Police in Salt Lake City are investigating after a number of Pride flags were set alight in the Utah capital.
The investigation began on Monday morning (3 July) after officers were called to a home where the owner reported their flag being cut down and burned, the police said in a statement.
After responding to the incident, they learned that at least four other LGBTQ+ flags in the area had been vandalised, reportedly during the early hours of that morning.
Pride flags were cut and burned in Salt Lake City. (Twitter/@slcpd)
The police want to hear from anyone with information and have asked people in the area to check home-surveillance systems to see if they captured footage of any suspect.
In its statement, the police department also said it recognised “our responsibility to investigate hate crimes thoroughly and impartially to hold offenders accountable and ensure justice for survivors”.
They went on to say: “The Salt Lake City police department educates its officers and works with our community to recognise and condemn hate crimes and works to prevent them from occurring in the future.
“Hate has no place in our community.”
Photos of four of the flags were posted on social media by the police, with the images showing them having been cut and one in ashes on the ground.
Fox 13 reported more flags being cut and burned on Tuesday morning (4 July), this time near Harvey Milk Boulevard, named after the prominent gay rights pioneer.
One resident, Joseph Leyba, told the news outlet that he and four neighbours woke on Tuesday morning to find their flags in ashes on the pavement, and that he was “at a loss for emotions and feelings”.
He said it was particularly shocking because the area was Salt Lake’s unofficial LGBTQ+ district.
On a positive note, he added a woman he did not know replaced all the flags.
“She had Pride flags in her hands and was setting them on the front porches of all the individuals that had been affected,” Leyba said.
A transgender woman and former inmate who was held in solitary confinement for six years is suing the Missouri Department of Corrections (MODOC) for what is described as its “unconstitutional and discriminatory policy against people living with HIV.”
The plaintiff, identified only as Jane Roe, claims in the lawsuit filed last week she was held in solitary confinement between 2015 and 2021 at the Jefferson City Correctional Center (JCCC) because she was living with HIV. She is represented by Lambda Legal, the MacArthur Justice Center, and the law firm Shook, Hardy & Bacon
“No person should be subjected to the inhumane and devastating effects of long-term solitary confinement, conditions that Ms. Roe faced every day for more than six years,” Richard Saenz, Lambda Legal senior attorney, criminal justice and police misconduct strategist, said in a statement. “We filed this lawsuit to hold the Missouri Department of Corrections accountable for its use of an unconstitutional and discriminatory policy that singles out people living with HIV.”
“Ms. Roe was trapped in isolation with no way to challenge her conditions,” MacArthur Justice Center attorney, Shubra Ohri, said. “Six years of that led Ms. Roe to self-harm, suicidal ideation, and actual suicide attempts. This tracks with widespread consensus among the human rights experts, psychologists, physicians, and mental health authorities who say solitary confinement is torturous and should be abolished.”
“We seek justice for our client who endured six years of unwarranted solitary confinement. We will work to prevent this from ever happening to another human being,” Gregory Woo, a Shook partner, said in a statement.
The lawsuit, Roe v. Precythe, et. al., was filed in the U.S. District Court for the Western District of Missouri, and claims “MODOC’s policy on incarcerated people living with HIV lacks any consideration of modern medicine and does not engage in individualized assessments.”
The lawsuit alleges that MODOC’s policies and actions violated Roe’s Eighth and Fourteenth Amendments, the Americans with Disabilities Act, and Section 504 of the Rehabilitation Act. Roe claimed she was denied the services, programs, and activities offered to other inmates because of her HIV status. Roe is seeking policy changes by MOCOD, monetary damages, and other unspecified relief.
If you are having thoughts of suicide or are concerned that someone you know may be, resources are available to help. The 988 Suicide & Crisis Lifeline at 988 is for people of all ages and identities. Trans Lifeline, designed for transgender or gender-nonconforming people, can be reached at (877) 565-8860. The lifeline also provides resources to help with other crises, such as domestic violence situations. The Trevor Project Lifeline, for LGBTQ+ youth (ages 24 and younger), can be reached at (866) 488-7386. Users can also access chat services at TheTrevorProject.org/Help or text START to 678678.
The bar where police raids sparked the 1969 Stonewall uprising has revealed why it stopped serving Bud Light – and it has nothing to do with calls for a boycott over the beer brand’s collaboration with trans influencer Dylan Mulvaney.
Co-owners of New York’s Stonewall Inn, Stacy Lentz and Kurt Kelly, have revealed that the bar turned its back on Bud Light’s parent company, Anheuser-Busch, in 2021.
At that time, the bar staged a “Keep Your Pride” campaign, which involving refusing to serve products of companies that claimed to be allies of the queer community but which also donated funds to anti-LGBTQ+ individuals.
“The reason we did that… was because they were out there waving the rainbow flag very vehemently, then turning around and contributing to anti-LGBTQ legislators, which can’t happen,” Lentz told Newsweek. “Our communities are fed up with that.”
Lentz said Bud Light’s collaboration with Mulvaney, who has 12 million followers on TikTok, “makes sense” and warned other businesses: “If you don’t market to Gen Z, then in 20 years or 30 years, your business will not exist because Gen Z is all about equality. Your consumer is ageing out.”
The backlash to the collaboration “was ridiculous,” and “the fact that they catered to it was alarming,” she added.
“But at the same time, they at least made an effort. I thought it was a great campaign.”
Dylan Mulvaney was the victim of a transphobic backlash over her social media collaboration with Bud Light. (Credit: Getty Images)
Anheuser-Busch faced a deluge of attacks from anti-trans people after they sent Mulvaney a single personalised can to celebrate the first anniversary of her “Days of Girlhood” TikTok series.
However, despite Target, Bud Light and Innocent Drinks being among the brands to face boycott calls over LGBTQ+ inclusion, stats show that most Americans appreciate and value queer people being featured in advertising.
According to GLAAD’s Accelerating Acceptance survey, 75 per cent of straight people feel comfortable seeing LGBTQ+ in advertising, while 60 per cent of heterosexuals agree that seeing queer people in ads makes them more comfortable with those who are different to themselves.
As the UK government fights to save its Rwanda asylum plan in the Supreme Court, a gay man from the country reports on the dangers facing the community there.
On Thursday (29 June), the Court of Appeal ruled that the government’s much-criticised plan to send asylum seekers to Rwanda was unlawful. Prime minister Rishi Sunak and home secretary Suella Braverman have indicated that they intend to challenge the ruling.
On the same day, the government’s Illegal Migration Bill, which backs up the Rwanda plan, suffered heavy defeats in the House of Lords.
Innocent Uwimana – whose name has been changed to protect his identity – is a gay man from Rwanda who migrated to the UK about 20 years ago.
He knows first-hand what life is like for LGBTQ+ people in Rwanda, and it’s for this reason that he is so disturbed by the UK’s proposal.
As debate rages on about the bill, Innocent set about finding out what life is like right now for queer people in Rwanda. Here, he reports on conversations during which he found that stigma and abuse are still a part of every-day life for LGBTQ+ people in the East African country.
‘We don’t understand how the UK government would send LGBTQ+ people here’
However, same-sex marriage is prohibited and LGBTQ+ people are not protected from discrimination by any specific legislation.
LGBTQ+ people face stigmatisation and abuse there every day and there are many other factors that fuel hatred against them, especially religious and cultural factors.
Protesters outside the Home Office in central London. (NIKLAS HALLE’N/Getty)
I’ve had a chance to speak to a group of Rwandan LGBTQ+ people who currently live in the country, and who have faced discrimination their entire lives because of their sexual orientation and/or gender identity.
“We don’t understand how the UK government would send LGBTQ+ people here knowing that they will face discrimination. Although the country’s recent human rights advances have been ‘enormous’, not all Rwandans are able to enjoy them equally,” one person told me.
The people in the group explained the tactics used to discriminate anyone perceived to be a member of the LGBTQ+ community.
Religion and culture are used as arguments to discriminate against LGBTQ+ people
Protesters demonstrate against deportation flights to Rwanda outside the the Royal Courts Of Justice in London. (SOPA Images/LightRocket via Getty Images/Vuk Valcic)
The UK government has to understand that Rwandans’ conceptions of the world are substantially shaped by their religious beliefs, that religious ideas heavily shape their attitudes and behaviours.
On tope of that, homophobia has evolved into a rallying cry that mobilises the masses by urging them to guard themselves against westernisation. Political and religious leaders, as well as social media influencers, justify discrimination against LGBTQ+ people on the grounds of culture.
They claim that homosexuality and non-heteronormative gender identities are not part of African culture and that they were brought to Africa by Western countries (especially the US and European nations) as a way to impose their beliefs on the continent.
Some also claim that Western countries intend to wipe out the African population by promoting homosexuality and preventing people being in heterosexual relationships in which they can have children.
Innocent was finally free to be himself when he arrived in the UK. (Envato Elements/PinkNews)
However, there is historical evidence of same-sex relationships and gender expression versatility as they are well-documented in many places in Africa, including Rwanda.
For example, in Rwanda, cyabakobwa (men behaving and crossdressing as women) and ibishebago (women behaving and dressing as men) were tolerated and they lived in peace in the communities in pre-colonial times.
But, unfortunately, this is no longer the case, and LGBTQ+ individuals have to hide or are forced to flee to other countries.
The controversial cases of a Rwandan fashion star and a social media influencer
The people I spoke with noted recent, well-documented cases of violence against LGBTQ+ people and people simply perceived to be part of the community.
During a trip to Rwanda’s capital Kigali home secretary Suella Braverman claimed Rwanda is “one of the world’s safest countries”. (Getty Images)
One example is that of a famous DJ and social media influencer who has been accused of being a lesbian. Despite her denial, she has been attacked in the media by religious leaders and other social media influencers, demanding she be arrested or beaten up.
‘We hope the UK government will hear our voice’
Rwanda is clearly a country from which most LGBTQ+ people want to get out, to live in a place where they can be free and themselves. So why would the UK government think it is safe to send queer people there?
The people I chatted to were surprised that a country like the UK, previously known for pushing the human rights agenda, was now deliberately planning to send people to a place where it is known that they will face stigmatisation and discrimination.
When I asked the group what they sought to achieve, they said: “We hope the UK government will hear our voice and don’t put other people in a situation many others want to get out of.“
Ivan Miadini said it was like a scene out of the Old Testament.
He and his husband were walking their dog a week ago Saturday night in Drogheda, north of the Irish capital in Dublin, when a gang of teenage boys starting verbally abusing them, calling them “f****t bastards”, “queers” and “pedophiles.”
“They threatened to kill us, rape our dog and told us to go back to our own countries,” Miadini told the Independent. “They were going to chase us off the island.”
The incident escalated as the teenagers started hurling stones at the couple and their dog and then physically attacked them. Both men were punched in the head and face. One man suffered a broken nose.
The attack lasted over a minute.
Despite the violence, Miadini managed to record most of the incident — he said the boys knocked his phone from his hands twice — and he posted it online in hopes local residents would come forward with information about the attackers’ identities.
Remarkably, the couple hasn’t contacted cops.
Referring to the state police in Ireland, Miadini told a local radio station, “I didn’t film with the intention of sharing it with the Garda. I think there is another way to go here.”
“I am sharing this with various outlets, with people I know to share it among themselves so we can find out who these people are and see what their situation is.”
“I really want to know before taking this further down the line.”
A local Garda source told the Irish Mirror police are aware of the video online and that it was a “shocking” attack. He hopes the couple comes forward.
“These teenage gangs should not get away with this,” he said. “There is no excuse for such vile homophobic and racist abuse.”
Imelda Munster, a member of the Irish Parliament representing Drogheda, said she’s spoken to the victims and condemned the attack.
“These are two law-abiding citizens going out for a walk with their dog when they are attacked in broad daylight because of who they are.
“Under no circumstances should these thugs get away with this. It was a frightening incident and everyone in Drogheda is shocked and angry.”
For their part, the couple, who recently relocated from Dublin, think their attackers should avoid jail time and be directed on a path to community service.
“I don’t think the solution here is just to throw the book at them with a criminal prosecution,” Miadini said.
“If these young people aren’t educated, they will grow up to carry out worse assaults.”
“Hopefully it doesn’t take root,” said Miadini, “because that kind of hate can only grow.”
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.
The Supreme Court in Nepal has issued an interim order enabling the registration of same-sex marriages, a move which has been described as a “significant step towards marriage equality” in the country.
The interim order was issued by the Supreme Court on Wednesday (28 June), asking the government to establish a separate register of marriages for same-sex couples in the country, the Associated Press (AP) reported.
The US embassy in Nepal wrote on Twitter: “This decision is a significant step towards marriage equality and recognition in Nepal that marriage is a fundamental right.
“With the recognition of full marriage equality, Nepal will continue to be a leader in protecting all citizens against discrimination.”
While same-sex marriage is still not yet fully legal in Nepal, activists have said that the move is “very significant” for same-sex couples and “third gender” people. “Third gender” people are officially recognised in Nepal as of 2007, and can list their gender on ID including passports. The gender has been included in Nepal’s census since 2021.
“This is a very significant development, as same-sex as well as third genders and their partners can register their marriages. They will be entitled to the same rights as heterosexual couples,” LGBTQ+ rights activist and former parliamentarian Sunil Babu Pant said.
“Parliament may take a while to pass the marriage equality law, but this order gives a practical solution to members of the sexual and gender minority communities who wish to register their marriage legally.”
Reveller takes part in a Pride parade in Kathmandu, Nepal on 10 June 2023. (Sanjit Pariyar/NurPhoto via Getty Images)
Couple Surendra Pandey and Maya Gurung told AP that they married in a Hindu ceremony six years ago. However, their marriage is not legally binding. They told the outlet that they were “relieved” to finally be able to register their marriage.
Gurung said: “I am overwhelmed with joy because of this decision and it is a day of commemoration for our community.
“This court ruling has established that we are equal citizens of this country.”
A 24-year-old man has been charged in connection with the stabbing of a university professor and two students during a gender studies lecture in Canada, in what police say was a “hate-motivated incident”.
Geovanny Villalba-Aleman, an international student who had recently graduated from Waterloo University in Ontario, is alleged to have carried out the “planned and targeted” attack “motivated by hate related to gender expression and gender identity”, police said in a press release.
About 40 students were attending the class on Wednesday (28 June) when a man stabbedthe 38-year-old professor, a 20-year-old woman and a 19-year-old man, police said.
The victims sustained serious but not life-threatening injuries.
Villalba-Aleman has since been charged with aggravated assault, assault with a weapon, possession of a weapon for a dangerous purpose, and mischief under $5,000.
“It is both sad and disturbing that this incident has occurred during Pride month,” Waterloo regional police service chief Mark Crowell said at a press conference on Thursday (29 June).
“We hope that this incident does not diminish from these celebrations but, instead, encourages us all to come together to continue to celebrate and inspire love over hate.”
In a statement on Twitter, the president of the university, Vivek Goel, said that the campus will continue to fly Pride and Two-Spirit flags until the end of July in response to the “hate-filled” attack.
“Professor Katy Fulfer and two students in her gender studies course were attacked because they were exploring society and gender,” Goel wrote.
“That this hate-filled attack, due to gender expression and identity, happened at the end of Pride month is even more painful.
“Our world is increasingly polarised and there are those who try to intimidate the 2SLGBTQIA+ community. They want us to be afraid – afraid to learn, afraid to share, afraid to speak our truths.
“We won’t let this deter us from proclaiming our values of inclusion and openness.”
Justin Trudeau, Canada’s prime minister, tweeted that he strongly condemned the “despicable” and “vile” incident.
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.”
Max Adomat, 26, has been on a steady regimen of feminizing hormones for the last six years.Max Adomat
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.”
