On Wednesday, Democratic North Carolina Gov. Roy Cooper vetoed a trio of anti-trans bills passed by wide margins in the Republican-controlled state House and Senate. The three bills would ban gender-affirming care for minors, prohibit trans athletes in school sports, and limit classroom discussions about gender and sexuality.
Despite the governor’s vetoes, prospects for killing the legislation are poor. Republicans hold veto-proof majorities in both state chambers.
Cooper condemned the bills as “a triple threat of political culture wars” and accused Republicans of “scheming for the next election” at the expense of vulnerable children.
“A doctor’s office is no place for politicians,” said Copper, echoing a popular line of defense among Democrats defending trans minors. “North Carolina should continue to let parents and medical professionals make decisions about the best way to offer gender care for their children.”
“Ordering doctors to stop following approved medical protocols sets a troubling precedent and is dangerous for vulnerable youth and their mental health,” Cooper said, referring to H.B. 808, which would ban puberty blockers and hormone therapy for trans youth in the state.
Cooper also vetoed H.B. 574, a ban on athletes competing on middle school, high school, and college sports teams that align with their gender identity. A “student’s sex shall be recognized based solely on the student’s reproductive biology and genetics at birth,” the bill reads. Sports teams would be designated for males, men or boys; females, women or girls; or coed or mixed by those strict gender definitions.
The third bill vetoed by Cooper, S.B. 49, would ban instruction on “gender identity, sexual activity, or sexuality” in kindergarten through fourth grade and require parents to be notified “prior to any changes in the name or pronoun used for a student in school records or by school personnel.”
Cooper denounced that measure as hampering “the important and sometimes lifesaving role of educators as trusted advisers when students have nowhere else to turn.”
Conservatives in North Carolina were trailblazers, pioneering the transphobic moral panic that has swept red states in the last two years.
In 2016, the state’s notorious “bathroom bill,” which banned trans people from public restrooms and shut down local efforts to enact anti-discrimination measures, cost North Carolina millions in lost business and was a national embarrassment. The law was partly repealed in 2017.
While Cooper’s vetoes will likely be overridden, activists hold out hope the courts will intervene, as they did then, on at least some of the legislation.
More than 20 states have enacted bans on gender-affirming care for minors, but almost all face court challenges. In June, a federal judge struck down Arkansas’ ban as unconstitutional, and federal judges have temporarily blocked bans in Alabama, Indiana, Kentucky, and Tennessee. Plaintiffs in Florida won a reprieve when a federal judge there blocked enforcement for three minor children.
Max Adomat considers themself fortunate. Adomat, 26, who is nonbinary and uses they/them pronouns, has been on a steady regimen of feminizing hormones for the last six years. They also began their gender transition in New Jersey, a progressive state where clinics offering transition-related medical care are commonplace, and name changes are confidential, they said.
But Adomat still found themself obtaining and self-administering gender-affirming hormones from unregulated, and oftentimes illegal, overseas online pharmacies instead of licensed medical offices. The reason, Adomat said, was a lack of both health insurance and money: When they began transitioning, their low-paying job in the food service industry did not provide insurance, and they were unable to afford the steep cost of transition-related care — including hormone therapy and routine doctors appointments — without it.
Though they knew the risks — which, without supervised care, can include higher chances of blood clots, heart attacks and some cancers — Adomat felt their window for a successful transition was closing, they said.
“I just sort of decided, ‘I’m going to do it, and if and when I can see a doctor somewhere down the road, sure, but I would rather do it now and face those consequences,’” they recalled, adding that their alternative at the time was to continue to “live miserably.”
Interviews with health care providers and lawyers, as well as transgender individuals who use or have used a do-it-yourself approach to transitioning, suggest the reasons people opt for the nonprescription and self-administration route vary and include cost savings, health care accessibility, medical discrimination, and the desire to choose which hormones and dosages are involved in the process.
A DIY approach, however, is not without its health and legal risks. Despite the risks, some experts predict this approach will become even more common given the current political climate: Nearly 20states have already passed laws blocking access to gender-affirming care for minors, and other states have proposed measures that would restrict this type of care for some adults.
Out of pocket costs
A monthly supply of common feminizing hormones — including estrogen and anti-androgens — can cost patients up to $115, according to GoodRx, which tracks U.S. drug prices. Masculinizing hormones, including injectable testosterone, are typically cheaper, costing about $40 to $90 a month. Through unregulated online pharmacies, however, a monthly supply of these feminizing and masculinizing hormones can be purchased for as low as $8, plus shipping.
While price sensitivity to health care costs is not unique to transgender people, this community faces higher rates of economic hardship and poverty, with 1 in 3 trans adults reporting an annual household income under $25,000, according to a 2021 report from the liberal think tank Center for American Progress.
Samme Qandil, 28, was on a medically supervised hormone regimen for three years, but when she landed a new job and her health insurance changed, she was unable to pay her new provider’s $300 copay for a six-week supply of injectable hormones. Faced with both high copay fees and a nationwide shortage of injectable estrogen, she decided to begin purchasing her hormones from an unregulated online pharmacy recommended by her friends.
While Qandil, now a graduate student in Oregon, said she didn’t have many reservations about obtaining and administering hormones by herself, since she knew others who had gone through the process, she still undergoes regular blood tests to ensure her estrogen levels are within a safe range.
The prescription route cost her nearly $700 a year for medications and $400 in appointment copays, Qandil said — more than twice what she now pays for a two-year supply of hormones and related expenses like estrogen blood tests.
While hormone replacement therapy using a DIY approach is “cheaper and technically more accessible,” Qandil said, orders from overseas pharmacies can be unreliable, with some packages of unregulated hormones seized at the U.S. border. However, she added, DIY is cheaper even with the sunk costs, and she even has the ability to stock up on a yearly supply to ensure the hormones don’t run out during a shortage or customs confiscation.
“In an era when patients may have no option but to ‘DIY’ their transitions, just as it is happening with abortions in many states, it might be important for them to know that there are ways to do it that are overall less risky.”
DR. URI BELKIND, CALLEN-LORDE COMMUNITY HEALTH CENTER
Stephanie Coiro, a clinical social worker at Northwell Health’s Center for Transgender Care in New Hyde Park, New York, estimates about 10% of her transgender patients have tried acquiring hormones without a prescription at one time or another. She said this route can cut their costs by more than 50%. Though, she emphasized, those with a prescription, even if they do not have health insurance, can get testosterone or estrogen for $20 to $30 a month at stores like Target and Walmart with manufacturer coupons.
For those who do not have health insurance, anything out-of-pocket, including doctors appointments, is “incredibly expensive,” Coiro acknowledged. In addition to price concerns, she said recent shortages of hormones, like testosterone, could also drive patients to acquire medication through nonprescription means.
The cost of hormones is often one of many expenditures associated with a transition, according to experts and those receiving transition-related care. And a number of transition-related services and procedures are typically not covered by health insurance, including hair removal, which can be mandatory for some gender-affirming surgeries; therapy visits for referral notes, which are typically mandatory for prescriptions and surgeries; and gender-affirming facial and chest surgeries.
Dr. Uri Belkind, the associate director of adolescent medicine at Callen-Lorde Community Health Center, an LGBTQ-focused health clinic in New York City, called the long list of transition-related expenses a “transgender tax” that can cost trans people hundreds of thousands of dollars over their lifetime.
Across the pond, in the United Kingdom, Alicia Tuplin West, 19, has turned to unregulated online pharmacies for both cost and expedience. While England offers free gender-affirming care through a publicly funded health care system, West, a university student, said she faced a waitlist of up to several years through England’s National Health Service (joining around 26,000 others, according to The Guardian). Unwilling to wait and unable to afford a private health care alternative costing 1,000 pounds a year ($1,250), West bought hormones through an online pharmacy and cut the price by 90%, she said.
“The traditional way, it’s all socialized; it’s all paid for by my taxes,” West said. “However, I would argue that the traditional way is like a myth — the idea of getting treatment from the NHS — if you want to transition in this decade.”
Access to care
Most U.S. states still permit minors to obtain gender-affirming care with parental consent, and, for those over 18, this type of care is still legal in all 50 states. However, recent years have seen an unprecedented wave of state laws seeking to ban or restrict transition-related care, particularly for trans youths.
Eighteen states now have laws on the books banning or restricting the prescription of puberty blockers and hormones to minors, though a federal judge struck down Arkansas’ law last month, and judges have temporarily blocked laws in Alabama, Florida, Indiana, Kentucky, Oklahoma and Tennessee. At least two dozen other statesare considering such measures, and a few, like Tennessee and Oklahoma, have considered bills that would restrict this type of care for some adults.
This legislative push makes legal access to gender-affirming care nearly impossible for some people, three experts told NBC News, which could lead them to unregulated online pharmacies.
Belkind said this recent legislation “absolutely” has the potential to send more transgender people online to seek hormones. He also pointed to a recent request by Florida Gov. Ron DeSantis, a Republican, that asked state universities to send information to the governor’s office about students who sought or received treatment for gender dysphoria.
“People are not going to want to be on those lists for obvious reasons,” Belkind said. “They might not even disclose to their medical providers, if they seek medical care for other things, that they are on hormones.”
Dr. Danielle Brooks, an endocrinologist at Northwell Health’s Center for Transgender Care, said state legislation restricting transition-related care will likely drive more people, including minors, down the DIY path.
“I think more and more people are aware of the path,” Brooks said. “I do think that will be something that will increase over time, and it’s probably increasing now.”
Dr. Joshua Safer, director of the Center for Transgender Medicine and Surgery at Mount Sinai in New York City, said patients have historically self-medicated when they don’t have access to conventional medical care. While he doesn’t think most trans youths will be able to acquire gender-affirming hormones through the informal economy, he said parents may resort to seeking medical care in other states if they have the resources.
If these youths are unable to acquire hormones, Safer said, there are “going to be negative mental health implications.”
The data supports Safer’s assertion: Transgender and gender-nonconforming individuals are at an increased risk for mental illness and suicidality, according to a study published last year in JAMA Network Open, and receipt of transition-related care is associated with 60% decreased odds of moderate or severe depression and 73% decreased odds of suicidality.
Even for adults and minors who have health insurance and live in states not affected by restrictions on transition care, insurance companies may not approve coverage for such care.
Dale Melchert, a staff attorney at the Transgender Law Center, said he has seen most insurance companies oscillate gender-affirming health care coverage based on what’s required under federal regulation, such as individual presidential administrations’ interpretation of the Affordable Care Act. While Obama-era policies blocking widespread coverage exclusions have historically prompted insurers to adjust their plans to cover more gender-affirming care, Trump-era rollbacks of these policies have since barred many from affordable access to transition care, Melchert said.
“Most insurance companies will do anything they can to save money, and denials are a way to save money,” he said. “Technically, we still have Trump’s rollbacks on the books.”
Apart from the expenses associated with transitioning, unpleasant experiences with health care providers can also dissuade individuals from seeking supervised care.
“Doctors can also ask unnecessary questions that have nothing to do with the reason they came to seek care. That feels really invasive,” Melchert said. “A lot of times doctors don’t know how to provide competent care.”
A 2018 study of students at 10 medical schools found that approximately 80% of survey respondents felt “not competent” or “somewhat not competent” treating transgender patients. According to the same study, while 93% of respondents felt somewhat or very comfortable treating sexual minority patients, 68% felt comfortable treating gender minority patients.
Dr. Ricardo Correa, an associate professor at the University of Arizona College of Medicine-Phoenix, acknowledged that there’s a “high” amount of bias in the health care community against trans people, echoing a sentiment also expressed by Brooks. However, he added, even those who want to refer patients to practices where they can receive gender-affirming care may be unable to, because the patients are based in communities where there’s an absence of physicians who are able to provide adequate help.
“Instead of food deserts, there are medical deserts,” Correa said. “The patient just gets more traumatized [and] trusts the system less.” This, he said, can lead patients to pursue a DIY approach, until they are able to find the care they seek.
A desire for control
A., a postdoctoral fellow in life scienceat a Canadian university who requested that her name not be published due to safety concerns, sourced gender-affirming hormones through overseas online pharmacies for roughly a year. She wasn’t, however, prompted by a desire to save money or a lack of health insurance. Instead, she said, her driving factor was control over her own transition.
She said she received care from a Planned Parenthood clinic in the Midwest for nearly three years, followed by care at the LGBTQ nonprofit Howard Brown Health in Chicago for several years. Eventually, she grew dissatisfied after facing remasculinization and plateauing effects, she said. Her decision to take a DIY approach was the result of a conservative approach to hormone replacement therapy by her previous health providers and a general lack of information about trans care among doctors, she said.
“At first, everything seemed to be doing fine,” she said of her transition-related care. “You see breast growth, you see that your skin is getting smoother. … All of a sudden, for no reason whatsoever, you stall or you start regressing. Your facial and body hair come back in force, and you feel general discomfort in your body and mind.”
Following years of remasculinization — including “$3,000 of laser hair removal out the window” and persistent gender dysphoria — she grew desperate for a solution, she said. That’s when she decided to turn to online pharmacies, which enabled her to increase her hormone dosage.
She said the DIY process made her “feel empowered.”
“You feel very lost, but you feel that there’s the possibility of something moving forward,” she said. “You feel like you’re taking the reins of your care.”
After a year of ordering hormones through unregulated online pharmacies and self-administering, she said, she finally found a “good, private” clinic that was willing to listen to her concerns and address her needs. While she no longer personally uses a DIY approach, she continues to serve as a resource for others starting their DIY journeys through online forums, she said.
Health and legal risks
Obtaining and administering hormones without regulated pharmacies and licensed health care providers can expose individuals to serious health risks, including blood clots, stroke, liver damage and cardiovascular disease.
“We’re always worried about excess dosing if someone’s not being monitored, because the risks are real,” Brooks said. “There’s a possibility that medical history is not being taken into account or there is something being missed.”
Brooks said several patients have come to her office with a higher-than-normal concentration of red blood cells as a result of taking “very inappropriately” high levels of testosterone. This, she added, can cause vision problems, dizziness, fatigue, weakness, confusion and, of most concern, blood clots.
“The vast majority of products offered through online pharmacies are, at best, non-U.S. FDA-approved medicines and, more often, at worst, dangerous fakes.”
LIBBY BANEY, ALLIANCE FOR SAFE ONLINE PHARMACIES
Belkind, of Callen-Lorde, said his colleagues have seen patients who ended up with injection-site infections after self-administering hormones using the wrong technique, as well as blood clots due to using the incorrect hormone dosage.
On the flip side, Belkind said, he has had patients who, prior to seeking his care, used self-prescribed hormones and found helpful resources online, where they “learned what medications are safer.”
“In an era when patients may have no option but to ‘DIY’ their transitions, just as it is happening with abortions in many states, it might be important for them to know that there are ways to do it that are overall less risky and that there are resources created by the community where they can learn how,” he said.
Libby Baney, a partner at the law firm Faegre Drinker and a senior adviser to the Alliance for Safe Online Pharmacies, a nonprofit that combats illegal online drug sellers, cautioned that those who buy medication from unregulated online pharmacies may not actually be getting what they ordered.
“U.S. consumers buying medications from online pharmacies rarely, if ever, receive exactly what they think they are ordering,” she said. “The vast majority of products offered through online pharmacies are, at best, non-U.S. FDA-approved medicines and, more often, at worst, dangerous fakes.”
The National Association of Boards of Pharmacy’s 2022 “Rogue Rx Activity Report,” which Baney’s team shared with NBC News, cites a 2008 European Alliance for Access to Safe Medicines report that found 62% of medicines purchased online are substandard or counterfeit, and a 2010 Korean study that found 26% of medications tested from online pharmacies contained toxins like mercury, lead and arsenic, while 37% of samples tested didn’t have any active ingredients at all.
“Anytime that you have a product where people have either a legitimate medical need or perceived need, people will go online to find it outside the regulated supply chain,” Baney said.
Of the approximately 30,000 to 40,000 online pharmacies around the globe, 96% don’t require a valid prescription, 85% offer medicines that aren’t authorized by the FDA and more than 50% offer controlled substances, according to the 2022 National Association of Boards of Pharmacy report.
When it comes to the legal risks, enforcement efforts generally aren’t targeted at individual consumers, but rather the unregulated pharmacies selling the medication or the intermediaries helping to facilitate importation, according to Carrie Harney, vice president of government and regulatory affairs at United States Pharmacopeia, a nonprofit that annually publishes standards for prescription and over-the-counter drugs.
As for Adomat, they have recently scrapped the DIY method in favor of medically supervised care in Pennsylvania. This decision, they said, came after a career switch that included health insurance coverage. Still, Adomat said, they wouldn’t change their five-year DIY experience if given the opportunity.
“My attitude for a while was, ‘If it ain’t broke, don’t fix it,’” Adomat said. “Adding on to a general distrust of doctors, I decided to continue to put it off and shoulder the costs and risks myself.”
Now, with the right insurance and doctor, Adomat said, they “pay a fraction” of what they did using DIY methods. But, they added, those aren’t the only reasons why they’re currently content with the state of their care and their health: “I’m grateful I have a supportive family and legislature around me.”
If you or someone you know is in crisis, call 988 to reach the Suicide and Crisis Lifeline. You can also call 800-273-8255, text HOME to 741741 or visit SpeakingOfSuicide.com/resources for additional resources.
A Kansas law will reverse gender markers on trans people’s birth certificates and driving licences, in a move deemed “disastrous” for those affected.
On Monday (26 June), state attorney general Kris Kobach confirmed to reporters that the new law – Senate Bill 180 – which takes effect from 1 July, will legally erase trans people’s gender identities.
Kobach said the law will also force public schools to record students as the gender assigned at birth, regardless of whether teachers and staff recognise gender identities of trans and non-binary students.
The legislation, described by the Kansas Senate as a “women’s bill of rights,” defines “sex” as “either male or female at birth” in state law, with no alternative definition for individuals who identify as trans, non-binary, gender fluid, or gender-non-conforming.
In addition, trans people will be forced to use toilets and other single-sex spaces corresponding to the gender they were assigned at birth.
Republican representative Brenda Landwehr, who voted for the bill, said it would “protect women’s spaces currently reserved for women and men’s spaces currently reserved for men”.
‘That does not make you a woman’
Senator Renee Erickson, one of three Republican lawmakers who joined Kobach during his news conference, said: “You can choose whatever name you want. You can choose to live however you want. That does not make you a woman.”
The law follows a 2019 ruling which saw a federal judge order Kansas to allow trans people to change their birth certificates to settle a lawsuit over a no-change policy. SB 180 would see the 2019 order cancelled.
Micah Kubic, the executive director of the American Civil Liberties Union of Kansas, accused Kobach of rushing to “impose his own stamp of extremism”. He added that state agencies are not required to adopt the attorney general’s views.
‘Disastrous and fraught with difficulty’
Trans activist and journalist Erin Reed, whose partner is trans Montana lawmaker Zooey Zephyr, said of the new law: “Rolling back transgender people’s legal markers would be disastrous and fraught with difficulty.”
Reed said enforcing incorrect gender markers could lead trans people to experience heightened “harassment and abuse”.
In May, Montana’s Senate Bill 458 was signed into law. The Republican-backed legislation defines “sex” as binary – excluding intersex, non-binary and trans people.
Zephyr has been vocal in opposing Republican’s anti-LGBTQ+ bills, which saw her banned from the floor of the state’s House of Representatives.
‘Calculated manoeuvre’
Reed added: “The calculated manoeuvre of redefining sex to systematically exclude transgender individuals is an attempt to sidestep legal challenges. These laws represent a clear attempt to move beyond targeting transgender youth and the beginning of the campaign to eradicate transgender adults from all legal protections.”
According to AP News, Omar Gonzalez-Pagan, a lawyer for Lambda Legal, said: “The attorney general must be off his rocker. This was a bunch of bombast by an attorney general engaging in politics.”
A survey has found that a slim majority – just over half – of LGBTQ+ people in the UK feel comfortable being “out” in the workplace.
The study by consultancy firm Deloitte found that 52 per cent of the 402 LGBTQ+ Brits polled were comfortable being openly queer at work, compared to 43 per cent of the 5,474 LGBTQ+ people polled worldwide.
The survey also found that 43 per cent of LGBTQ+ people in the UK fear being seen differently by their straight, cisgender colleagues, compared to 39 per cent of respondents globally.
Deloitte polled queer people from 13 countries for the survey, and nearly half of the British respondents (49 per cent) reported being discriminated against at work due to their sexuality or gender identity.
Thirty-eight per cent said they had come up against homophobic or transphobic behaviour – including sexual jokes – at work.
Phil Mitchell, co-lead for the Deloitte LGBTQ+ staff network Proud, said: “When people feel that their employers aren’t doing enough to support inclusion or are not taking non-inclusive behaviours seriously, many instances go unreported.
“Employers should take action to ensure that they provide a positive culture of LGBTQ+ inclusion, underpinned by respect.”
Of the LGBTQ+ 18 to 25-year-olds polled for the survey, 19 per cent added that they had been bullied in the workplace, while the study also found that LGBTQ+ young people are paid less than their straight, cisgender peers on average.
Amy Ashenden, interim CEO of Just Like Us, said: “Our research shows that the treatment of LGBT+ people in British society today is preventing young adults from thriving at work.
“LGBT+ young people deserve to safely be themselves at school, home and work – there must be no exceptions.”
A UK-based charity dedicated to LGBTQ+ people over 50 has revealed that many feel “excluded and isolated” in a community “geared towards younger people”.
Research by Opening Doors found people over the age of 50 “especially within the gay community” feel less visible due to being less likely to have “familial networks”.
Due to “distrust in the system”, the charity also found that older people often go without help from external support networks.
John Campbell, who identifies as androsexual, said his experience as an older LGBTQ+ person has been “trying at times, owing to the amount of emotional trauma”.
‘I feel excluded’
Campbell, 64, told Metro: “At times I feel excluded from the community as it is mainly geared towards younger people.
“A lot of this is due to the fact many people from older generations were lost to the AIDs pandemic. It wiped out a generation of movers and shakers, and has left trauma for so many.”
The term ‘androsexual’ refers to people who, regardless of their gender identity, are sexually or romantically attracted to masculinity.
Angela, who didn’t provide her last name and is trans, echoed Campbell’s thoughts regarding a shared trauma within the community.
The 59-year-old said: “The majority of people my age or older have lived through different times and share a common set of experiences and emotions associated with a far less accepting society.
“It is a less frightening place to be known as LGBTQ+ than it ever was when I growing up in the 1970s, 80s and even the 90s.”
‘It can be quite a scary and unsettling experience’
Head of fundraising and communications at Opening Doors, Jonathan Buckerfield, said the findings show the need for support systems suited for LGBTQ+ people as “everything is set up for straight people”.
“As we age, we become less visible in wider society, and this is especially true in the LGBTQ+ community,” Buckerfield said.
“We don’t have the same familial networks and we can find ourselves increasingly cut off from social networks and services. It can be quite a scary and unsettling experience.”
Buckerfield noted that past traumas linked to a time when being LGBTQ+ was less tolerated mean activities that focus on reminiscing are not as suited to older LGBTQ+ people.
“LGBTQ+ people also experience health inequalities, as they are more likely to struggle with alcohol and addiction – but they are also less likely to trust the NHS as straight people do, as they can remember a time when conversion therapies were offered,” he continued.
In March, older LGBTQ+ people spoke to PinkNews about the struggle they faced hiding their true selves from prejudiced eyes and fighting for their right to grow old.
According to GLAAD, the average life expectancy of trans women of colour is 35. For a cis woman, it is 78.
Despite the struggles faced by the ageing LGBTQ+ community, 92-year-old Betty proved that age doesn’t have to result in being cut off from the world as she had her lifelong wish to watch a male strip show granted by her care home in Hampshire.
Some corporate sponsors have kept lower profiles at Pride celebrations this year, but most have not tightened their purse strings or ditched LGBTQ causes in the face of conservative blowback, event organizers and advocates say.
Nearly 78% of U.S. Pride organizers surveyed this year by InterPride, a network of Pride events around the world, said their corporate sponsorships either rose or held steady since last year — higher than the 62% global figure — while 22% reported declines.
Indy Pride, which organizes official celebrations in Indianapolis, faced new difficulties in the run-up to this year’s festivities. One corporate sponsor pulled its logo from an event, and another raised questions about a youth Pride carnival it had agreed to sponsor after getting “blasted” on social media, said executive director Shelly Snider.
Most of the Pride organizers NBC News spoke with, including Snider, declined to identify corporate sponsors that shrunk their involvement or visibility, concerned about alienating important financial backers. Like Indy Pride, Pride organizations are typically nonprofit organizations that also offer year-round services to the LGBTQ community, such as grants, educational events and support for political activism.
“We’ve hired extra security, gone through ‘stop the bleed’ training in case there is an active shooter,” she said. “This is new to this year. I didn’t think when I took this job that we would have to [learn how to] use a tourniquet, but here we are.”
Even so, Indy Pride raised a record $641,000 and saw crowds swell to an estimated 60,000 at its festival and parade last weekend, putting the event at full capacity.
The mix of changes Snider and other organizers described paint a more complicated picture than recent headlines around brands’ scrambles to respond to anti-LGBTQ backlash — like that faced by Bud Light and Target — may suggest. While some businesses have walked back their ties to LGBTQ events and causes, including Pride-related marketing, many more have maintained or increased their support.
We’ve seen an uptick in support throughout the year. More people are showing up and out, including allies.
JOSH COLEMAN, PRESIDENT OF CENTRAL ALABAMA PRIDE
Josh Coleman, president of Central Alabama Pride in Birmingham, said some longtime corporate sponsors dropped out this year, including Wells Fargo. Others have demanded more input on where their branding appears. But donations have held steady this month, he said, in part because more local and regional sponsors have filled the gaps left by larger companies’ retreats.
“It’s been a little frustrating,” Coleman admitted. “Some folks use allyship when they want to.”
Overall, though, “we’ve seen an uptick in support throughout the year,” he said. “More people are showing up and out, including allies.”
In Tennessee, where a federal judge recently rejected a drag ban that state Republicans enacted earlier this year, corporate backing for Memphis’s Mid-South Pride hasn’t suffered.
“We had issues,” festival director Vanessa Rodley said in an email, but after the judge temporarily blocked the measure from taking effect in late March, “we saw a wave of new sponsors that wanted to show support. There are a few we never got back, but thanks to our community stepping up and new sponsors, we were able to make it.”
A handful of major brands, including Kroger and Terminix, didn’t return as Mid-South Pride sponsors after making $7,500 and $3,500 contributions, respectively, in 2022, the group’s public sponsor listsin recent years show.
But others, such as Nike, Ford, Charles Schwab and Tito’s Vodka, either matched or upped their previous-year investments, which ranged from $5,000 to $10,000 apiece. And regional businesses, including a mortgage brokerage and a dentistry practice, jumped in this year with $5,000 sponsorships.
A Wells Fargo spokesperson said the bank “is a longstanding supporter of the LGBTQ+ community” and still “sponsoring parades in cities across the country.”
After being contacted, a Kroger spokesperson said the grocery chain “discovered a recent retirement left the [Memphis] parade without a contact at the company” and reached out to Mid-South Pride organizers. “We provided a contact from which to request support for this year or a future event.”
Some advocates warn that any pullback in the visibility of corporate support during Pride Month — especially by the most well-known brands — risks signaling that LGTBQ consumers are expendable. Others have long called for fewer rainbow-slathered logos and more substantive, if quieter, support from private-sector allies.
“Visibility is the least important,” said Bruce Starr, CEO of the marketing agency BMF. “What are you actually donating and giving” to support LGBTQ causes year-round matters more, he said.
In Auburn, Alabama, Pride on the Plains President Seth McCollough said one of the group’s three corporate sponsors gave money this year but asked to not be thanked or recognized publicly.
“It was kind of surprising to me,” McCollough said, but added, “I guess I understand where they are coming from.”
Among them is Target, which drew national attention for pulling some Pride merchandise last month after store employees were threatened. The retailer continues to be a top sponsor and provides volunteers to Pride on the Plains, McCollough said. But while big businesses can often contribute larger sums, the group relies on smaller companies for most of its funding anyway.
Many Pride celebrations facing difficulties are in the Midwest and South, regions that have seen a wave of Republican-led anti-LGBTQ legislation this year. Organizers in bluer states haven’t experienced much difference.
Pride officials in New York City, home to the first Pride March, in June 1970, said this year would be on par with last in terms of arranging sponsors and security. But Pride organizers in Charleston, South Carolina, said they’ve seen a significant drop in funds and sponsorships post-pandemic, after setting records in 2019.
Kendra Johnson, executive director of Equality NC, said threats against the community and Pride events have risen dramatically throughout North Carolina.
“I’m 52 — I’ve never seen it like this,” Johnson said, citing threats of violence and cases in which she said organizers were doxed. Johnson’s LGBTQ advocacy group doesn’t plan Pride festivities, but she said some organizers in the state have told her of sponsors pulling out of local events.
Ron deHarte, co-president of the United States Association of Prides, an umbrella group representing nearly 100 organizers across the country, acknowledged that many groups face growing challenges.
“We’re hearing that there are a few organizations that have made their own decision to modify their programs or cancel based on legislation, out of fear of government action” by some state authorities, he said.
But many sponsors remain committed after years of support for the LGBTQ community, despite the criticism that often comes with it. Tense political climates, as well as presidential election years, tend to drive enthusiasm and attendance at Pride celebrations because many people become more engaged, deHarte said.
“This certainly isn’t the worst we’ve seen,” he said, “and we’ve continued to survive for decades.”
A Californian transgender man claims a pharmacist at a Walgreens chain in Oakland refused to hand over his hormone replacement medicine due to their “religious beliefs”.
In a Reddit post made on Tuesday (20 June), 30-year-old trans Oakland resident Roscoe Rike wrote that he had entered the pharmacy to pick up his prescription when he was asked by an employee what the medication was for.
“I told him I was pretty sure that it wasn’t any of his business,” he said in the post which has since been deleted.
Rike explained that he had been going to the Walgreens pharmacy on Telegraph Avenue for nearly a decade, and had been picking up his hormone prescription for three years, always without issue.
But the pharmacist, who Rike said he had never seen before, allegedly claimed he could not fill the prescription “due to his religious beliefs”.
Rike then said he immediately began recording a video that had also been uploaded to the post, in which he asks the pharmacist: “So you think you know better than my doctor, is that what’s going on?”
The clip then sees the pharmacist say: “I just need to know the diagnosis”, which Rike responds with: “That’s none of your f**king business.”
The pharmacist then allegedly told Rike, after making “some phone calls”, that he was still not going to give him his prescription.
“At this point, I completely lost my temper and demanded to speak to a manager,” Rike continued. “The pharmacist ignored me and walked away.”
After speaking to one of the employees Rike said was “familiar to me”, a manager was then called in who “apologised profusely” and issued his prescription.
“The whole experience was extremely distressing and caused me severe emotional pain,” he said. “I have reached out to the transgender law center, and plan on filing a formal complaint with the Walgreens corporate office.“
Rike finished by urging any local trans residents to make sure “this person isn’t working” when picking up their hormones, because, Rike said: “He will deny you care.”
PinkNews contacted Walgreens for comment on the alleged incident.
In a statement to the local news station KRON4, a spokesperson said: “Our policies are designed to ensure we meet the needs of our patients and customers while respecting the religious and moral beliefs of our team members.
“In an instance where a team member has a religious or moral conviction that prevents them from meeting a customer’s need, we require the team member to refer the customer to another employee or manager on duty who can complete the transaction. These instances, however, are very rare.”
A federal judge on Wednesday struck down Florida rules championed by Gov. Ron DeSantis restricting Medicaid coverage for gender dysphoria treatments for potentially thousands of transgender people.
“Gender identity is real” and the state has admitted it, U.S. District Judge Robert Hinkle wrote in a 54-page ruling.
He said a Florida health code rule and a new state law violated federal laws on Medicaid, equal protection and the Affordable Care Act’s prohibition of sex discrimination.
They are “invalid to the extent they categorically ban Medicaid payment for puberty blockers and cross-sex hormones for the treatment of gender dysphoria,” Hinkle wrote.
The judge said Florida had chosen to block payment for some treatments “for political reasons” using a biased and unscientific process and that “pushing individuals away from their transgender identity is not a legitimate state interest.”
An email seeking comment from the DeSantis’ office wasn’t immediately returned.
Hinkle’s harsh language echoed that in his ruling two weeks ago over a law that bans transgender minors from receiving puberty blockers. Hinkle, who was appointed by Democratic President Bill Clinton, issued a preliminary injunction so that three children could continue receiving treatment.
The DeSantis administration and the Republican-controlled Legislature had banned gender-affirming treatments for children and a law that DeSantis signed in May made it difficult — even impossible —for many transgender adults to get treatment.
The latest ruling involved a lawsuit filed last year on behalf of two adults and two minors, but advocacy groups estimate that some 9,000 transgender people in Florida use Medicaid to fund their treatments.
Hinkle also addressed the issue of whether gender-affirming treatments were medically necessary and noted that transgender people have higher rates of anxiety, depression and suicide than the general population.
Transgender medical care for minors is increasingly under attack — Florida is among 19 states that have enacted laws restricting or banning treatment. But it has been available in the United States for more than a decade and is endorsed by major medical associations.
As an increasing proportion of Americans identify as LGBTQ, leaders in sexual and gender minority health care say that the nation’s medical schools are largely failing to adequately prepare the next generation of doctors to properly care for this population.
The need is critical, according to experts in medical education and LGBTQ care. Lesbian, gay, bisexual, transgender and queer people, as stigmatized minorities, often have difficulty accessing health care that properly addresses their health concerns, that is sensitive to their sexual and gender identities and that is not flat-out discriminatory, researchers have found.
“It’s terrible that there’s a whole population of people who aren’t getting the health care they need,” said Ann Zumwalt, an associate professor of anatomy and neurobiology at the Boston University Chobanian & Avedisian School of Medicine and a leader in the effort to improve medical school curricula pertaining to LGBTQ care.
In 2014, the Association of American Medical Colleges, or AAMC, released a call for the 158 U.S. and Canadian medical schools to provide comprehensive training in caring for LGBTQ people and those born with sex-development differences.
Since then, the need for such instruction has only ballooned, given the dramatic increase in LGBTQ identification among young people in particular.
“The current political and social climates are unfortunately leading to many, many health care-professional students and residents feeling uncertain and frightened to engage in LGBTQ+ education and training.”
DR. DUSTIN NOWASKIE, OUTCARE HEALTH
A constellation of medical schools has heeded the AAMC’s call — progress that inspires hope among queer-health advocates. But the schools’ adoption of comprehensive LGBTQ-focused curricula are the exceptions to the rule. The organization’s call, which was buttressed by a 300-page roadmap for reform but lacked the teeth of a mandate, has mostly gone unheeded nearly a decade later.
Progress at medical schools has been stymied by a myriad of factors, including the lack of LGBTQ-related content in medical licensing exams; inadequate or nonexistent knowledge and clinical experience among educators; administrators and the medical old guard’s resistance to change and concerns about competing educational priorities; and outside political pressures as conservatives seize upon transition-related care for minors and diversity policies as wedge issues and as they scrutinize higher education.
Dr. Alex S. Keuroghlian, director of education and training at the LGBTQ-focused Fenway Institute in Boston, and six other medical educators who asked to remain anonymous out of fear of the very reprisals they described told NBC News that recent state-level efforts to restrict diversity programs in education and transition-related health care for transgender minors have instilled fear in some medical schools that their LGBTQ-related medical training could draw increased scrutiny and punitive attacks from legislators.
Keuroghlian, who is also an associate professor of psychiatry at Harvard Medical School, said that the recent state gender-care bans would likely have a chilling effect “on our ability to teach in an evidence-based way that is grounded in human rights and autonomy.”
Where are the needs?
Researchers who have assessed the capacity of the nation’s health care workforce to serve the specific needs of LGBTQ Americans have found them woefully unprepared, especially to care for transgender people. And LGBTQ people remain in dire need of improved physical and mental health care, according to a trove of studies.
Despite the population skewing younger, 23% of LGBTQ people report being in poor health, compared with 14% of the non-LGBTQ population, according to the health-care analysis nonprofit KFF. And research finds that as many as 1 in 5 LGBTQ people have experienced discrimination during health care encounters, including refusals to prescribe medication and even verbal attacks.
Resulting alienation from the health care system, researchers say, is a key driver of the various health disparities that plague LGBTQ Americans. Such apparent consequences include elevated rates of heart disease, cancer, depression and anxiety, substance use disorders and risk of suicide. These disparate outcomes, according to researchers, are likely also fueled by the damage that being a member of a stigmatized minority can apparently inflict upon the mind and body. These are pervasive problems that the health care establishment would ideally mitigate, not exacerbate.
And yet a 2011 survey of 176 U.S. and Canadian medical schools found that their students received a median of just five hours of LGBT-related training. One in 3 schools devoted no such time during clinical rotations.
Dr. Dustin Nowaskie is the founder and president of OutCare Health, a nonprofit LGBTQ health-equity organization that is at the forefront of a growing movement to improve medical training on this front and has developed queer-medicine training programs for both medical students and physicians. Nowaskie, who uses gender neutral pronouns, argued in a 2020 paper that medical schools should, in fact, provide at least 35 hours of such training. This instruction, according to Nowaskie, should start with basic terminology and cultural sensitivity and expand to issues such as health conditions that occur at higher rates among LGBTQ people, including sexually transmitted infections and skin cancer.
“These skills should absolutely be required,” Nowaskie said, because of the expanding LGBTQ population and the inevitability that doctors will frequently treat such patients. Nowaskie said they consistently hear from medical students nationwide that LGBTQ-specific instruction is “often minimal,” and that it is “very outdated,” relying on language, terminology and an overall understanding of queer people that has otherwise been retired thanks to recent social progress.
A recent Gallup poll found that over the past decade, the proportion of Americans openly identifying as LGBTQ has doubled, to 7.2%, and that 1 in 5 young adults say they identify as something other than a cisgender heterosexual. The Williams Institute at UCLA Law recently estimated that 0.5% of older adults identify as transgender, compared with 1.4% of adolescents and 1.3% of young adults.
A team directed by Dr. Carl Streed, research lead for the Center for Transgender Medicine and Surgery at Boston Medical Center, is preparing to publish an update of the 2011 medical school survey. Streed was keen to highlight medical schools that have adopted comprehensive LGBTQ-related curricula — including, among many others, the University of Kentucky at Louisville, Stanford University and Boston University, where Streed is an assistant professor. But Streed tempered expectations that his team would identify much of an uptick in overall training.
“Who ends up being remotely comfortable and competent” in caring for sexual and gender minorities, Streed said, “is a matter of wherethey trained rather than whether they’ve been trained.”
Any progress over the past decade has transpired against a split-screen backdrop of sweeping advances for LGBTQ civil rights and, in response, a fierce backlash against transgender rights, in particular. At least 20 states have now passed various restrictions on transition-related care for minors — a legislative effort that even many physicians who express misgivings about the science backing such treatment say they oppose.
“The current political and social climates are unfortunately leading to many, many health care-professional students and residents feeling uncertain and frightened to engage in LGBTQ+ education and training,” Nowaskie said.
“At the same time,” Nowaskie said, “these climates are perpetuating health care stigma among biased, discriminatory providers.”
How medicine can fail LGBTQ people
Delia M. Sosa, a first-year medical student in Ohio, wants to focus on LGBTQ care. Sosa, who uses gender-neutral pronouns, said they are motivated, in part, by their own alienating encounter with the medical old guard.
After growing up in what they described as a conformist Christian community in New England, Sosa came into their trans and nonbinary identity in their early 20s. At 21, they sought to establish a relationship with a primary care physician in their hometown in hopes of eventually having a double mastectomy, or what’s known in trans medical care as top surgery. But after Sosa disclosed to the doctor their queer identity and the fact that they were dating a nonbinary person, they recalled, “she looked at me with a look of confusion” that was also “mixed with frustration.”
“Medicine is playing catch-up in a lot of ways. … I get some really seasoned, experienced physicians who come up to me and say, ‘I never had a chance to learn about this, yet I know this is something I need to learn.’”
DR. SARAH PICKLE
Sosa said they spent the bulk of the appointment providing the doctor a trans-identity 101 tutorial, including breaking down the difference between gender and sex, what it means to be nonbinary, what gender neutral pronouns are and how sexual orientation can be fluid with respect to the gender of partners. They found the experience so off-putting, they let three years pass before seeking surgery again, which they ultimately had last year.
Dr. Sarah Pickle, a family physician and medical educator in Ohio, is a leading proponent of medical schools cultivating a deft hand in up-and-coming physicians in how to care for LGBTQ people. Pickle insists that such training, which focuses, for example, on speaking with sensitivity and inclusivity regarding queer people’s differences, can be crucial in keeping LGBTQ people engaged in care.
“Medicine is playing catch-up in a lot of ways,” Pickle said. “I get some really seasoned, experienced physicians who come up to me and say, ‘I never had a chance to learn about this, yet I know this is something I need to learn.’”
Sosa discovered their own evidence of the potential perils of physicians’ lack of knowledge about treating LGBTQ patients when researching trans people’s experiences with cancer care. Some oncologists, Sosa found, were confounded over how to manage such treatment in a patient taking cross-sex hormones.
“I can’t tell you how many stories I heard of trans folks where they had delayed care because an oncologist didn’t know what to do with them,” Sosa said.
One expert in LGBTQ medicine, who preferred to remain anonymous because of attacks from the far right, described an often cavalier attitude among specialists toward trans patients’ hormone therapy. A cardiologist, they said, might advise a patient to simply go off hormones due to cardiovascular risk, rather than thoroughly reviewing the risks versus benefits of a therapy that is fundamental to many trans people’s sense of self and well-being.
This health care provider and medical educator expressed frustration that such doctors often remain ignorant to studies that provide insight into managing hormonal therapy in the context of certain health problems.
Who is leading the change?
Keuroghlian stands at the vanguard of the movement to train doctors in caring for trans and gay patients.
At Harvard, he and a team of colleagues led a three-year effort to design and implement a new curriculum that provides comprehensive training in such care.
The curriculum, which other schools are free to adopt, permits all professors, regardless of their own identity or experience, to weave LGBTQ themes and practices into their own instruction. So, for example, a course on endocrinology would include instruction on cross-sex hormonal treatment and an embryology course would teach about intersex variations.
Bringing a broad swath of medical educators up to speed is crucial, Keuroghlian said. A major roadblock to progress has been the fact that the professors, who are meant to pass on their own acquired knowledge, have typically never received their own training in sexual and gender minority care. So, in addition to the four-hour training he helped craft for Harvard faculty about how to teach this subject, Keuroghlian is among the educational pioneers, a group that includes Nowaskie, who are designing medical education seminars to train other health care providers nationwide.
Dr. Christopher Terndrup, an associate professor of medicine at Vanderbilt University Medical Center in Nashville, Tennessee, noted that most demand for LGBTQ health education “is actually pushed by the medical students themselves.”
But such eagerness from the new generation can hit old bureaucratic walls, according to Dr. Nelson Sanchez, an associate professor of clinical medicine at Weill Cornell Medicine and the chair of the annual LGBT Health Workforce Conference. Sanchez said administrators often resist calls for such curriculum by insisting that a zero-sum game governs all medical-school education hours.
Dr. Lily Rolfe, who recently graduated from Rush Medical College in Chicago and is matriculating to a residency in family medicine, with a focus on caring for LGBTQ patients, at Swedish Hospital in Seattle, conducted an informal survey of students at Chicago area medical schools about the quality of their education in caring for LGBTQ people.
“It’s always, ‘The gay guy has HIV,’” Rolfe quipped regarding the typical way the respondents characterized their limited education on this front.
“HIV is important,” Rolfe said. “We should learn about it. But that shouldn’t be the entirety of LGBT health.”
Otherwise, the Chicago students said that social determinants of health pertaining to sexual and gender minorities were commonly addressed. But the survey respondents, Rolfe said, “noticed a lack of discussion about trans people, including gender dysphoria; gender euphoria; medical, social, legal and surgical transitioning; and a lack of the discussion of the over pathologization of trans people.”
Harvard’s LGBTQ curriculum, meanwhile, goes beyond just infectious disease, including basic concepts and terminology about gender and sexuality; stigma’s impacts on health inequities; major health concerns that are more common in LGBTQ people, such as anal cancer in gay men or breast cancer in lesbians; effective doctor-patient communication methods; navigating power imbalances and implicit bias; addressing microaggressions; and how to generate learning opportunities if an LGBTQ patient responds negatively to a physician’s words or actions.
Other med schools that have also established substantial training efforts on such subjects include Louisiana State University, the University of Mississippi at Jackson, the University of Wisconsin at Madison, Vanderbilt University, the University of Pennsylvania and Cedars-Sinai in Los Angeles.
The current hostile political environment notwithstanding, Keuroghlian said he remains optimistic for how well prepared the next generation of doctors will be.
“People in medical school are increasingly passionate about doing this work, because there’s more understanding for the need for skilled, culturally responsive care,” Keuroghlian said of sexual and gender minority care.
“There’s also a sense of social justice and health equity that drives young people to do this work,” he said. “They see this as one of the major health rights issues of their generation, and that’s very engaging for them.”
Large majorities of U.S. adults across different racial, ethnic, and religious identities oppose religious-based discrimination against LGBTQ+ people, according to a new Williams Institute report.
Even majorities of Republicans oppose religious-based anti-LGBTQ+ discrimination, the report found. Its findings suggest that Republican-led attacks on LGBTQ+ civil rights — many of which are couched in religious terms — are actually opposed by most American adults.
A survey of non-LGBTQ Americans show large majorities disagree with right-wing discrimination.
The data came from the Williams Institute’s September 2022 survey of a nationally representative sample of 1,003 adults.
Approximately 84% of survey respondents said they opposed religious-based denials of healthcare to LGBTQ+ people, 74% opposed religious-based anti-LGBTQ+ employment discrimination, and 71% opposed business employees denying services to LGBTQ+ people based on the employees or employer’s religious beliefs.
Over 80% of respondents in all non-white racial and ethnic groups opposed the use of religious beliefs to deny LGBTQ+ people business services, medical care, and employment. About 70% of white respondents felt the same. Female, younger, or college-educated respondents were also more likely to oppose religious-based anti-LGBTQ+ discrimination than respondents who are men, older in age, or non-college educated.
While Democrats unsurprisingly opposed these various types of religious-based anti-LGBTQ+ discrimination by about 90%, the report surprisingly found that Republican majorities also opposed such discrimination: 52% opposed religious-based refusal of business services to LGBTQ+ people, 54% opposed religious-based anti-LGBTQ+ employment discrimination, and 71% opposed religious-based anti-LGBTQ+ healthcare discrimination.
Respondents who personally know LGBTQ+ people were more likely to oppose such religious-based discrimination, the report found. However, even respondents who don’t personally know LGBTQ+ people were also opposed to religious-based anti-LGBTQ+ discrimination by margins of 65% to 80%.
Even majorities of Protestant/Christian, Catholic, and non-Christian faiths opposed such religious-based anti-LGBTQ+ discrimination.
When asked about their support for allowing religious-based anti-LGBTQ+ discrimination, less than 30% of respondents in almost every different demographic supported allowing such discrimination.
These findings matter specifically because Republicans have introduced over 400 anti-LGBTQ+ bills in state legislatures nationwide. Many have been couched in religious justifications.
Florida, for example, passed a law in May that allows any medical worker or insurer to deny care to anyone based on “ethical, moral, or religious beliefs.” The U.S. Supreme Court is also about to issue a ruling on whether religious beliefs should permit public-facing businesses to violate LGBTQ+ anti-discrimination laws.
“Recent efforts by some state legislatures to expand religious exemptions from LGBTQ-inclusive non-discrimination laws are largely out of alignment with the views of most Americans,” wrote Christy Mallory, Legal Director at the Williams Institute and author of the study. “More than three in four Americans now favor civil rights laws protecting LGBTQ people against religiously motivated discrimination.”