SOUTHERN INDIANA — For the past three years, Ellie has helped her patients in Indiana and Kentucky overcome all kinds of mental health challenges as a professional therapist. Her patients, ages 12 and up, come in with conditions like generalized anxiety disorder and attention deficit hyperactivity disorder, among others.
She said she’s happy to help anyone who needs it, but lately, the majority of her patients are LGBTQ people, including transgender youth, who need help dealing with gender dysphoria and other related issues. One of her main goals, she said, is to give trans youth a place to feel comfortable expressing themselves and their problems.
“That’s where the collaboration comes in with the client, or anyone I work with or talk to,” said Ellie, who asked to be identified only by her first name. “I usually [talk to] people in a very open space, making it safe for them to be able to discuss the issues.”
Ellie is a trans woman. She said her gender was assigned male at birth, but she transitioned to a woman beginning in college. She started her studies to become a therapist in part because of her own trauma. In 2009, her father died by suicide. Today, she said her career helps her not only process that time in her life, but also offer help to people who need it.
She said a lot of what she does focuses on the concept of trans joy, which she said means something different to every trans individual. But she said the idea is to empower trans people through helping them find validity in their identity and getting them support through other trans individuals.
“Trans joy, first and foremost, is the ability to feel valid in your identity and valid in your gender and your body,” Ellie said. “That joy can be brought out by talking about the pieces of their life that bring out hope.”
Another big part of that is helping trans youth begin their journeys with other types gender-affirming care, providing assessments and other interventions to begin therapy with puberty blockers or hormones. Both are medications used to help trans youth cope with the difference between the gender they identify with and the presentation of that in their own bodies.
“There’s some of me wanting to understand why it happened with my father, but there’s also the idea of putting back into my community,” Ellie said.
Gender-affirming care bans
As Indiana and Kentucky move forward with bills that could limit or ban certain types of gender-affirming care for minors, Ellie said she’s concerned about people like her patients. A study from the Journal of Interpersonal Violence shows in its abstract that more than 80% of transgender participants had considered suicide at some point in their lives, and about 40% of participants attempted it.
Among those interventions are puberty blockers and hormone replacement therapy.
Puberty blockers temporarily delay the onset of testosterone or estrogen, and Ellie said most trans youth aren’t on those medications for very long. She said those treatments are reversible. Sometimes, blockers are used in tandem with hormone replacement therapy, which increases the production of the desired sex hormone in the patient. She said some of those effects are more permanent because they can lead to the development of secondary sex characteristics, such as breasts for trans women.
Ellie said she’s worried that blocking various kinds of gender-affirming care could lead to more trans youth harming themselves, or worse. Bills like Indiana’s Senate Bill 480, which has been passed by the State Senate and has moved to the State House of Representatives, would ban puberty blockers and hormone therapy for anyone under the age of 18.
Kentucky’s legislature hurriedly passed a similar bill on Thursday – Senate Bill 150. Both bills include provisions to block gender-affirming surgeries for minors, but Ellie said those kinds of surgeries are extremely uncommon for patients younger than 18.
She said the process of getting a prescription for either puberty blockers or hormone therapy isn’t something taken lightly by therapists or patients. Before those treatments can begin, a therapist must assess the patient, make sure they’re aware of what the medication does, then write a letter of support to their insurance company that affirms the patient can give informed consent to begin those medications.
“[Those medications] help reaffirm how they are in their identity,” Ellie said. “There will be physical changes, and that can vary depending on the person. Not only are you getting reaffirmed in your identity, but you also get to see your body reflect what you see.”
However, she said the threat of removing medical interventions can lead to devastating consequences for trans youth. She said both puberty blockers and hormone therapy can play a role in reducing feelings of gender dysphoria and help curb suicidality in trans patients.
“With trans youth, specifically, being pulled off of [puberty] blockers, is dangerous strictly because it raises the suicidality rate by over 50-some-odd percent,” Ellie said. “They’re more likely to self-injure.”
She isn’t the only mental health professional in the area concerned with the effects of blocking such medical care. Katharine Standiford, Ellie’s colleague, is also a therapist based in Southern Indiana. She said gender-affirming care, through medication or otherwise, is crucial.
“A lot of trans youth struggle with not being accepted, or being bullied,” Standiford said. “Without the gender-affirming care, not just in mental health, but across the board, they can really suffer.”
She said even if those forms of medical care are blocked, the problems for trans youth will still exist.
“Gender affirming care is about kindness,” Standiford said. “Listening to the child and what they’re going through, and trying to understand what they’re going through… when it comes down to it, their body is their own. Their feelings about it aren’t just going to disappear or change. Those views need to be heard and they just need someone to listen to them.”
Other harmful legislation
Ellie said other forms of gender-affirming care don’t involve medical intervention at all. Another study, published in The Counseling Psychologist, suggests that simple supports, including family acceptance, social supports, and participating in LGBTQ activism can help trans people find a sense of belonging to overcome some of their issues.
She also said, sometimes, that support is something as simple as agreeing to use a person’s preferred pronouns or name.
Transgender-rights advocates gather near the Kentucky House chamber on March 2, in Frankfort, Ky. Republican lawmakers in Kentucky struggled to wrap up a bill restricting gender-affirming care for minors, as internal differences complicated their push to beat a Thursday, March 16 deadline to complete the sweeping proposal denounced by some outside voices within their party.
“If someone is transitioning and they’re not getting support from family, it may make them more likely to explore suicide,” Ellie said. “Gender-affirming care, by providing it, reduced it by half. Even just using pronouns will do that.”
As of Thursday, Kentucky’s SB 150 is one of several so-called “Don’t Say Gay” bills across the country. It includes language that would prevent the state Department of Education from recommending policies requiring the use of a student’s preferred pronouns that don’t conform to their assigned gender, and keeps school districts from requiring staff from using those pronouns for students.
She said other laws, such as those targeting drag show performances across the country, could have all kinds of other consequences for trans people. She said there’s too much room in the interpretation of those laws, which makes her worry it could lead to trans people getting prosecuted for leaving their homes.
“They will impact anyone who does not blend into society very well,” Ellie said. “They’re so ambiguous that it’s hard to know whether or not it’s safe for people just to be out in public. One of my concerns is that even in the event that I do blend into society very well, there’s a potential that if someone knows me and they out me, I could get arrested.”
Helping trans youth now
Ellie said regardless of what happens with legislation, trans people will continue to need care and support from medical professionals, family, and others.
She works with a nonprofit in Louisville to help homeless LGBTQ people. She said she’s seeing more and more trans people and youths in that community, which she said could be the result of unsupportive families who kick out their children because of their gender identity.
She said there are resources available for LGBTQ youth, regardless if they feel comfortable coming out at home or elsewhere. She said looking for a local LGBTQ center can help, and finding community members to talk with and look up to can make a difference for minors.
However, she said she knows coming out can be difficult at home, especially if family isn’t supportive.
“What I’m hearing a lot in the community is extreme worry about having to hide who they are with regard to their safety,” Ellie said. “I see a lot of that with trans youth, specifically.”
She said if it’s not safe to come out with someone’s identity, then it’s best to seek help elsewhere. Sometimes, searching online can provide insight, but other resources in the community can make a bigger difference.
For parents who don’t know how to support a trans child, she said simply hearing out that child helps a lot.
“Please just listen,” Ellie said. “Listen, don’t give reactions to the kid. Make sure to leave open space and ask questions about specific things, but don’t ask about surgeries or hormones until they actually bring it up.”
Standiford said she hopes people can become more understanding and accepting of trans community members.
“With all these bills going through that would cause them to feel so rejected by our whole society, they’re just normal people, too,” Standiford said. “They deserve to be treated with the same rights and respect as anyone else. I think everyone should be treated with that same basic respect to see themselves as who they are, and I just wish that everyone would be more open to seeing the views of other people who are different from themselves. “
Ellie said it’s a scary time for trans people, and she hopes others try to understand their trans neighbors. Otherwise, she hopes trans people don’t come to more harm.
“I think the last thing I say to people is just to be safe,” Ellie said. “That’s usually what I tell people all the time.”
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