The rules proposed by two state departments would have required the psychiatrists, endocrinologists and medial ethicists to have roles in creating gender-affirming care plans for clinics and hospitals. And patients under 21 would have been required to receive at least six months of counseling before starting hormone treatment or receiving gender-affirming surgery.
The Department of Health and Department of Mental Health and Addiction Services both issued revised proposals Wednesday after gathering public comment. Both said in memos that they were swayed by what they had learned as transgender people and care providers weighed in. The Health Department said it received 3,900 comments. In the new versions, the rules would apply only to the care of minors, not adults.
Over the last few years, 21 states have adopted laws banning at least some aspects of gender-affirming care for minors. Some are so new they haven’t taken effect yet, and a ban in Arkansas was struck down in court. But so far, only Florida has restricted care for adults.
The departments said the rules will now advance to the next step of review before being implemented.
The draft rules would still require that patients under 18 receive at least six months of mental health counseling before they can receive gender-affirming medications or surgeries. The revisions made Wednesday also expand the list of mental health professionals qualified to provide the required counseling, adding clinical nurses, social workers, school psychologists and some physicians.
Further, a medical ethicist would no longer be required to have a role in developing facility-wide treatment plans for the care. In a memo, the Health Department said that change was made partly because institutions already use medical ethics professionals to develop policies.
Some parts of the rules regarding care for minors could have a muted effect. Last month, the Legislature banned gender-affirming surgeries and hormone therapies for minors by overriding DeWine’s December veto of that measure, which would allow children already receiving treatment to continue.
South Dakota has apologized and will pay $300,000 under a settlement with a transgender advocacy group that sued Gov. Kristi Noem and her health secretary last year after the state terminated a contract with it.
Attorneys for the Transformation Project announced the settlement Monday. The nonprofit sued last year after the state canceled the contract for a community health worker in December 2022. The contract included a roughly $136,000 state-administered federal grant, about $39,000 of which the group received, according to its attorneys.
The organization alleged the state’s decision “was based purely on national politics,” citing Noem’s statement to conservative media outlet The Daily Signal that the state government shouldn’t participate in the group’s efforts. The outlet had asked Noem about the group and one of its events.
“This settlement marks a significant milestone in our ongoing commitment to civil rights advocacy,” lead attorney Brendan Johnson said. “We commend the resiliency of the LGBTQ community and remain committed to vigorously upholding their rights.”
The apology, in a letter dated Jan. 18 and signed by South Dakota Secretary of Health Melissa Magstadt, reads: “On behalf of the State of South Dakota, I apologize that the Transformation Project’s contract was terminated and for treating the Transformation Project differently than other organizations awarded Community Health Worker contracts.
“I want to emphasize that all South Dakotans are entitled to equal treatment under the law — regardless of their race, color, national origin, religion, disability, age, or sex. South Dakota is committed to ensuring that no person is excluded from participation in, denied the benefits of, or subject to discrimination under any program, activity, or service that it provides,” she wrote.
Transformation Project Executive Director Susan Williams said she is glad the lawsuit is over and “it feels good to know that we won.”
“I would say that we settled with the apology. It would have been nice to have the apology come from our governor,” she said.
Magstadt was not health secretary at the time the contract was terminated. Her predecessor announced her retirement days after the state terminated the contract. The Transformation Project had hired a community health worker before the state ended the contract.
The state alleged contract violations in a letter from the deputy secretary noticing the termination. The group said it had complied.
Spokespersons for Noem and the state Department of Health did not immediately respond to email requests for comment on the settlement.
Transformation Project Community Health Worker/Project Coordinator Jack Fonder said in a statement: “I assumed the role of CHW with the intention of providing trans people in our community with the resources they require to succeed in this state, little realizing that doing so would result in my own outing as a trans man for standing up for what is right. We promise to keep up the battle for transgender rights and to make sure they have access to the resources they require.”
Fundraising helped continue Fonder’s position, Williams said. Fonder helps transgender people find shelter, housing and employment, as well as support with legal paperwork and driving people to appointments, among other needs.
Williams said the organization would apply for future grants from the state, and she hopes similar groups “will feel more confident” to apply, too.
The nonprofit offers help for LGBTQ people and their families, such as suicide prevention and guiding people through health care and social services, and educates about gender identity.
Iowa lawmakers on Wednesday declined to advance a bill that would have stripped gender identity from the state’s civil rights law, a proposal that opponents said could have subjected LGBTQ Iowans to discrimination in education, housing and public spaces.
The bill has been floated in recent years without success but reached the first step in Iowa’s lawmaking process Wednesday, when it was rejected by three members of a House Judiciary subcommittee. As they discussed the measure, LGBTQ advocates outside the room cried out: “Trans rights are human rights.” Two of the subcommittee members are Republican and one is a Democrat.
Not every state has explicit protections for a person based on their gender identity, but opponents of the bill suggested that removing such already existing protections from a state’s anti-discrimination law would have stood out in an already historic period of anti-trans laws in Republican-led statehouses.
Republican House Majority Leader Matt Windschitl — who is not a member of the subcommittee and didn’t take part in the vote — said Wednesday that he doesn’t think it would be the “wise choice” to break open established civil rights code “whether you agree with all of it or not.”
“Taking that protection away would then be an opportunity to discriminate against one of those protected classes,” he said of how the bill would be perceived.
LGBTQ Iowans and allies who descended upon the Iowa Capitol to protest the bill far outnumbered those in support, though the testimony initially alternated between pro and con. Some trans Iowans in the room shared personal testimony about discrimination they’ve faced and fears of being further marginalized.
Iowa’s civil rights law protects against discrimination in employment, wages, public accommodations, housing, education and credit practices based upon certain characteristics of a person. That includes gender identity, as well as someone’s race, color, creed, sex, sexual orientation, religion, national origin and disability status.
Sexual orientation and gender identity were not originally included in Iowa’s Civil Rights Act of 1965. They were added by the Democrat-controlled Legislature in 2007, with about a dozen Republicans across the two chambers joining in favor.
State Rep. Jeff Shipley, who authored the bill discussed on Wednesday, gave an impassioned introduction in which he argued that there is no objective criteria to evaluate gender identity and that there is a “viciously hostile” culture around the protection of these individuals over others. Shipley said the latter was made clear by the protesters shouting expletives and giving him the finger as he left the room.
As written, the bill would have amended the civil rights law’s definition of disability, a protected status, to include the psychological distress that some transgender people experience, known as gender dysphoria, or any another diagnosis related to a gender identity disorder.
Those individuals would be protected, but advocates Wednesday made clear that being trans is not a disability and that a broad swath of transgender Iowans who do not experience gender dysphoria would be left exposed.
“I am not disabled,” said Annie Sarcone, a transgender Iowan and director of the Des Moines Queer Youth Resource Center. “Shame on the Iowa Legislature for trying to pull something like this. For being the only state to take things this far.”
Iowa’s Republican-controlled statehouse has passed multiple bills that Republican Gov. Kim Reynolds signed into law targeting LGBTQ Iowans in recent years, including prohibiting transgender students from using public bathrooms that align with their gender identity, banning gender-affirming care for transgender minors and prohibiting transgender females from participating in girls high school and women’s college sports.
Those measures are part of a wave of laws recently passed in conservative states across the country that have led the Human Rights Campaign to declare a state of emergency for LGBTQ Americans.
About half of U.S. states include gender identity in their civil rights code to protect against discrimination in housing and public places, such as stores or restaurants, according to the Movement Advancement Project, an LGBTQ+ rights think tank. Some additional states don’t explicitly protect against such discrimination, but it is included in legal interpretation of the statutes.
Federal protections against employment discrimination on the basis of gender identity were reinforced in a landmark U.S. Supreme Court case in 2020, when conservative Justice Neil Gorsuch wrote for the majority that discrimination because of LGBTQ+ status was an extension of sex-based discrimination.
he leader of the California Senate on Friday said she would run for governor in 2026, entering a campaign that is far from the minds of voters but is quickly filling with candidates in a state that requires frequent fundraising to compete in some of the nation’s most expensive media markets.
Toni Atkins, a Democrat from San Diego, made history as only the third person and the first woman to hold both of the state Legislature’s top jobs — speaker of the Assembly and president pro tempore of the Senate.
Atkins is still in the latter role, but plans to step down early next month as she enters the final year of her term and cannot seek reelection because of term limits.
California, despite its progressive reputation, has never had a woman or an openly LGBTQ governor. Atkins, who is a lesbian, could be both. But she’ll have to compete against a strong field of Democrats, including Superintendent of Public Instruction Tony Thurmond, former Controller Betty Yee and Lt. Gov. Eleni Kounalakis. Attorney General Rob Bonta is also considering a run to succeed current Gov. Gavin Newsom, who cannot seek a third term.
Kounalakis, Thurmond, Yee and Bonta have the benefit of appearing — and winning — in a statewide election, meaning voters will be familiar them. Atkins has only ever been elected by voters in San Diego.
But she is well-versed in the inner workings of the Capitol and policymaking. She has negotiated multibillion-dollar budgets and major legislation with two governors. And she has a compelling personal story — growing up in a house with no running water in rural Virginia before making her way out West and becoming one of the most powerful elected officials in the state.
“I certainly don’t fit the mold of past governors or even some of the candidates that will be in this race,” Atkins said. “I’m going to lean on my story, because I think Californians are going to want someone more like them.”
Atkins came to California in 1985 to help care for her sister’s young son. She later worked at a women’s health clinic that performed abortions before getting elected to the San Diego City Council. She had a brief stint as mayor before getting elected to the state Assembly in 2010 and the state Senate in 2016.
In the Legislature she worked with former Gov. Jerry Brown and Newsom to craft a series of budgets marked by multibillion-dollar surpluses. That ended last year when the state had a multibillion-dollar deficit.
Newsom has steadfastly refused sweeping tax increases to balance the budget — something Atkins, too, said she would try to stay away from if she were elected governor.
“We want to preserve what we’ve done. It took a lot of work,” Atkins said. “I would not gravitate toward raising taxes in this moment. I don’t think it’s called for yet.”
A bill advanced by Florida Republicans on Wednesday would ban teachers and other government employees from displaying a rainbow flag — even wearing one as a lapel pin for a day — but they could hang the full-size flag of any “recognized nation” as long as they want, according to the bill’s sponsor.
Flag displays that depict a “racial, sexual orientation and gender, or political ideology viewpoint” would be banned from any state or local government building, including public schools and universities, under the bill authored by GOP Rep. David Borrero.
Opponents say the bill is inspired by hate. Borrero said it protects children and it would ban even lapel pins representing the flags of the LGBTQ and Black Lives Matter movements.
“Public classrooms should not be the place where our kids go to be radicalized and evangelized into accepting these partisan, radical ideologies,” Borrero said. “It’s wholly inappropriate to be putting those types of flags in front of public school students and in government buildings.”
Asked about other flags, Borrero said those of sovereign states recognized by the U.S., such as Israel, could be displayed in a classroom. Because the U.S. doesn’t recognize Palestine as a nation, this would rule out the Palestinian flag.
The ban wouldn’t apply to students, or to government employees when they’re not at work or in public buildings, Borrero said. But it would extend to lawmakers’ offices, and at least some Democrats said they’ll break the law if the bill is ever signed by DeSantis.
“Are we in Russia? Are we in Cuba? That’s authoritarianism. That’s fascism at it’s best,” said Sen. Shevrin Jones, who is Black and gay and has a “Pride at the Capitol” poster with rainbow colors in his public lobby, along with other pride symbols.
“How I was raised, the rainbow meant hope. … I can promise you it wasn’t that that made me gay,” Jones added. “I’m not taking a damn thing down. I want everybody to see it.”
Florida lawmakers have already passed several anti-LGBTQ laws while Republican Gov. Ron DeSantis runs for president. DeSantis has signed bans against teaching about sexual orientation and gender identity in schools. He’s banned transgender health care for minors and created new hurdles for transgender adults, and made it easier for parents to get books with LGBTQ themes removed from schools.
This bill advanced with a party-line 9-5 vote by the House Constitutional Rights, Rule of Law & Government Operations Subcommittee faces an uncertain path, even with Republican supermajorities in the Legislature. It has one more House committee stop before being considered by the full chamber. A companion Senate bill has been referred to three committees and hasn’t been scheduled for a hearing.
DeSantis’ office didn’t respond to an email asking if he supports the legislation.
Democratic Rep. Michele Rayner, who is Black and lesbian, spoke with frustration that anti-LGBTQ bills keep coming up in the Florida Legislature, ignoring more pressing needs such as access to affordable housing and property insurance.
“Once again we’re focusing on things nobody has asked us to focus on,” said Rayner, sitting in her office near a stack of “Protect LGBTQ+ Students” flyers printed over rainbow colors. “I have a Black Voters Matter sign outside of my office. It will remain outside my office regardless of what bill they pass because there’s a thing called the First Amendment.”
Borrero’s bill would also apply to local governments such as the Fort Lauderdale suburb of Wilton Manors, a gay-friendly town of 11,000 where Pride flags fly almost everywhere, including City Hall during Pride Month. A bridge leading into town is framed by rainbow-colored barriers and a Pride flag and a trans pride flag fly year-round above a small park across the street from City Hall.
Robert Boo, CEO of the town’s Pride Center, said DeSantis and the bill’s backers hope to “erase the LGBTQ community” and throw “red meat” to their political supporters while ignoring complicated issues plaguing the state.
“Wilton Manors is the second-gayest city in the country. It is important for Wilton Manors to be able to raise the flags that represent the community’s members,” Boo said. “This may not pertain to middle Florida and they may not want to do that, but I think municipalities should have the ability and freedom to put up the flags that best represent their constituents.”
The family of a transgender volleyball player has added a South Florida school district as a defendant in a federal lawsuit that challenges a 2021 state law banning transgender girls from playing on female sports teams, claiming school officials have placed the family in danger.
Attorneys for the family filed an amended complaint Thursday that adds the Broward School Board, the school district’s superintendent and the Florida High School Athletic Association. The school officials had been named as defendants when the lawsuit was initially filed in 2021 but were dropped the next year, leaving just the Florida Department of Education and Education Commissioner Manny Diaz as defendants.
“While we can’t comment on pending litigation, Broward County Public Schools remains committed to following all state laws,” district spokesman John J. Sullivan said in a statement. “The District assures the community of its dedication to the welfare of all its students and staff.”
U.S. District Judge Roy Altman, a Trump appointee, ruled in November that state officials had a right to enforce a 2021 law that bars transgender girls and women from playing on public school teams intended for student athletes identified as female at birth but allowed the family to file an amended complaint.
The law, which supporters named “The Fairness in Women’s Sports Act,” was championed and signed in by Republican Gov. Ron DeSantis, who is running for president and has leaned heavily into cultural divides on race, sexual orientation and gender.
The transgender student, a Monarch High School 10th grader who played in 33 matches over the past two seasons, was removed from the team in November after the Broward County School District was notified by an anonymous tipster about her participation.
According to the lawsuit, the student has identified as female since before elementary school and has been using a girl’s name since second grade. At age 11 she began taking testosterone blockers and at 13 started taking estrogen to begin puberty as a girl. Her gender has also been changed on her birth certificate.
The girl’s removal from the volleyball team led hundreds of Monarch students to walk out of class in protest. At the same time, Broward Superintendent Peter Licata suspended or temporarily reassigned five school officials pending an investigation, including the girl’s mother, an information technician at the school.
The Associated Press is not naming the student to protect her privacy.
The initial lawsuit didn’t identify the student or her school, but the amended complaint said the family lost all privacy when the school district began its investigation. The student’s mother issued a statement at the time calling the outing of her daughter a “direct attempt to endanger” the girl.
The Human Rights Campaign, an LGBTQ+ rights organization, has been supporting the family.
“The reckless indifference to the well-being of our client and her family, and all transgender students across the State, will not be ignored,” the group’s litigation strategist, Jason Starr, said in a statement last month.
Alabama can begin immediately enforcing a ban outlawing the use of puberty blockers and hormones to treat transgender people under 19, a federal appeals court ruled Thursday, granting the state’s request to stay a preliminary injunction that had blocked enforcement of the 2022 law.
The 11th U.S. Circuit Court of Appeals had previously ruled that the injunction should be vacated, but the decision had been effectively on hold while families with transgender children asked the full appellate court to reconsider the decision. The Thursday order will allow the ban to take effect while the full court decides whether it will revisit the decision.
The state Attorney General Steve Marshall called the order a “significant victory for our country, for children and for common sense.”
“The physical and psychological safety of our children can now be better protected from these untested and life-altering chemical and surgical procedures through the implementation of the Alabama Vulnerable Child Compassion and Protection Act,” Marshall said.
Lawyers representing parents of transgender adolescents who challenged the ban said the decision will “hurt parents and children in the state.”
“Alabama’s transgender healthcare ban will harm thousands of transgender adolescents across the state and will put parents in the excruciating position of not being able to get the medical care their children need to thrive,” read a joint statement from GLBTQ Legal Advocates & Defenders, the National Center for Lesbian Rights, the Southern Poverty Law Center and the Human Rights Campaign.
Alabama Gov. Kay Ivey signed the Vulnerable Child Compassion and Protection Act into law in 2022, making it a felony punishable by up to 10 years in prison for doctors to treat people under 19 with puberty blockers or hormones to help affirm their gender identity.
At least 22 states have now enacted laws restricting or banning gender-affirming medical care for transgender minors, and many of them face lawsuits or blocked enforcement. Courts have issued mixed rulings, with the nation’s first law, in Arkansas, struck down by a federal judge who said the ban violated the due process rights of young transgender people and their families.
Attorneys representing Tennessee transgender teens and their families have asked the U.S. Supreme Court to block the state’s ban on gender-affirming care for minors that a lower court allowed to go into effect. The court is expected to decide later this year if it will hear the case.
Four families with transgender children ranging in ages 12 to 17 challenged the Alabama law as an unconstitutional violation of equal protection and free speech rights, as well as an intrusion into family medical decisions. The U.S. Department of Justice joined their lawsuit, seeking to overturn the law.
U.S. District Judge Liles Burke, nominated to the court by then-President Donald Trump in 2017, ruled when issuing the preliminary injunction that Alabama had produced no credible evidence to show that transitioning medications are “experimental.” Alabama appealed the decision to the 11th Circuit. The challenge to the Alabama ban is scheduled to go to trial early this year.
Four days of waiting under the flickering fluorescent lights of UNC Hospitals’ emergency room left Callum Bradford desperate for an answer to one key question.
The transgender teen from Chapel Hill needed mental health care after overdosing on prescription drugs. He was about to be transferred to another hospital because the UNC system was short on beds.
With knots in his stomach, he asked, “Will I be placed in a girls’ unit?”
Yes, he would.
The answer provoked one of the worst anxiety attacks he had ever experienced. Sobbing into the hospital phone, he informed his parents, who fought for days to reverse the decision they warned would cause their already vulnerable son greater harm.
Although they initially succeeded in blocking the transfer, the family had few remaining options when a second overdose landed Callum back in UNC’s emergency room a few months later. When the 17-year-old learned he was again scheduled to be sent to an inpatient ward inconsistent with his gender identity, he told doctors his urge to hurt himself was becoming uncontrollable, according to hospital records given by the family to The Associated Press.
“I had an immense amount of regret that I had even come to that hospital, because I knew that I wasn’t going to get the treatment that I needed,” Callum said. “That moment of crisis and shock and fear, I would wish anything that that hadn’t happened, because I truly think that I took a step backwards from where I was before in terms of my mental health.”
As the political debate over health care for transgender youth has intensified across the U.S., elected officials and advocates who favor withholding gender-affirming medical procedures for minors have often said parents are not acting in their children’s best interest when they seek such treatment.
Major medical associations say the treatments are safe and warn of grave mental health consequences for children forced to wait until adulthood to access puberty-blocking drugs, hormones and, in rare cases, surgeries.
Youth and young adults ages 10–24 account for about 15% of all suicides, and research shows LGBTQ+ high school students have higher rates of attempted suicide than their peers, according to the Centers for Disease Control and Prevention.
Some transgender teens say the negative rhetoric popularized by many Republican politicians in recent years has become too much to bear. In North Carolina, legislators enacted new limits to gender-affirming care for trans youth this year while barely discussing flaws in the psychiatric care system. It’s one of at least 22 states that have passed laws restricting or banning gender-affirming medical care for transgender minors. Most face legal challenges.
North Carolina lacks uniform treatment standards across hospitals and runs low on money and staff with proper training to treat transgender kids in crisis. That means the last-resort measures to support patients like Callum often fail to help them, and sometimes make things worse.
Sending a transgender child to a unit that does not align with their gender identity should be out of the question, no matter a hospital’s constraints, said Dr. Jack Turban, director of the gender psychiatry program at the University of California, San Francisco, and a researcher of quality care barriers for trans youth in inpatient facilities.
“If you don’t validate the trans identity from day one, their mental health’s going to get worse,” Turban said. “Potentially, you’re sending them out at a higher suicide risk than they came in.”
When North Carolina lawmakers allocated $835 million to shore up mental health infrastructure earlier this year, none of the money was specifically allocated to the treatment needs of trans patients. Though the funding may benefit everyone, a lack of direct action has left trans youth at the mercy of a system ill-equipped to help them when they need it most.
A nationwide dearth of pediatric psychiatric beds was compounded by the COVID-19 pandemic, which saw an unprecedented number of people seeking emergency mental health services, according to a report by the American Psychiatric Association. Demand has yet to return to pre-pandemic levels.
A “dire shortage” of at least 400 inpatient psychiatric beds for North Carolina youth has left UNC with no choice but to send patients to other facilities, even those that cannot accommodate specific needs, said Dr. Samantha Meltzer-Brody, chair of the UNC Department of Psychiatry.
Emergency rooms are not designed for boarding, nor can they provide comprehensive mental health treatment. That creates an immediate need to place patients left waiting in the ER for days or even weeks before a bed opens up, Meltzer-Brody said.
While UNC’s own inpatient program assigns all children to individual rooms on co-ed floors, it sends overflow patients to some hospitals that don’t make such accommodations.
“We have no choice but to refer people to the next available bed,” Meltzer-Brody said of the University of North Carolina-affiliated hospital. “If you’re talking about the LGBTQ+ community and seeking trans care, you may be sent to a place that is not providing care in a way that is going to be most optimal.”
Callum exploded when he was told about plans to place him in a unit for girls, his records note. He shouted and cried hysterically until he ended up in an isolation room. Doctors later found him banging his head against the wall in a trance-like state.
“It was almost as if sort of my brain had turned off because of such a shock,” he recalled. “I had never acted on such severe self-harm without even realizing that I was doing it.”
UNC declined to comment on Callum’s case, despite the family’s willingness to waive its privacy rights. But Meltzer-Brody did broadly address barriers to gender-affirming treatment for all psychiatric patients.
The public hospital system’s policy on gender-designated facilities recommends inpatient assignments based on a patient’s “self-identified gender when feasible.” But with the ER overrun in recent years, Meltzer-Brody said meeting that goal is a challenge.
The issue extends beyond transgender youth, affecting patients with autism, addiction and acute psychiatric disorders who are sometimes sent to facilities unfit to provide specialized care.
It doesn’t help, she said, that there is no national standard for how psychiatric hospitals must cater to transgender patients.
The LGBTQ+ civil rights organization Lambda Legal has outlined best practices for hospitals treating transgender patients under the Affordable Care Act. The organization says denying someone access to a gender-affirming room assignment is identity-based discrimination, based on its interpretation of the law.
But such cases rarely end up in court, because the burden falls on families to advocate for their rights while supporting a child in crisis, said Casey Pick, law and policy director at The Trevor Project, a nonprofit focused on LGBTQ+ suicide prevention.
“These are circumstances that are themselves often inherently traumatic, and adding a layer of trauma on top of that in the form of discrimination based on an individual’s gender identity just compounds the issue,” Pick said. “The last thing we should have to do is then add the additional trauma of going to court.”
Parents including Callum’s father, Dan Bradford, describe feeling helpless while their children are receiving psychiatric care involuntarily, which isn’t uncommon after attempted suicide. Callum’s involuntary commitment designation also temporarily stripped his mother and father of many parental rights to make medical decisions for their son.
A psychiatrist himself, Dan Bradford always has supported his son’s medical transition, which began with puberty-blocking drugs, followed by a low dose of testosterone that he still takes. Eventually, Callum underwent top surgery to remove his breasts. Irreversible procedures like surgery are rarely performed on minors, and only when doctors determine it’s necessary.
“In Callum’s case, the gender dysphoria was so strong that not pursuing gender-affirming medical treatments, like pretty quickly, was going to be life-threatening,” his father said, wiping tears from his eyes. “Any risk that might be associated with the treatments seemed trivial, quite frankly, because we were afraid we’re going to lose our kid if we didn’t.”
North Carolina law bars medical professionals from providing hormones, puberty blockers and gender-transition surgeries to anyone under 18. But some kids like Callum, who began treatment before an August cut-off date, can continue if their doctors deem it medically necessary.
Although he retained access to hormones, Callum said it has been brutal seeing the General Assembly block his transgender friends from receiving the treatments he credits as life-saving.
“When these public policies are discussed or passed, that sends a really strong message to these kids that their government, their society and their community either accepts them and validates them or doesn’t,” said Turban, the researcher at UC San Francisco.
His research has found that many medical providers still lack training about LGBTQ+ identities and make common mistakes, such as printing the wrong gender designation on a hospital wristband or placing a transgender patient in a single-occupancy room when everyone else has a roommate.
Fearing the plan to place his son in a girls’ ward would be deeply traumatizing, Dan Bradford secured a spot at a residential treatment center in Georgia. He pleaded with UNC to release Callum early and convinced the North Carolina hospital that was supposed to take him to reject the transfer.
The teen then spent 17 weeks in an individualized treatment program in Atlanta, recovering from the circumstances that landed him in the ER and the added trauma he endured there. He has since returned home and is taking care of his mental health by playing keyboard and rowing with his co-ed team on the calm waters of Jordan Lake. For the first time in years, Callum said he’s thinking about his future.
There are some positive developments on the horizon for North Carolina youth facing mental health crises.
The new state funding for mental health services approved in October has enabled UNC Hospitals to open a 54-bed youth behavioral health facility in Butner, 28 miles (45 kilometers) north of Raleigh. State Department of Health and Human Services Secretary Kody Kinsley said the facility should alleviate some barriers to individualized care, including for transgender patients. And UNC has announced plans to open a freestanding children’s hospital within the next decade.
Leaders of the Butner facility, which began its phased opening this month, have promised to take a whole-family approach so parents are not shut out of their child’s treatment plan. Nearly every patient will be placed in an individual room on a co-ed floor.
The new facility and funding will allow more patients to stay in single-occupancy rooms at UNC, but overflow patients may still be sent elsewhere, Meltzer-Brody said. The hospital system has not changed its policies on transgender patient referrals, and other facilities across the state that receive those patients still lack uniform standards for treating them.
Although Callum said his experiences eroded his trust in the state’s inpatient care network, he is optimistic that the new resources could give others a more gender-affirming treatment experience, if they are paired with policy changes.
“I’m still here, and I’m happy to be here,” he said. “That’s all I want for all my trans friends.”
Seattle Children’s Hospital filed a lawsuit in Austin, Texas, this month asking a court to invalidate or narrow the requests from Paxton, a staunch conservative who has helped drive Republican efforts that target the rights of trans people. His office sent similar letters earlier this year to Texas hospitals.
Texas is among more than 20 states that have enacted laws restricting or banning gender-affirming medical care for transgender minors. On Friday, court records showed there been no decision yet on the Seattle hospital’s lawsuit.
The hospital argued Paxton’s office was overstepping its jurisdiction and had no authority to request the records.
“Additionally, the Demands represent an unconstitutional attempt to investigate and chill potential interstate commerce and travel for Texas residents to another state,” the lawsuit states.
Paxton’s office did not immediately respond to a phone message and email seeking comment Friday. Lawyers and spokespersons for Seattle Children’s Hospital also did not immediately respond to a phone messages and emails seeking comment.
The Seattle hospital received the request from Texas in November. The lawsuit includes a copy of the letter from Paxton’s office, which among other requests asks the hospital to produce records identifying medication given to children who live in Texas; the number of Texas children who received treatment; and documents that identify the “standard protocol or guidance” used for treatment.
The hospital argued in cannot respond to the letter under a law signed by Democratic Gov. Jay Inslee earlier this year that aims to protects minors seeking gender-affirming care in Washington.
In May, Paxton’s office sought information from Dell Children’s Hospital in Texas about its policies on puberty blockers as well as documents identifying patients it has referred for treatment or counseling. The attorney general’s office request at the time asked to examine hospital records “to determine whether any state laws have been violated or misrepresentations have been made to parents and patients.”
Those efforts began before Texas’ restrictions were signed by Republican Gov. Greg Abbott, who was the first governor to order the investigation of families of transgender minors who receive gender-affirming care.
The Texas law prevents transgender minors from accessing hormone therapies, puberty blockers and transition surgeries, even though medical experts say such surgical procedures are rarely performed on children. Children who already started the medications being banned are required to be weaned off in a “medically appropriate” manner.
Over the last six years, blood center employee Dylan Smith was often asked how frequently he gave blood himself. His answer was always the same: As a gay man, he couldn’t.
That changed this month.
Thanks to new federal guidelines finalized in May, gay and bisexual men in monogamous relationships can now donate at many blood centers around the country without abstaining from sex.
Bloodworks Northwest, where Smith works as a donor services supervisor, adopted the change on Dec. 6. He and his partner gave blood for the first time the next day.
“It’s been really emotionally difficult just to explain every single time the reason why,” said Smith, 28. “To be able to finally step up and support the mission that I really have just believed in since I started here just makes my heart feel so happy.”
The new U.S. Food and Drug Administration guidelines are the latest step in a yearslong effort to reverse restrictions that were designed to protect the blood supply from HIV, but which were increasingly criticized as discriminatory following scientific advances that allowed better detection of the virus.
The American Red Cross, which accounts for about 40% of blood and blood component donations in the U.S., began implementing the new guidance in August.
About half of the 16 independent blood bank organizations that are members of the Alliance for Community Transfusion Services have rolled out the new guidelines, with more expected next year, the organization said.
“It is going to take time,” said Benjamin Prijatel, president of Shepeard Community Blood Center in Augusta, Georgia. “Blood centers and health professionals are going to have to put forth the effort to engage and educate this community in order to overcome years of distrust. That’s the only way this rule change will translate into additional donations.”
The change puts the emphasis on sexual activity rather than on sexual orientation. All potential donors are screened with a new questionnaire evaluating their HIV risk based on sexual behavior, partners and other factors that can contribute to the spread of blood-borne infections, such as intravenous drug use or recent tattoos or piercings.
Potential donors who report having anal sex with new partners in the last three months are barred from giving until a later date, and anyone who has ever tested positive for HIV will continue to be ineligible. Those taking pills to prevent HIV through sexual contact are still barred until three months after their last dose; the medications, known as PrEP, can delay the detection of the virus, the FDA said.
Donated blood is then tested for HIV, hepatitis C, syphilis and other infectious diseases.
Bloodworks Northwest, which supplies blood to more than 90 hospitals in the region, isn’t keeping track of how many newly eligible donors are coming in, said Dr. Kirsten Alcorn, the nonprofit’s co-chief medical officer. But workers have heard plenty of stories from people excited to give.
“It feels very meaningful to many of them to now be able to contribute to somebody’s survival,” Alcorn said.
Bloodworks executive Aaron Posey, whose own life was saved by a transfusion when he fell down a set of stairs and broken glass sliced an artery, welcomed the new guidance. He said hospitals and patients need access to a new pool of donors.
“Having always witnessed a shortage in the blood supply, it has at times been very frustrating,” said Posey, who first donated blood during the pandemic when the abstinence period was cut to three months.
Smith learned of the restrictions on gay men giving blood when he was screened while trying to donate his freshman year of college in 2013. The rules blindsided him, he said. It was a long time to wait before he could finally donate with his partner and other friends.
“Just being able to see them donating next to me, smiling next to me … meant so much,” Smith said.