to align with their gender identity.
Treatment for transgender adolescents is a two-step process, first pausing hormones and puberty, and then giving new hormones to advance puberty in the target sex. If the bill becomes law, the second step would be banned for those under 18.
Medical professionals would still be allowed to prescribe a hormone treatment that aims to delay puberty or stop it from progressing under the proposal. Children who don’t identify with their biological sex at a young age are often prescribed the puberty blockers.
Scientists who deal with such patients say a new, yearslong delay between pausing puberty and beginning hormone replacement therapy could lead to both physical and psychological issues.
The bill would also allow for minors to continue to receive hormone treatments if they began before July 1, when the bill, if signed into law, would take effect, so minors in Michael’s situation wouldn’t be affected.
SB 140′s sponsor, state Sen. Carden Summers, a Cordele Republican, says the legislation aims to stop parents from allowing their children to make permanent decisions about their gender identity before they are legal adults.
“It’s also been proven that children who have gender dysphoria issues sort of outgrow them as they mature. ... They should get a little bit more mature before they make a decision that is 100% irreversible,” he told the House Public Health Committee on Tuesday. “After (transgender children turn) 18 years old, whatever they decide to do is their business. This bill is simply to pause.”
An AJC reporter contacted organizations more than a week ago that support the legislation in an attempt to speak with Georgians who received transgender treatment and regretted transitioning. The person whose information was provided did not respond to a request for comment.
Greater risk of suicide
Opponents of the legislation say bills such as SB 140, which are advancing across the country in Republican-controlled legislatures, are targeting a small, already vulnerable population. According to a 2022 study by the law school at the University of California, Los Angeles, about 1.2% of Georgians between the ages of 13 and 17 identify as transgender, or about 8,500 minors.
Studies have found that transgender youth, and adults, consider suicide at a rate exponentially higher than those who are not transgender.
Michael first told his mother that he was transgender when he was about 11 years old, but the family didn’t immediately address it. That’s when Michael said he fell into a depression and began cutting his arms as a way to deal with what he was feeling. “Cutting,” or self-injury, is a nonsuicidal, yet harmful way to cope with emotional pain, sadness, anger and stress. Michael said he eventually considered suicide.
“I didn’t understand at the time, but seeing Michael in so much pain made it impossible not to address,” his mother said. “I needed Michael to be happy, and I was going to do whatever that took.”
A study published in 2020 in the Journal of Interpersonal Violence, a peer-reviewed publication that studies victims and perpetrators, found that 56% of transgender youth between ages 14 and 18 who were surveyed said they had tried to take their lives within the previous six months.
According to a 2019 U.S. Centers for Disease Control and Prevention study, 9% of high school students reported attempting suicide in the previous 12 months.
The British journal The Lancet reported a risk of suicide in one U.S. study in 36% of patients of all ages with gender dysphoria — the distress that comes from feeling you’re one gender when you physically look like another. In contrast, risk of suicide was found in only 5% of the group without gender dysphoria.
Major scientific organizations such as the American Medical Association, the American Academy of Pediatrics and the World Health Organization say that medical and surgical care to transition genders is appropriate when properly administered.
Some dissenters have formed alternate groups, disagreeing with the organizations and calling for a halt to such treatments.
Erica Anderson, a California-based clinical psychologist and former board member of the World Professional Association for Transgender Health, told a reporter for the website the BMJ that she believes some kids are allowed to transition too fast.
“We don’t have lab tests that reveal if someone is trans nor not,” Anderson told the BMJ. “We have growing numbers of self-reported transitions that were very rapid — in my opinion, too rapid — getting on hormones right away, getting gender affirming surgery, and then shortly thereafter regretting it all.”
Health care leaders in Finland and Sweden have slowed the administration of gender-affirming care in adolescents, recommending it only on a case-by-case basis.
In issuing the new Swedish guidelines, that country’s National Board of Health and Welfare cited the lack of new research and what it called the “new knowledge” that some young transition patients have regretted their transition and reversed their transition.
It also said that the number of young patients seeking to transition had significantly increased in recent years, especially among those seeking to transition from female to male, and that it wanted to better understand why.
Credit: Natrice Miller/AJC
Credit: Natrice Miller/AJC
”To minimize the risk that a young person with gender incongruence later will regret a gender-affirming treatment,” the Swedish guidelines were changed, it said. It added, “Questions on how to ensure that all young people suffering from gender dysphoria be taken seriously and confirmed in their gender identity, well received and offered adequate care are becoming increasingly relevant, and will need to be answered.”
Scientists say that some patients who transition end up stopping, and some end up reversing their transition. But they say the numbers are tiny compared with the numbers who transition.
However, many of those who specialize in transgender care say that careful psychological assessment is important.
Dr. Dane Whicker of Duke University’s School of Medicine, a clinical psychologist who works with transgender patients, said he’s had two or three kids in his decade-plus experience who didn’t go through transitioning.
A key point is the concept of regret.
Stopping or reversing a transition doesn’t mean the patient regretted the transition, said Dr. Angela Kade Goepferd, a pediatrician and medical director of gender health at the Children’s Minnesota hospital system. Instead, she said, almost all of those who stop — often adults — do so because they’re getting backlash from their communities and families.
“They’re experiencing too much stigma, too much discrimination, and they just can’t do it,” Goepferd said. “It’s not that they want to stop, but they feel like that’s the choice they have to make.”
Care in Georgia
Dr. Izzy Lowell, who runs the Decatur-based gender transition practice Queer Med, said her clinic has about 4,000 active clients from across the South, and about 20% of them are under 18.
She has a handful of patients who are as young as 6 or 7 who only come in to her practice once a year and receive no medical treatment. The bulk of her patients that are under 18 are in their teens and usually have to have already started puberty before being treated with puberty blockers or other hormones. She does not do surgical treatment on minors, nor does she know anyone who does in Georgia.
Lowell said people who seek out her practice want medical treatment, though she partners with mental health providers for patients who want to undergo therapy.
“In the best cases, the family has known they’re trans their whole life, they come in and, as soon as we can, we get them on treatments, everything goes smoothly and they never have to experience the wrong puberty and go through that terrible dysphoria,” Lowell said. “The worst cases, patients come to me after a suicide attempt and the family decides that they’ll try anything not to have their child kill themselves. And that’s far more common than it should be.”
Families with transgender children who spoke with the AJC say that while it may have taken children a while before putting the feeling that they were transgender or nonbinary into words, it was always evident. Someone who is nonbinary doesn’t identify as strictly male or female. Dare, a 16-year-old from Dacula who uses “they” as their pronoun, said they were about 10 when they started to think they may be nonbinary.
“I’ve always been gender neutral my whole life,” Dare said. “My mom talks about how, when I was really little, I would pick toys from the boys aisle and the girls aisle.”
Dare and their sibling, a 13-year-old transgender boy named Jay, told their parents about their gender identities about the same time in 2020. Neither has been able to secure an appointment to get a diagnosis of gender dysphoria and begin medical treatment, so their transition has been social — meaning changing their names and dressing in a way that more aligns with their gender identity.
“Being nongender conforming isn’t a decision that’s made on a whim,” Jay said. “They’ve most likely known for a long time before they decided to tell anyone.”
‘She wants you to leave her alone’
Jen Slipakoff, a Kennesaw resident, said her daughter first started talking about being transgender when she was 5. Up until then she had been raised as a boy. She’s 15 now.
“We already knew exactly what was happening before she ever said anything,” Slipakoff said. “She has an older brother, so our house was full of traditional boys toys. And our daughter would play with those toys in a very different way than our son was. She would take her little soldiers shopping instead of putting them on the battlefield. She was always drawn to what we would consider traditional girls toys and traditional female clothing.”
When she turned 5, she asked her mother to change her name.
“She became more and more insistent,” Slipakoff said. “That’s when we realized like OK, this is something that we need to address.”
During a Senate hearing last month, Slipakoff told lawmakers she was concerned that her teenage transgender daughter would be bullied by her classmates when she came out as trans.
“I’m happy to report, she has never been bullied by her classmates,” Slipakoff said. “That’s not to say she doesn’t have bullies. Here in this room right now, they sponsored this bill and they’re the ones that are going to vote for it. ... She doesn’t want and she doesn’t need your protection. She wants you to leave her alone.”
Democratic lawmakers and other opponents of SB 140 have also questioned how the same group of lawmakers could push legislation last year that allowed parents to opt their children out of school policies for things such as vaccines, masks and lessons and now say that parents shouldn’t be able to make health decisions for their children.
During a House panel debating the legislation on Tuesday, state Rep. Shelly Hutchinson, a Snellville Democrat, read a series of arguments Republican lawmakers made in the media during those debates. Among them were comments such as “parents have the right to make decisions about their children’s health care without interference from government.”
“At what point did Georgia shift from giving parents rights to taking away their rights for whatever medical treatment they deem appropriate with their doctors?” she asked Summers.
“I’m just doing the bill to protect children,” Summers said. “That’s it, pure and simple.”
Opponents of the bill say it would harm more children than it would help.
Michael, the 17-year-old Duluth resident, said if SB 140 was the law at the beginning of his transgender journey and banned him from receiving testosterone, he doesn’t think he would still be living.
“I most likely, honestly, would not be alive,” he said. “That’s what I’m saying. That’s how much it affects me. That’s how much it’s changed my life. And I just couldn’t imagine it because I know where I was, and I know I wouldn’t be here without it.”