LEXINGTON, Ky. — As Republican lawmakers continue advancing bills that regulate the treatment of and deny health care to transgender youth in Kentucky, medical experts are sounding the alarm on a worsened “LGBTQ+ mental health crisis” that is sure to follow the passage of such measures.
Senate Bill 150 and House Bill 470 are gaining support from the Republican supermajority General Assembly. Senate Bill 150 from Sen. Max Wise, R-Campbellsville, regulates communication between K-12 districts, schools and parents regarding students’ use of pronouns, school curriculum around sexuality, contraception and family planning. House Bill 470 disallows the full spectrum of gender-affirming care in health care settings for trans youth.
Though these proposals aren’t the only legislation filed this session aimed at LGBTQ youth, they are likely to have the biggest combined impact, both on students’ life in schools and in a health care setting.
The portion of Senate Bill 150 that has provoked the most ire from opponents is its explicit prohibition against districts requiring or recommending that school personnel use a student’s pronouns if they conflict with their assigned-at-birth gender.
Likewise, the Kentucky Board of Education and Department of Education would be barred from requiring or recommending policies related to the use of pronouns in this way. KDE distributed such guidance in September, in an information sheet titled “Considerations for Using Student Preferred Names.”
Wise, the lead sponsor of the bill, has lambasted the infiltration of what he calls the “woke agenda” in schools, and he has denounced the “misinformation” surrounding his bill, saying it “does not target or condemn lifestyles.” Rather, it emboldens parents to be engaged with their students’ education, he said.
Though the bill does not outlaw the use of trans students’ pronouns, opponents say it’s predicated on the idea that to be trans, for example, is a choice that school personnel would lawfully be allowed to ignore and therefore invalidate.
High school students have taken to protesting Wise’s bill and others like it through organized walkouts in Louisville, Lexington and Danville. Last week at Paul Laurence Dunbar and Lafayette high schools, throngs of students left their classrooms and stood shoulder to shoulder outside on their campuses, holding signs and pride flags. LGBTQ students addressed their peers at both rallies, sharing personal experiences and explaining why bills like Wise’s should be quashed.
“The point was to show the legislators that we’re here and we will not be quiet, even though they continue to try and infringe on our rights,” Lafayette sophomore Joey Hester said.
‘Denial and erasure’
Another bill with momentum is House Bill 470 from Rep. Jennifer Decker, R-Shelbyville, a sweeping proposal that would wholly restrict how health care providers across specialties, including mental health therapists, school counselors, psychologists and primary care doctors, treat their underage trans patients.
The bill, as it was initially drafted, would block health care professionals from providing “social transition services” and “gender transition services” to any minor, even with parental consent. Those services not only include gender-affirming hormone therapy, but also verbal “encouragement, affirmation, or advocacy for gender transition,” including calling a patient by their pronouns and affirming their name change.
Providers in violation would risk losing their license and being charged with a misdemeanor for a first and second offense, and a felony for each subsequent offense.
The bill, which directly contradicts medical guidance, would also formally deem the provision of these services as “unethical and unprofessional.” Gender-affirming care for minors, as well as adults, is the scientifically evidence-based standard of care and is recommended by major medical associations, including the American Academy of Pediatrics and the American Psychological Association.
“What we are seeing is medical misinformation with these legislative efforts,” said Dr. Anthony Carney, a family medicine nurse practitioner for UK HealthCare. It’s a “denial and erasure” of this population’s lived experience, he said. Passage of this bill would lead to a “worsening of an LGBTQ+ mental health crisis” that would bloom into a “public health emergency,” by Carney’s estimation.
Carney is a provider with UK’s Transform Health Services, working out of Lexington and a clinic in Wilmore. Launched less than a decade ago with the goal of improving health equities for an underserved and marginalized population, Transform is designed to be a safe medical space for LGBTQ+ patients young and old seeking all forms of health care.
The debate among lawmakers “around the valid existence of trans people is already having a damaging effect on the mental health of trans folks in our community,” Carney said. Mental health struggles like depression and anxiety are already disproportionately high among this group of patients, particularly trans youth.
Julie Cerel, director of the University of Kentucky Suicide Prevention and Exposure Lab, echoed this point. Mental health support hinges on meeting students where they feel safe, supported and seen.
“We know that if they’re not supported in their sexuality and in their preferred pronouns, that might be associated more with their mental health symptoms than just identifying as LGBTQ,” Cerel said. “Researchers found that it’s not those kids that identify necessarily as LGBTQ that are having mental health problems. It’s those that identify (as LGBTQ) aren’t being supported.”
Should the bill pass, Dr. Keisa Fallin-Bennett, who co-founded Transform Health Services seven years ago, said she is “genuinely fearful of a very dramatic increase in suicide for families and children who cannot leave the state (for this care).”
The 2022 National Survey on LGBTQ Youth Mental Health from The Trevor Project found that 45% of LGBTQ youth had considered attempting suicide in the past year. LGBTQ youth who felt supported by their families and schools had lower rates of attempting suicide, the survey found.
Providers are worried that such a bill will dissuade trans youth and adults, generally, from seeking even routine health care. Joanne Brown, a nurse practitioner for Transform who provided gender-affirming care to University of Kentucky students until she retired in February, said one of the ways to rectify health inequities is first and foremost by “recognizing people for who they are. That means addressing someone by their name and pronouns.”
When providers don’t do that, Brown said, “it sends the message that there’s something wrong with that person. If you’re a patient and your provider doesn’t use your correct name, or you feel they’re discounting you for who you are, you’re not going to back to that provider for any care.”
‘They’re very resolute’
As a primary care and family medicine doctor, Fallin-Bennett sees many children and teenagers on the LGBTQ+ spectrum. Her approach has to be holistic, she said — her patients’ gender identity is not separate from their medical health, or their emotional or spiritual health.
“You can’t separate someone’s gender, or dysphoria about it, from their depression or from their joint pain or from anything else,” she said. “They all go together in what’s going to make them thrive as a human being.”
Gender-affirming health care is “anything that helps a person live in the gender with which they identify and feel comfortable,” Fallin-Bennett said. It can be as simple as referring to a patient by their preferred name, or as involved as prescribing hormone therapy, which, for minors, is done only with informed parental consent; it’s a family decision, providers interviewed for this story said.
These patient-provider conversations are involved, tailored, and always include elaborate input from a child or teenager and their parent or guardian. To start, who is their support network? What is their current state of mental health? What does gender mean to them?
“I start by asking about their journey of discernment around their gender not fitting their body completely,” Fallin-Bennett said. “With adolescents, when their parent is in the room, I ask the teen’s permission to also get the story from their parents.”
It’s not a decision a minor or their family has reached on a whim. Most trans teens, for instance, have an established relationship with a mental health therapist by the time they see a Transform provider for the first time.
“For many, they have been working on this and researching, even the younger ones, for at least a year by the time they get to us,” she said.
Carney said many of his patients under 18 have known for a “long time” that their gender doesn’t match the one they were assigned at birth.
“The decision is not to be trans — they are trans. The decision is to disclose that information to their parents, friends, their support network and me as their provider,” he said.
“We see time and time again when you help someone affirm their gender, how much happier their life is, how much better their mood becomes, how much more controlled things like anxiety and depression become once they’re living in the gender in which they want to live,” Carney added.
To lawfully revoke the ability for a medical professional to affirm a trans patient’s lived experience will unequivocally worsen the lives of this population, sources interview for this story agreed.
“Depression is often from a lack of hope. When hope is zapped, it’s what starts a depression cycle from being inescapable,” Fallin-Bennett said. What a proposal like HB 470 says to a trans youth is, “all my own understanding of myself is being negated. I’m being told I can’t understand myself, and I must be wrong (about my identity) even though I’m having my own lived experience.”
The underpinnings of lawmakers’ debate over GOP-backed bills like House Bill 470 and Senate Bill 150 is the validity of the trans identity, providers interviewed for this story said.
It’s not that more people are “deciding to be trans,” but rather, incrementally, “our culture is more accepting of trans people,” Carney said.
“The more visible trans people become, it brings more opportunities for folks who have always been trans to feel comfortable being out. That’s why we’ve seen more trans folks exist in the world and seek affirming care: we’ve seen incremental support changes that allow their existence to be safer,” he said.
Legislative proposals like these not only feel like a “regression,” Carney said, “it feels like retribution for being more visible and existing.”
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GETTING HELP
The national suicide prevention hotline has recently been changed to a three-digit suicide and crisis hotline. It is available 24/7 and can be reached by dialing 988. More information can be found at 988lifeline.org.
Any young LGBTQ person can call The Trevor Project’s 24-hour crisis hotline at 1-866-488-7386, and transgender people of any age can call the Trans Lifeline at 877-565-8860.
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