“I hated my body,” the nonbinary 16-year-old said. “I hated looking at it.”
When therapy didn’t help, Pitchenik, who uses the pronoun they, started going to the Center for Transyouth Health and Development at Children’s Hospital Los Angeles, the country’s biggest public provider of gender-affirming care for children and teens. It changed their life.
But in response to the Trump administration’s threat to cut federal funds to places that offer gender-affirming care to minors, the center will be closing its doors July 22. Pitchenik has been among the scores of protesters who have demonstrated regularly outside the hospital to keep it open.
Sage Sol Pitchenik in Santa Clarita, Calif., on Monday.Jae C. Hong / AP
“Trans kids are done being quiet. Trans kids are done being polite, and trans kids are done begging for the bare minimum, begging for the chance to grow up, to have a future, to be loved by others when sometimes we can’t even love ourselves,” Pitchenik said, prompting cheers from dozens of protesters during a recent demonstration.
They went to the center for six years.
“There’s a lot of bigotry and just hate all around, and having somebody who is trained specifically to speak with you, because there’s not a lot of people that know what it’s like, it meant the world,” they told The Associated Press.
The center’s legacy
In operation for three decades, the facility is among the longest-running trans youth centers in the country and has served thousands of young people on public insurance.
Patients who haven’t gone through puberty yet receive counseling, which continues throughout the care process. For some patients, the next step is puberty blockers; for others, it’s also hormone replacement therapy. Surgeries are rarely offered to minors.
“I’m one of the lucky ones,” said Pitchenik, who received hormone blockers after a lengthy process. “I learned how to not only survive but how to thrive in my own body because of the lifesaving health care provided to me right here at Children’s Hospital Los Angeles.”
Many families are now scrambling to find care among a patchwork of private and public providers that are already stretched thin. It’s not just patient care, but research development that’s ending.
“It is a disappointment to see this abrupt closure disrupting the care that trans youth receive. But it’s also a stain on their legacy,” said Maria Do, community mobilization manager at the Los Angeles LGBT Center. “I think it showcases that they’re quick to abandon our most vulnerable members.”
Maria Do, community mobilization manager at the Los Angeles LGBT Center, outside Children’s Hospital Los Angeles on Thursday.Jae C. Hong / AP
The closure comes weeks after the Supreme Court upheld Tennessee’s ban on gender-affirming care for minors, amid other efforts by the federal government to regulate the lives of transgender people.
The hospital initially backed off its plans to close after it announced them in February, spurring demonstrations, but later doubled back.
The center said in a statement that “despite this deeply held commitment to supporting LA’s gender-diverse community, the hospital has been left with no viable path forward” to stay open.
“Center team members were heartbroken to learn of the decision from hospital leaders, who emphasized that it was not made lightly, but followed a thorough legal and financial assessment of the increasingly severe impacts of recent administrative actions and proposed policies,” the statement said.
California Attorney General Rob Bonta has warned that by closing the center, the hospital is violating state antidiscrimination laws, but his office hasn’t taken any further actions. Bonta and attorney generals from 22 other states sued the Trump administration over the executive order in February.
“The Trump administration’s relentless assault on transgender adolescents is nothing short of an all-out war to strip away LGBTQ+ rights,” Bonta told the AP in an email. “The Administration’s harmful attacks are hurting California’s transgender community by seeking to scare doctors and hospitals from providing nondiscriminatory healthcare. The bottom line is: This care remains legal in California.”
LGBTQ protesters and health care workers offer visibility
Still wearing scrubs, Jack Brenner, joined protesters after a long shift as a nurse in the hospital’s emergency room, addressing the crowd with a megaphone while choking back tears.
“Our visibility is so important for our youth,” Brenner said, looking out at a cluster of protesters raising signs and waving trans pride flags. “To see that there is a future, and that there is a way to grow up and to be your authentic self.”
Jack Brenner, an emergency room nurse at Children’s Hospital Los Angeles, on Thursday.Jae C. Hong / AP
Brenner, who uses the pronoun they, didn’t see people who looked like them growing up or come to understand what being trans meant until their mid-20s.
“It’s something I definitely didn’t have a language for when I was a kid, and I didn’t know what the source of my pain and suffering was, and now looking back, so many things are sliding into place,” Brenner said. “I’m realizing how much gender dysphoria was a source of my pain.”
Trans children and teens are at increased risk of death by suicide, according to a 2024 study from the Centers for Disease Control and Prevention.
Brenner described encountering young patients in the emergency room who are trans or otherwise on the gender-nonconforming spectrum and “at the peak of a mental health crisis.” Brenner wears a lanyard teeming with colorful pins emblazoned with the words “they/them” to signal their gender identity.
Jack Brenner shows their lanyard decorated with pronoun pins and buttons.Jae C. Hong / AP
“I see the change in kids’ eyes, little glints of recognition, that I am a trans adult and that there is a future,” Brenner said. “I’ve seen kids light up when they recognize something of themselves in me. And that is so meaningful that I can provide that.”
Beth Hossfeld, a marriage and family therapist, and a grandmother to an 11- and 13-year-old who received care at the center, called the closure “patient abandonment.”
“It’s a political decision, not a medical one, and that’s disturbing to me,” she said.
On June 18, the Supreme Court of the United States (SCOTUS) upheld Tennessee’s ban on gender-affirming care for minors. The 6-3 ruling is expected to have a broad impact as 24 other states have already enacted similar laws, which bar puberty blockers, hormone therapy (HRT) and gender transition surgeries for trans youth.
Uncloseted Media wanted to pass the microphone to the kids and young adults who could be directly affected by SCOTUS’ decision. So we called up Romana, Zavier, Ray, Dylan and Samuel—who are all receiving some form of gender-affirming care—to get their reaction to the decision.
Watch the full interview above or read the transcript here:
Spencer: Hi everyone, I am here with five trans kids and young adults from across the United States. Guys, thank you so much for speaking with me and Uncloseted Media today.
All: Thank you for having us.
Spencer: Last week, the Supreme Court ruled 6 to 3 in a landmark case that prohibits health care providers [and] doctors from administering gender-affirming care to minors. That includes puberty blockers and HRT. I want to know, where were you guys when you heard the news and what was your reaction to that?
Samuel: So I’ve been following this case since November. I think the ruling’s ridiculous. I think it’ll kill kids.
Spencer: When you say this ruling is going to kill kids, that is a really bold statement. Why do you say that?
Samuel: It’s a bold statement. The care that enables so many people to live their lives. I think taking that possibility away from people who need it is incredibly cruel and short-sighted.
Romana: Ifelt disgusted, especially since I think [it’s] just from [the] hate. And I know people who gender-affirming care has saved the life of as teenagers. And I think every kid should be able to have that. And also, this ruling makes me scared that a state might try to ban trans care for adults.
Spencer: It could be a slippery slope.
Romana: Yeah,definitely.
Spencer: When you think about your future as a trans person without the care, what does that look like for you? Why is that so devastating?
Dylan: Because there’s not one.
Samuel: Yeah.
Spencer: Unpack that a little bit more. Why? Like, why do you think there is not one?
Photo courtesy of Dylan Brandt.
Dylan: Personally, now that I have had [testosterone] for almost five years, there would be no way that I would be able to lose everything that I have worked so hard for… And go back to living a life that was not me.
Spencer: Would you compare it to, like, if I were being forced to live as a woman every single day? Is it the exact same thing to you?
Dylan: Absolutely.I mean, if you were forced to be living [as] a woman and you, that was not something that you wanted? Absolutely.
Samuel: I couldn’t do it. I couldn’t do it. When I was younger, it almost killed me then. I couldn’t do it now. I think they’d have to kill me to force me to stop transitioning because it saved my life. I think living as myself, living as Sam, as a man, is so integral to who I am. For somebody to even try to force me to stop that would include stopping me entirely, if that makes sense.
Spencer: Okay, let’s talk about Donald Trump. Trump has tasked several federal agencies to police and ultimately stop gender-affirming care for minors, which he has equated to child abuse and child sexual mutilation. He’s also falsely stated that kids are going to school and coming back with sex changes. I wanna know, as a trans kid, what would you say if you could talk to President Trump right now?
Ray: It’s kind of painful to hear the same argument that he pulls out of his asshole every single time just because he wants to weaponize the fact that we’re a marginalized community and people are afraid of us because they don’t understand so his tactic to basically throw people off is to make us look like we’re indoctrinating kids. We’re coming back from school with surgeries. Which, by the way, you don’t just go to school and be like, “Ah, yes, I would like a surgery please.”
Spencer: Do you guys feel sometimes like you’re being used by adults as political pawns?
Ray: All the time!
Dylan: Yeah, I have been fighting this fight for so long that I’m not even necessarily surprised by what’s said anymore. I think that if I could say something directly to Trump, it wouldn’t be very nice. Because at this point I’m done being nice. At this point I’m just mad, because it has gotten to a point where they’re toying with people’s lives. They are toying with people’s lives making us look like monsters for their political gain. Because if they have people on their side that think that we are everything that they say they are, people are gonna believe ‘em.
Spencer: Especially when most Americans have never even met a trans person before.
Dylan: Absolutely.
Spencer: And trans people represent, as far as we know, less than one percent of the overall population.
Romana: I feel like a political pawn, because there’s so much talk about trans people and so much legislation passed around it and it just feels like we’re being used as a scapegoat and just someone to put the blame on and hate on in society. If I could say something to President Trump, I would proudly say something like, “Just leave us alone.”
Photo courtesy of Romana.
Spencer: It’s hard for me to square away why [Trump] would make trans issues the number one platform of [his] campaign when it’s such a small percentage of the population. It doesn’t really make sense mathematically.
Samuel: I think to your point, it’s exactly because it’s a small area of the population. For a lot of these politicians, the hate is real. But to some extent, it’s like we are the issue they can use right now because we’re such a small community that we’re targetable. It’s the small size of the transgender community and the lack of education that the general public has that is what drives being able to target this group.
Spencer: I think there’s a lot of misinformation in the United States about what gender-affirming health care actually is. So tell me what gender-affirming health care means to you and how did you make the decision to get on it?
Dylan: It took me a really long time to realize or to put words to how I was feeling. And once I did, I spoke with my primary doctor who referred me to the gender spectrum clinic in Little Rock. And I went, had my first appointment with them. And that was a six-month process where you meet with those doctors multiple times. You have to be in therapy. You have to get a psychiatric evaluation to make sure that you are doing this for the right reason. And when I tell people that they’re like, “Oh! I didn’t know that. I didn’t know that there was a process,” and I [would say], “Yeah, I’m not just walking in and saying, ‘Hey can I have it?’” And then with my top surgery too. I had to have been in therapy. I had to get letters of recommendation. I had to get it signed off, basically, by multiple people.
Gender-affirming care, to me, is hope. I graduated last year, and I never thought that I would make it to graduation, and the only reason that I did is because of my gender-affirming care. I’ve been on testosterone for almost five years, and even up until four years ago I was just so unhappy with the way that I looked, with the way I felt. I didn’t want to go out, I didn’t want to go do anything, and now I do.
Sam: I think I resonate with everything Dylan said, from the length of the process to the sort of life-saving benefits. I don’t think I would have made it to 18 without starting care at 14 when I did. I was just so uncomfortable, but the process is long. I think it was two years because my parents weren’t really sure about care at first.
Spencer: I think one of the critiques a lot of adults in this country have on gender-affirming care is that there are irreversible impacts, right? And for things like testosterone, like there are things like facial hair, for example, that you can’t fully go back on, right? Was that decision hard to make when you know that sometimes there will be elements of this that could be not completely reversible?
Photo courtesy of Samuel.
Sam: I can see why it would be a hard decision for a lot of people and I think in some ways that’s like why there’s so many safety checks and it’s also why maybe my parents were so. You know, like…
Spencer: Cautious?
Sam: Nervous, yeah. Especially because they were like, oh, you know my daughter now, you’re no longer my daughter and that was a huge adjustment. But for me, as long as I’ve been out, I’ve known that this is what I wanted to do. Like once I had the language to be able to say, “Yeah, I’m trans,” and knew that that was the path I wanted to go down. So in the end, after considering everything, it wasn’t really a hard decision.
Spencer: And Zavier, you are 11. A lot younger than everyone else on this panel, and it sounds like you are taking blockers, which to any Americans watching are completely reversible and have been given to cisgender girls for things like precocious puberty for decades. Zavier, what does gender-affirming care mean to you?
Photo courtesy of Zavier.
Zavier: Well, when I was 3 years old, I came out and I was wanting to be trans. Once I got older, my parents, they put me on blockers and let me take medicine for it.
Spencer: A lot of people, adults particularly, would say, how could a kid ever know at 3 that they’re trans? What would you say to that? How did you know?
Zavier: I just saw people. I just thought about wanting to be trans and I’ve wanted to be trans ever since.
Spencer: And you’ve always felt like a boy?
Zavier: Yeah.
Spencer: And Ray, how about you? When did you kind of know you were trans or start having feelings that you could be trans and what’s the process for you been like to get on gender-affirming care?
Ray: I’ve known since I was like 6, 7-ish. I’ve always wanted to be the dad, always wanted to be a king. I didn’t want to be a queen, none of that. It took about seven to eight months of doctors visits. First we had to make sure my mental health was good. So they prescribed me like Strattera and other types of medicines to help elevate my levels and stuff. And then they eventually put me on testosterone.
Spencer: And how has that been for you, the transformation? Has that felt good?
Ray Oh, I feel like myself now, finally! I feel like everybody in this call or this meeting feels like themself after they finally take their hormones.
Spencer: So for me, a cisgender gay boy growing up, I’d want to wear my mom’s clothes and kind of act like a girl and do different things that would tap into my femininity. But there’s never been a question that I could be a trans woman, right? What do you think is the difference between how you guys feel versus how I feel about wanting to explore my gender?
Dylan: So in my house, I’ve had both. You know, my brother is a 17-year-old gay man. And when he was little, he did. He put on my dresses and my mom’s high heels and boots and everything. And so we had that, and then we had me. From the time I could dress myself wanting strictly jeans and t-shirts, and nobody was allowed to touch my hair. And there is so much of a difference. My brother was exploring that, and I don’t want to say exploring that as in a hobby, and I was exploring it more as a lifestyle. That sounds wrong to me. But that’s the best way I can explain it.
Spencer: A big difference could be comparing it to some gay guys [who] like to dress up in drag on Halloween. You want Halloween to be every single day for the rest of your life.
Dylan: My entire life, yes, yes.
Spencer: Take me more into your mind about the feelings of wellness, of health, if you are able to live as your gender identity.
Photo courtesy of Dylan.
Dylan: The validation started the moment I cut my hair off. I mean, from that moment, I opened the door for somebody. It was, “Thank you, sir.” We went out to eat with my mom, me and my brother. “What do you boys want?” I mean it was right off the bat. And that’s honestly what made me realize that’s who I was supposed to be, because it made me feel so good. I mean, even to this day, somebody calling me sir or any form of male affirmation, anything, makes me feel so good. Just knowing that these random people in the deep south have no clue who they’re talking to. And if they did, their reaction would be way different. But the fact that these country hicks in the Deep South, who I know voted for Trump, are calling me sir or bub or anything? Makes me feel so good about myself knowing that they have no idea.
Spencer: And Zavier, how about you? You’re the youngest, why is it important for you to transition at such a young age?
Zavier: When I was growing up and people would call me a girl, I would just not feel like I was a girl. And when they said that I would just be like, “No,” inside my head.
Spencer: And do you play on the boys sports teams and do you use the boys bathroom?
Zavier: I do use the boys bathroom and my parents are signing me up for kickboxing.
Spencer: Love it, that’s super cool, yeah. And you feel great since you’ve transitioned. Is there ever any regret or feeling like, “I wanna go back to living as a girl?” No? And that would be the case for everyone here is my sense, right? No regret, no sense of de-transitioning, anything like that, yeah? Do you guys find that when you meet people and actually have conversations with them about who you are and why you need this care, hearts and minds are changed, does that help?
Sam: Yeah.
Spencer: You’re shaking your heads. Yeah, go ahead.
Dylan: [In my] School, everybody knew, I live in a small town. It wasn’t a secret. Even the 60 Minutes episode, I mean, you have no idea how many people watched that and came to me and said, “I am so sorry. I never thought about it the way that you put it. I didn’t understand until I watched that.” Like there were so many people in my school and work that [60 Minutes] truly changed the way that they thought about the transgender community. People have this pre-idea of what the transgender community is. And it’s just not, at all, how it actually is. And you don’t know that until you speak with somebody that is living it.
Spencer: And to your point on misinformation, I mean, if you turn on Fox News, which is the most watched cable news channel in this country right now, misinformation is rampant. There are comparisons that gender-affirming care is literally just bottom surgeries or so-called general mutilation. What do you think those media portrayals of trans kids and gender-affirming care for trans kids does to the mindset of Americans as they see you guys?
Dylan: They see that people are talking about giving 7-year-olds bottom surgery at school. Yeah, that could be scary to somebody that doesn’t understand. You see that, and your brain automatically goes to, “Oh, that’s not right. They can’t do that. That’s not right.”
Spencer: But that’s not happening.
Dylan: That’s not happening, absolutely. But, you see that as somebody that doesn’t know for sure that that’s not happening. And I mean, yeah, I don’t blame them for being like, “Oh, we have to stop this.” But it’s that misinformation of people saying, “Oh this is happening” when it’s not. So they’re scaring people for no reason.
Romana: I definitely agree that they make it sound really scary. And I’ve met people who’ve thought that way. I think the news really paints trans children especially as victims of being trans, which isn’t true. Or like, you’re being groomed into it, which doesn’t happen.
Spencer: Zavier, as an 11-year-old, have you even had conversations about surgeries or anything like that?
Zavier: The answer is no, because I’m only 11 years old, and I started the blockers about a year ago. So, since I’m 11 years old and you usually get surgeries at like 17 or 18, maybe. Nobody’s talked about it to me. Because if I change my mind, which I probably won’t, it’s in like six, seven years.
Spencer: Right, and you started on blockers because it gives you more time to delay puberty so you can still give yourself time to make up your mind. Right? And that’s something that I’m assuming you’re exploring with your family and your doctor to decide what’s best for you, is that right?
Zavier: Yeah.
Spencer: Ray, is it okay if I speak about the experience we had in South Carolina?
Ray: Yeah.
Spencer: Okay, well, we came to film an episode on conservative-minded dads. May your dad rest in peace, I know he passed away, and I’m so sorry about that. When we were filming with your dad, who was a military veteran, who was kind of a redneck—can I say that? From Georgia. I remember him saying to me, “This is completely against Republican ideology, get the government the hell out of my child’s doctor’s office.” Do you guys have anything to say about why it’s all Republicans coming after trans health care when it really is completely opposite to how conservatives see government intervention in family health care and parents’ rights?
Ray: Republicans are really bad at realizing that everything is not their business. We have HIPAA for a reason. They don’t seem to grasp the concept that they don’t to be in everybody’s lives. They feel like they have to protect these children, even though they’re not really protecting them.
Spencer: Is it fair to say that like gender-affirming care can be complicated and it can be nuanced and we need to have conversations about nuance by this but it’s tough to have those when you have people just attacking, attacking, attacking?
Samuel: Yeah, exactly. I mean, it’s medicine and all medicine is complex. Doctors and patients and their families are more qualified than politicians.
Photo courtesy of Ray.
Ray: Politicians, they don’t have like a degree in anything to be able to say, “Oh, this is bad.” Like they’ve never done the research. They do not have a qualification. Until I see them have an MD, they don’t have any qualifications to say anything. And I do believe research should be done. I mean, everything has so many different symptoms for every different person. I believe research is very important.
Dylan: Lawmakers don’t need to be involved in my doctor visits. They have no right. They have no knowledge. I just… They’ve got a lane and they should stay in it.
Earlier this month, the Defense Department told transgender service members that they had to choose whether they would voluntarily or involuntarily separate from the military.
Four trans service members who are now in the process of separating said nothing about their decisions feels voluntary at all.
“Nobody feels like this is voluntary,” said Emily Shilling, a commander in the Navy and the president of SPARTA, a nonprofit group that advocates for trans service members. “This is coercion. This is under duress.”
President Donald Trump signed an executive order a week into his administration prohibiting trans people from enlisting or serving in the military. Trans service members sued, and a federal judge temporarily blocked the order from taking effect. Then, last month, the Supreme Court allowed the Trump administration to enforce the order. Days later, the Defense Department issued guidance requiring active duty service members to voluntarily self-identify as having been diagnosed with gender dysphoria, which is the distress that results from a misalignment between one’s birth sex and gender identity, by June 6 and reserve service members to self-identify by July 7.
After that, the guidance said, the military will find trans service members who didn’t self-identify through medical readiness programs and begin involuntarily separating them. Affected service members “are eligible for an array of benefits,” the guidance said, including separation pay, “which will be higher for those who self-identify and agree to a voluntary separation.”
However, many details are still unknown, such as what benefits trans service members will be able to access and whether they will all receive honorable discharges. It’s also unclear how many service members will be affected. Just over 4,000 transgender people currently serve in the military, according to Defense Department data, and the department said last month that about 1,000 trans service members have begun the separation process from the military after voluntarily identifying themselves. The department said Tuesday that it does not have an updated number of affected service members.
“Characterization of service will be honorable except where the Service member’s record otherwise warrants a lower characterization,” a U.S. Defense official said in a statement to NBC News. “Military Services will follow normal processes for administrative separation.”
The four trans service members who spoke to NBC News all emphasized that they are speaking in their personal capacity and not on behalf of their respective branches. The biggest question they all face is what comes next.
Bree Fram
On June 30, 2016, the day then-Defense Secretary Ash Carter announced that transgender people could serve openly in the military, Bree Fram, who was then a major in the Air Force, came out to her teammates in an email as a trans woman and then went to burn off her nerves at the gym.
Col. Bree Fram served for 22 years and said she planned to serve “for many years to come” because she loved her job.Courtesy Bree Fram
When she returned to her desk later, she said her colleagues approached her one by one, shook her hand, and told her a version of “It’s an honor to serve with you.”
Fram, who is 46 and now a colonel for the U.S. Space Force at the Pentagon, said that scene repeated earlier this month with leaders from other branches of the military when she told them it would be her last meeting with them. An officer sitting next to her asked where she was going, and she said, “I’m being placed on administrative leave because I don’t meet this administration’s standards for military excellence and readiness.”
Fram said there was a moment of silence before it seemed like her colleagues realized which policy she was referring to — because, she said, trans service members don’t “walk into a room and lead with our identity.”
“I walk into a room and someone sees a colonel, and they see the uniform, and they see all the things that represents about my experience and my expertise,” said Fram, who is one of the highest-ranking out trans officials in the military.
Then, Fram said her colleagues walked over, one by one, and shook her hand and said, again, that it had been an honor to serve with her.
Fram, who served for 22 years until she was placed on administrative leave on June 6, was the director of requirements integration for the Space Force. She helped to identify future technological capabilities the military will need and provided those to developers who built them. She said she planned to serve “for many years to come,” because she loved her job and the team that she worked with.
Fram said she doesn’t know what she’ll do next, but she expects she’ll work in public service.
“I believe in this country, even though it may not believe in me right now,” Fram said. “The oath I swore and the ideals that are embedded in the Constitution still matter to me, and I believe they are worth fighting for.”
Sam Rodriguez
Sam Rodriguez, 38, was recently commissioned as a Medical Service Corps officer in the Navy and was supposed to begin officer training school and then a two-year clinical fellowship in San Diego to become a licensed clinical social worker. However, about a week after the Supreme Court decision allowing the trans military ban to take effect, Rodriguez, who uses they/them pronouns, said the Navy canceled those orders.
Lt. Junior Grade Sam Rodriguez, left, with Lt. Rae Timberlake, center, and Parker Moore, an electronics technician in nuclear power, right. All three of them are trans and nonbinary service members in the Navy.Courtesy Sam Rodriguez
“It was really gut-wrenching to receive that news,” Rodriguez said. They enlisted in 2015 and planned to serve for 15 or 20 years, when they would’ve left the Navy as an experienced licensed social worker. However, now they will leave with their master’s degree in social work, and they will have to look for an employer who is willing to provide supervision for them to receive their clinical license, which will be more difficult.
They submitted their resignation earlier this month and requested a separation date in the fall. They said they don’t think they’ll be able to find an entry-level job as a civilian that’s going to match their current salary, housing allowance, health care benefits and the stipend that they and their wife get to pay for child care for their two children.
They plan to move their family from San Diego to Washington, D.C., so they can become more involved in policy advocacy. Outside of work, they are a board member and membership director for SPARTA.
“People need to realize that this is a national security issue,” Rodriguez said, pointing to research from the Modern Military Association of America, an advocacy group for LGBTQ military members and veterans, which found that 73% of trans service members have between 12 and 21 years of experience.
“We’re not going to be one-for-one swapped tomorrow, and some people it will take two decades to replace,” they said.
Emily Shilling
Shilling, 42, is the highest-ranking out trans person in the Navy after having served for nearly two decades, including in over 60 combat missions in Iraq and Afghanistan. She was also one of the lead plaintiffs in a lawsuit against the administration’s ban.
After Trump was elected, she requested to retire in the fall. Her intention was to rescind that retirement because she expected that the ban on trans troops serving would be blocked, but with the policy taking effect, her last day was June 12, and she will officially retire in September.
Emily Shilling is the highest-ranking out trans person in the Navy.Leah Millis / Reuters
“I am deeply heartbroken that this is how my career has ended, but also deeply proud of what I’ve done,” Shilling said. “I lived my dream. I did everything I ever wanted to in the Navy and I did it honorably, and I stood proud. I might be getting out of the Navy, but it’s not me quitting this fight. I’m just choosing to take on this fight in a different way.”
Shilling said the Navy invested $40 million in training her, and as a result she has many desirable skills and has already accepted an offer to work in defense technologies and advanced development. However, she said her story is rare among trans service members, thousands of whom will be looking for private sector jobs for the first time.
Shilling said the lawsuit against the ban will return to the 9th Circuit Court of Appeals for a hearing in October, but by that time, most trans service members will be out of the military.
“The irreparable harm is done now,” she said.
Alex Shaffer
Alex Shaffer, 48, joined the military as a combat medic in the Oregon Army National Guard in 2007. His mentors in the guard convinced him to go to school to become a physician’s assistant, and he now also works in a private family practice as a PA.
Alex Shaffer, center, with two of the soldiers who are part of the platoon he oversaw.Courtesy Alex Shaffer
“In all of the military, it’s a family,” Shaffer said of what he’s enjoyed about serving in the guard.
Shaffer said he planned to stay in the guard “until I could no longer physically serve or they kicked me out for being too old.” He was in the process of trying to commission as an officer. However, his last drill was June 7, because he began the process to medically separate from the National Guard as a result of the ban. (The National Guard only provides retirement benefits to service members if a medical evaluation board deems them physically unfit for duty.)
“I’m devastated,” Shaffer said. “It’s a loss of identity to me. I’ve been a soldier for so long, and it’s a part of who I am.”
A report on the largest survey ever of trans Americans’ health was released on Wednesday, June 11, and its findings reaffirmed what many academics, health care providers and trans people already know: gender-affirming care saves and improves lives, but transphobia often dissuades people from pursuing or continuing it when they need it most.
Over 84,000 trans, nonbinary, and gender nonconforming people aged 18 and up responded to the 2022 U.S. Transgender Survey, spearheaded by Advocates for Trans Equality (A4TE). Of respondents who had transitioned, 9 percent had gone back to living as their sex assigned at birth at some point in their lives, at least for a short while — but in almost every single case, the reason was anti-trans discrimination from one’s family, friends, or community.
“Social and structural explanations dominated the reasons why respondents reported going back to living in their sex assigned at birth at some point,” the report found. “Only 4% of people who went back to living in their sex assigned at birth for a while cited that their reason was because they realized that gender transition was not for them. When considering all respondents who had transitioned, this number equates to only 0.36%.”
Meanwhile, respondents who received gender-affirming hormone therapy (GAHT) or gender-affirming surgery overwhelmingly reported feeling “more satisfied” with their lives, 98 percent and 97 percent, respectively.
This watershed report contradicts the popular narrative being circulated by mainstream media, far-right politicians, and anti-trans groups that transgender people are “detransitioning” en masse due to life-shattering “transition regret.” In reality, it shows gender diverse people are living rich and vibrant lives, so long as they are provided the space, support, and care they need from their health care providers and communities.
The survey found a trans person’s overall health and wellbeing also heavily depend upon rates of familial support, a factor that has a profound influence over a trans person’s lifetime experience of suicidality.
The survey has been released in increments as researchers at A4TE wade through the unprecedented amounts of data from trans people who lent their voice to the project. It is a much-needed, comprehensive overview of the challenges — and victories — seen in trans health care since the prior iteration of the study. The report is especially vital considering the Trump Administration moved to remove transgender people from the U.S. Census and other government websites, rendering trans communities potentially invisible, and robbing researchers of crucial data informing public policy decisions.
“Having real concrete and rigorous data about the realities of trans people’s day-to-day lives is also a vital part of dispelling all of those assumptions and stereotypes that plague the public discourse about our community,” said Olivia Hunt, A4TE’s Director of Federal Policy, during a press briefing this week.
The report also touched upon trans people’s access to health care, which increased between 2015 and 2022; the quality of care, as trust between doctors and trans patients has improved; disparities between trans people across racial groups, which showed trans people of color are generally more prone to experience discrimination compared to white trans people; and the mental health challenges facing the trans community, as 44 percent of respondents met the criteria for serious psychological distress, compared to less than 4 percent of the general U.S. population.
Many of these issues have likely been exacerbated since the data was collected. The lead-up to President Donald Trump’s return to the Oval Office incited a new wave of anti-trans animus, impeding access to care and stirring up transphobic vitriol and harassment.
“From 2015 to 2022, state-level policy environments became more protective in some ways for trans people; however, in 2022 alone, when the USTS was administered, 315 anti-LGBTQ bills were introduced across the country, many of which harm trans and nonbinary people’s access to healthcare, participation in sports, access to public facilities, or other facets of public life,” the report says.
“This political landscape has only worsened since the administration of the 2022 USTS, with the introduction of 571 anti-LGBTQ nationwide in 2023 and 489 in 2024,” it continues. “At the time of writing, data on trans and nonbinary people has been erased from federal health surveys. As funding for LGBTQ research is stripped away, the USTS has become an ever more critical resource on the lived experiences of trans and nonbinary people.”
Nonetheless, trans life and trans joy have persisted, as testimonies featured in the U.S. Trans Survey demonstrate.
“I have thrived in the past 12 months in transition, I have a genuine smile on my face most days & laugh with genuine joy,” wrote Charlotte, a trans woman, in her survey response. “I have grown into the woman I was meant to be.”
And as Roo, a nonbinary person, wrote: “Once I learned what it meant to be trans, I never looked back. I traded in my Regina George-esque life for a future with a balding head and a predisposition for a beer gut. I’ve never been more happy to be alive—every single day. ”
Tuesday’s ruling from U.S. District Judge Julia Kobick means that transgender or nonbinary people who are without a passport or need to apply for a new one can request a male, female or “X” identification marker rather than being limited to the marker that matches the gender assigned at birth.
In an executive order signed in January, the president used a narrow definition of the sexes instead of a broader conception of gender. The order said a person is male or female and rejected the idea that someone can transition from the sex assigned at birth to another gender.
Kobick first issued a preliminary injunction against the policy last month, but that ruling applied only to six people who joined with the American Civil Liberties Union in a lawsuit over the passport policy.
In Tuesday’s ruling she agreed to expand the injunction to include transgender or nonbinary people who are currently without a valid passport, those whose passport is expiring within a year, and those who need to apply for a passport because theirs was lost or stolen or because they need to change their name or sex designation.
The White House did not immediately respond to a request for comment.
The government failed to show that blocking its policy would cause it any constitutional injury, Kobick wrote, or harm the executive branch’s relations with other countries.
The transgender and nonbinary people covered by the preliminary injunction, meanwhile, have shown that the passport policy violates their constitutional rights to equal protection, Kobick said.
“Even assuming a preliminary injunction inflicts some constitutional harm on the Executive Branch, such harm is the consequence of the State Department’s adoption of a Passport Policy that likely violates the constitutional rights of thousands of Americans,” Kobick wrote.
Kobick, who was appointed by former President Joe Biden, sided with the ACLU’s motion for a preliminary injunction, which stays the action while the lawsuit plays out.
“The Executive Order and the Passport Policy on their face classify passport applicants on the basis of sex and thus must be reviewed under intermediate judicial scrutiny,” Kobick wrote in the preliminary injunction issued earlier this year. “That standard requires the government to demonstrate that its actions are substantially related to an important governmental interest. The government has failed to meet this standard.”
In its lawsuit, the ACLU described how one woman had her passport returned with a male designation while others are too scared to submit their passports because they fear their applications might be suspended and their passports held by the State Department.
Another mailed in their passport Jan. 9 and requested to change their name and their sex designation from male to female. That person was still waiting for their passport, the ACLU said in the lawsuit, and feared missing a family wedding and a botany conference this year.
In response to the lawsuit, the Trump administration argued that the passport policy change “does not violate the equal protection guarantees of the Constitution.” It also contended that the president has broad discretion in setting passport policy and that plaintiffs would not be harmed since they are still free to travel abroad.
On Thursday, Children’s Hospital Los Angeles (CHLA) announced the pausing of its transgender youth healthcare program, citing insurmountable pressure from the Trump administration.
In emails reviewed by The Los Angeles Times, the hospital’s Center for Trans Youth began telling its nearly 3,000 patients’ families about its upcoming closure.
“We’re just disappointed and scared and enraged,” stated Maxine, the mother of a current patient, who declined to give her last name for fear of attacks on her son. “The challenge is how we break news to this kid who has had such a positive experience with everybody at Children’s.”
The emails state there was “no viable alternative” that would allow the hospital to continue specialized care.
“There is no doubt that this is a painful and significant change to our organization and a challenge to CHLA’s mission, vision, and values,” hospital executives wrote to staff in a Thursday morning email. The center will close on July 22, and the emails say the decision “follows a lengthy and thorough assessment of the increasingly severe impacts of federal administrative actions and proposed policies.”
Executives have determined that continuing to operate the center would jeopardize the hospital’s ability to care for its hundreds of thousands of patients, noting the continual attacks by federal agencies, including the Department of Justice, Health and Human Services, Medicare and Medicaid Services who have been issuing numerous threats towards doctors and hospitals providing gender-affirming care for trans youth, including threats of prosecution.
“These threats are no longer theoretical,” the note said. “Taken together, the Attorney General memo, HHS review, and the recent solicitation of tips from the FBI to report hospitals and providers of GAC strongly signal this Administration’s intent to take swift and decisive action, both criminal and civil, against any entity it views as being in violation of the executive order.”
The hospital’s Trans Youth Center is among the oldest and largest programs in the country and the only facility to provide puberty blockers and other gender-affirming care for trans youth on public insurance. But because the hospital is significantly more reliant on public funding than other pediatric medical facilities in California, it is particularly vulnerable to the actions and de-funding threats of the Trump administration. The severity is exacerbated even more when taking in account that 40% of pediatric beds in Los Angeles are at this hospital.
“CHLA has a responsibility to navigate this complex and uncertain regulatory environment in a way that allows us to remain open as much as possible for as many as possible,” executives wrote. “In the end, this painful and difficult decision was driven by the need to safeguard CHLA’s ability to operate amid significant external pressures beyond our control.”
This isn’t the first time this year however, that CHLA has announced that it’ll no longer provide gender-affirming services. On February 4, CHLA declared that it would stop providing hormonal therapy to transgender people under 19 in the wake of President Trump’s executive order threatening to cut funding from hospitals treating trans patients under 19.
This decision was met with protests, as hundreds gathered outside the children’s hospital in East Hollywood. The hospital reversed its decision a few weeks later when a federal judge issued a preliminary injunction blocking Trump’s Executive order.
After that, California Attorney General Rob Bonta (D) issued a statement saying the hospital’s cancellation of gender-affirming care violated the state’s Equal Protection laws.
“Let me be clear: California law has not changed, and hospitals and clinics have a legal obligation to provide equal access to healthcare services,” Bonta said.
Bonta has yet to respond to this current attempt to leave thousands of transgender patients without proper healthcare. Activists say this closure sets a dangerous precedent to other hospitals being pressured to cave by the current federal administration.
“CHLA needs to be a leader in this and stand up to the Trump administration, because other hospitals are taking note of what they’re doing,” said Maebe Pudlow, a trans nonbinary activist who helped organize the February protests.
“It feels very conveniently timed when everybody’s focus is on [Immigration and Customs Enforcement] raids happening in Los Angeles,” the activist went on. “I think it’s despicable.”
The Supreme Court on Wednesday upheld a Tennessee law restricting gender transition care for minors, delivering a major blow to transgender rights.
The 6-3 ruling is likely to have a broad impact as 24 otherstates have already enacted laws similar to the one in Tennessee, which bars gender transition surgery, puberty blockers and hormone therapy for youth.
Those laws now look set to survive similar legal challenges. The ruling does not affect states that do not have such bans, meaning care in those states will still be available.
The court was divided on ideological lines, with the six conservatives in the majority and the three liberals in dissent.
Writing for the majority, Chief Justice John Roberts concluded that the Tennessee law does not constitute a form of sex discrimination that would violate the Constitution’s 14th Amendment.
“This case carries with it the weight of fierce scientific and policy debates about the safety, efficacy, and propriety of medical treatments in an evolving field,” Roberts wrote. “The voices in these debates raise sincere concerns; the implications for all are profound.”
“The Equal Protection Clause does not resolve these disagreements,” he added.
Liberal Justice Sonia Sotomayor wrote in a dissenting opinion that contrary to the majority’s conclusion, the law does discriminate based on both sex and transgender status and should therefore be analyzed closely.
“By retreating from meaningful judicial review exactly where it matters most, the court abandons transgender children and their families to political whims,” she wrote. “In sadness, I dissent.”
Sotomayor also took the relatively unusual step of reading a summary of her decision from the bench in court, saying the impact of the decision is “incredibly dangerous.”
Trans rights activists have warned that a ruling allowing bans on care for trans minors could pave the way for similar restrictions aimed at adults.
“Today’s ruling is a devastating loss for transgender people, our families, and everyone who cares about the Constitution,” Chase Strangio, a lawyer with the American Civil Liberties Union who represents the challengers, said in a statement.
Tennessee Attorney General Jonathan Skrmetti welcomed the decision as a win for “common sense over judicial activism.”
He added that legislators should give “careful scrutiny” before allowing such treatments, making judgments “based on science, not ideology.”
The legal challenge was brought by the administration of former President Joe Biden, as well as transgender teens and their families.
The ruling does not resolve all legal issues relating to the state bans, as it did not address a separate argument under the 14th Amendment that the laws violate the right of parents to make health care decisions for their children.
The court also did not rule on the question of whether laws that discriminate against transgender people are subject to what is called “heightened scrutiny,” meaning that judges should review them with a skeptical eye. But three of the conservative justices said transgender people are not a “suspect class,” meaning laws targeting them should not receive heightened scrutiny.
Other issues involving transgender rights, such as laws blocking transgender girls from participating in sports, are likely to reach the court in due course.
Upon taking office in January, President Donald Trump has set about unwinding Biden policies that sought to bolster transgender rights. Among other things, he signed an executive order seeking to restrict gender-affirming care for teenagers nationwide. A judge quickly blocked it.
Trump has also imposed new restrictions on transgender people serving in the military.
Enacted in 2023, the Tennessee law is among a wave of similar measures taken by states imposing restrictions on gender transition treatments. In defending its ban, the state’s lawyers pointed to similar measures taken in other countries, including in Europe.
Skrmetti emphasized in court papers the evolving debate over how best to treat minors diagnosed with gender dysphoria, the clinical term given to the distress people can experience when their gender identities are in conflict with the genders assigned to them at birth.
Major medical organizations say gender-affirming treatments are an effective way to treat gender dysphoria.
The challengers argued that the law is a form of sex discrimination that violates the 14th Amendment’s equal protection clause because the treatments at issue in the case — puberty blockers and hormone therapy — can be used in other situations.
The case marks the most significant ruling on transgender rights since the court in 2020, to the surprise of many, ruled that federal employment protections extend to gender identity, as well as sexual orientation.
The dispute reached the Supreme Court after the Cincinnati-based 6th U.S. Circuit Court of Appeals in 2023 rejected challenges to the Tennessee law and a similar measure in Kentucky.
A district court judge had blocked parts of the law, while concluding that the plaintiffs did not have legal standing to challenge the surgery ban. That provision of the law was not at issue before the Supreme Court.
A Christian-owned spa in Washington State can’t discriminate against transgender women, a federal appeals court has ruled.
Olympus Spa, which has locations in Lynnwood and Tacoma, has historically had a policy of admitting “biological women” only, “excluding, in addition to men, preoperative transgender women who have not yet received gender confirmation surgery affecting their genitalia,” notes the ruling from a three-judge panel of the U.S. Court of Appeals for the Ninth Circuit.
After Olympus turned away a trans woman fitting this description in 2020, the woman filed a complaint with the state’s Human Rights Commission, which enforces the Washington Law Against Discrimination. The law does not explicitly ban discrimination based on gender identity, but the state says the ban on sexual orientation discrimination includes gender identity.
The commission told Olympus Spa’s owners they had to change their policy to a more inclusive one. They did so, and they reached a settlement with the woman in 2021. Under the settlement, however, reserved the business’s right to file a constitutional challenge, which it did in 2023, represented by the Pacific Justice Institute, a right-wing legal group. The lawsuit argued that being forced to admit trans women who hadn’t had genital surgery violated the owners’ First Amendment rights to free speech, free association, and free exercise of religion.
“The family run business is owned by Korean Christians who hold sincere faith-based convictions against allowing persons whose genitals are external (males) to be present with persons whose genitals are internal (females) while in a state of partial or full undress if such persons are not married to one another,” the lawsuit said, according to the Seattle Times.
The U.S. District Court for the Western District of Washington dismissed the suit, finding that complying with the state antidiscrimination law didn’t interfere with the owners’ First Amendment rights. For instance, changing the language in its admissions policy was incidental to the business’s operations, and the state law is neutral with regard to religion, the court found. The owners then appealed to the Ninth Circuit.
A three-judge panel of the Ninth Circuit upheld the district court’s decision in a 2-1 ruling issued May 29. Because the Human Rights Commission’s enforcement of the state law “does not impermissibly burden the Spa’s First Amendment rights to free speech, free exercise, or free association, we affirm the district court’s dismissal of the Spa’s complaint,” Judge M. Margaret McKeown wrote for the majority. She was appointed by President Bill Clinton, as was Judge Ronald M. Gould, who joined her in the opinion.
Judge Kenneth Lee, appointed by Donald Trump during his first term, dissented. He said the state targeted “members of a racial minority group who want to share their cultural heritage and provide a safe space for women and girls.”
“Ultimately, this case is not just about the fate of a family-owned business. It is about power — which groups have it and which do not,” added Lee, is Korean-born. “And Asian Americans in Washington have historically lacked political clout.”
Attorney Kevin Snider of the Pacific Justice Institute told the Times he will ask for the full Ninth Circuit to hear the case. “Safeguarding the dignity of unclothed women in their intimate spaces implicates the right to association and the free exercise of religion,” he said in a statement. “We are committed to pressing forward to vindicate those rights.”
A Tennessee trans woman who was beaten in a “terrifying” attack at a storage unit has spoken out about the horrific incident.
Professional makeup artist Tyler Flanagan visited the Extra Space storage facility in Nashville on 30 May when an employee of Black Tie Moving verbally and physically assaulted her.
Flanagan claims she and her friend were moving items in their storage unit when five men wearing branded Black Tie Moving shirts began shouting hateful slurs and misgendering them.
Taking to social media, Flanagan shared horrendous CCTV footage which showed the men attacking her.
‘Loud, hateful, and terrifying’
She shared that the men “yelled” that they could “still beat out assesses because we’re men”. “Their aggression was loud, hateful, and terrifying,” she added.
The incident was reported to Extra Space Storage, who allegedly didn’t take any action to protect Flanagan. As the pair began walking to their car they were confronted again, before one of the men hit Flanagan.
“His assault was unprovoked, intentional, and fuelled by hate,” she wrote.
“This was the first time in my years living in Nashville that I’ve truly feared for my life. I was attacked by a grown man twice my size. I blocked part of the slap with my hand, but he still struck me in the face. If I hadn’t reacted, he might have knocked me out. I am injured, shaken, and scarred from the trauma of that moment,” she added of the assault.
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She told WSMV that she feels lucky to be alive: “Those are situations that some people like myself don’t make it out of. There’s a large percentage of people like myself who die from situations like this.”
Flanagan reported the incident to Nashville Police Department, and officers watched the CCTV footage of the attack. The case remains under investigation with the Special Investigations Division.
Extra Space Storage and Black Tie Moving condemned the attack.
Extra Space Storage wrote in a statement: “We are disturbed that this act of violence occurred on our property. “While the individual involved is not affiliated with our company, we are cooperating fully with law enforcement in their investigation. We are also reaching out to support the customer affected by this incident.”
Black Tie Moving took to social media and described the incident as “deeply troubling and entirely unacceptable”.
CEO Dustin Black noted that after being made aware of the incident that the company took “immediate and decisive action to terminate the employee involved,” and contacted law enforcement.
“Out hearts go out to the individual affected by this incident. No one should ever feel unsafe or be subjected to harm in any environment. We recognise the lasting harm acts like this can inflict, and we are truly sorry,” they statement added.
Laws banning gender-affirming care for transgender youth in the United States are inflicting severe harm on young people and their families, Human Rights Watch said in a report released today. Since 2021, 25 states have enacted sweeping bans targeting this best-practice medical care, replacing gradual, evidence-based treatments with blunt and politically driven restrictions.
The 98-page report, “‘They’re Ruining People’s Lives’: Bans on Gender-Affirming Care for Transgender Youth in the US,” documents the devastating consequences of these bans for transgender youth, including increased anxiety, depression, and, in seven reported instances, suicide attempts. Human Rights Watch found that these laws contribute to an increasingly hostile, anti-trans climate, compelling youth to hide their identities and socially withdraw. The bans also destabilize health care systems and undermine civil society and create geographic and financial challenges in accessing care. The impact has intensified since early 2025, when the administration of President Donald Trump took a series of executive actions escalating federal attacks on transgender rights.
“US officials have cut off transgender youth from essential, life-affirming care, throwing them instead into the crosshairs of a cultural war,” said Yasemin Smallens, LGBT Rights Officer. “Families are being pushed to the brink, forced to navigate impossible barriers to care, while the federal government intensifies its assault on transgender rights.”
Human Rights Watch interviewed 51 people in 19 states who have been affected by these legislative bans, including transgender youth, parents, health care providers, and advocates. Human Rights Watch also consulted 32 LGBT rights organizers and conducted an additional round of interviews after President Trump’s inauguration to document the impact of his administration’s new policies.
More than 100,000 transgender youth live in states with legislative bans on gender-affirming care for youth. Six states classify providing this care as a felony and eight state laws include vague “aiding and abetting” provisions that could penalize providers for making referrals or refilling prescriptions. The Trump administration has further attempted to restrict access through a January 28 executive order, which while not fully enforced, has caused some clinics to halt services in states where the care remains legal. A case challenging Tennessee’s ban, Skrmetti v. United States, is before the US Supreme Court, with a decision expected in June.
Families affected by bans said that their children lost access to medical care with little or no notice and often without alternative options. Eleven families said they were compelled to travel out of state to consult physicians or obtain prescriptions. Several youth said they were unable to begin care due to legal barriers combined with geographic and financial obstacles. One family relocated to another state.
“I want [lawmakers] to know they’re ruining people’s lives,” said an 18-year-old trans woman whose care was interrupted by a state ban. Youth who have retained access to care said the hostile legal and political environment has exacerbated their feelings of anxiety, depression, and isolation.
State bans have compelled many health care providers to shut down or curtail services. People interviewed reported instances in which providers or institutions ceased services more than may have been legally required. State bans have had a cascading negative impact on health care systems, Human Rights Watch found, as providers in states with bans reported difficulty retaining existing providers and recruiting new doctors.
Every health care provider interviewed said that they had experienced targeted anti-trans harassment. Providers said their institutions have increased their security budgets, diverting funds that could be used for patient care. Civil society organizations reported facing similar threats, alongside rising costs for safety measures.
In Texas, affected individuals described the state’s extreme targeting of transgender people, including a 2022 directive that classified certain forms of gender-affirming care for youth as “child abuse.” As a result, some families reported avoiding health care interactions altogether to protect their children, whose transgender identity, if disclosed, could trigger child abuse investigations. In April 2025, President Trump issued a proclamation asserting that parents who affirm their child’s gender identity are committing abuse.
“People are scared they’re going to lose their kids,” one advocate said. “You don’t have to legislate it if you scare people so much that they self-police.”
“The rhetoric in these legislative sessions suggests you just walk in and they’re handing you hormones and blockers,” one father said. “None of that happened. In the first year or more, not one prescription was written. They [doctors] said, ‘We’re here to listen to you and react based on what you think your needs are.’ Which was incredible as a parent. It puts you at ease … It’s a slow, methodical process.”
The US has international legal obligations to protect the rights of transgender youth, including access to gender-affirming care, as part of its obligation to guarantee the rights to health, nondiscrimination, family integrity, and personal autonomy.
“These laws are upending lives, driving young people into crisis, compelling families to uproot their lives, and fueling anti-trans hostility,” Smallens said. “Lawmakers should repeal these bans, ensure access to care, and protect transgender youth and their families so they can live safely and with dignity.”
