BY MORGAN FISCHER W ith orange Cheeto dust coating the tips of her fingers, 10-year-old Dempsey Button twirled her skirt and skipped around the courtyard of Phoenix Children’s Hospital on a recent February afternoon. Unable (or perhaps unwilling) to find a trash can, she gleefully handed an empty chip bag to the person who cleans up everything: Melissa Button, her mom. Mothers and daughters everywhere have that same interaction on a near-daily basis — Here, YOU throw this away — but the routine exchange between the two Button women was all the more resonant for what was happening around it. As Dempsey frolicked and munched, dozens of people waved signs and chanted slogans in front of the hospital, protesting for her right to exist. Dempsey is transgender and has identi- fied as a girl since she was old enough to make decisions for herself. (One of her first: rejecting her blue-colored room and Star Wars sheets.) As she neared puberty, though, another decision loomed. Soon, Dempsey’s physical development would begin diverging from her identity. That’s why, nine months ago, the Buttons had an appointment with doctors at Phoenix Children’s Hospital to discuss starting their daughter on gender-affirming care. PCH is the largest provider of gender- affirming care to transgender youth in the Valley — or was until recently. On Jan. 28, President Donald Trump signed an execu- tive order yanking funding from any entity aiding in “the so-called ‘transition’ of a child from one sex to another.” The order, which amounts to a direct attack on trans kids, applied to anyone seeking care who is under 19 years old. Not long after, PCH informed parents that the hospital would be “indefinitely pausing all gender-affirming medical care for children under the age of 19.” Another provider, Prisma Community Care, did the same. Prisma resumed offering gender- affirming care after a federal judge tempo- rarily blocked Trump’s order, though it is not accepting new patients. PHC hasn’t resumed anything, nor has it explained why. In a statement, the hospital said: “Phoenix Children’s is bound by all federal laws and regulations for the provision of care to its patients. For this reason, Phoenix Children’s is indefinitely pausing hormone therapy services within the Gender Clinic to ensure we are in full compliance with the recent executive order.” The statement did not address the fact that Trump’s executive order has been temporarily blocked. That’s what brought the Buttons and many other families with trans children to PCH’s doorstep on Feb. 18. In a protest organized by Trans Queer Pueblo, roughly 50 people waved signs and filled the air with chants. Melissa wore a “Momma bear” shirt with a rainbow in the middle, while Dempsey’s tie-dye top featured the familiar trans advocacy colors of blue, pink and white. Dempsey’s older sister and younger brother held handmade posters with painted trans flags. “You can’t change us,” the banners read. Cars drove by, honking in support. Together, they demanded that PCH resume offering gender-affirming care, something that the hospital currently faces no legal barriers to providing. Neither the hospital nor CEO Bob Myers has explained why the hospital has halted that care despite a court blocking Trump’s order, though it’s worth noting that PCH received roughly $4.5 million in federal grants last year. If the hospital doesn’t resume offering gender-affirming care, or if Trump’s order is eventually allowed to go back into effect, the consequences for trans children will be real. Without that care — which does not include sex reassignment surgery, contrary to many Republican-pushed myths — their appearances will gradually match their gender identities less and less. Kids like Dempsey, who has lived essentially her whole life as a girl, will develop male features. Without treatment, trans boys will develop as girls. The physical changes likely will cause severe emotional stresses, often worsened by the teasing of cisgender peers and leading to suicidal thoughts. “We are scared,” Melissa Button said. “There’s a lot of really heavy ramifications for us.” For the Buttons, that crisis is on the horizon. Dempsey is not yet at puberty, and her family has not yet decided on pursuing gender-affirming care. “We wanted to be able to meet with doctors and figure out what would be appropriate for her,” Melissa said. But now that option “has been taken from us.” For Dempsey and so many other trans children in Arizona, the ticking clock gets louder and louder. What is gender- affirming care? To understand the current plight of trans kids in Arizona, it’s important to know exactly what gender-affirming care is. And, just as importantly, what it isn’t. In Arizona, gender-affirming care for minors was provided primarily by PCH and Prisma. That care includes mental health support and general physician care, as well as puberty blocker shots and hormone replacement therapy. Trans boys may receive testosterone shots to promote the development of stereotypically male features. Trans girls may receive estradiol pills to promote the opposite. But gender-affirming care is not permanent, at least when it comes to minors. (In fact, its very reversibility is partly why Trump’s order threatens to cause so much damage to trans kids already in treatment.) Stop taking the puberty blockers and puberty reasserts itself. Cease the hormones and the body’s natural hormones will take over. Surgery, which is sought by many trans adults, is a much more permanent way to align one’s appearance and identity, but minors are barred from receiving it under a pair of 2022 laws signed by former Gov. Doug Ducey. Even before that ban, the number of minors undergoing gender- reassignment surgery represented a “tiny, tiny proportion of patients,” said Ari Kravitz, a nurse practitioner at Spectrum Medical, a Phoenix internal medicine clinic that provides gender-affirming care to adults. Far-right conspiracy theories warn of surgery being foisted upon children in a “very cavalier way without really consid- ering the overall health and ongoing health of the child,” said Prisma CEO Jessyca Leach. But the reality is the opposite. Just as in any family, parents of trans kids delib- erate carefully about any medical decisions regarding their children. The process of receiving gender-affirming care is rigorous, Leach said, and providers are “very, very thoughtful in working with parents and youth kiddos to make sure that the care we offer is suitable and is right for them wherever they’re at in their life.” Jezz Putnam knows this firsthand. Putnam, who is nonbinary and uses they/ them pronouns, is a board member of Arizona Trans Youth & Parent Organization. For the last four years, Putnam has worked to get gender- affirming care for their daughter, Nabi. Now 13, Nabi began experimenting with gender at 3 years old. She was always drawn to more feminine things TURNED AWAY Cowed by Trump, Phoenix Children’s Hospital abandons trans kids. >> p 14 Phoenix Children’s Hospital has halted gender-affirming care for patients under 19 years old. (Photographs in the Carol M. Highsmith Archive, Library of Congress, Prints and Photographs Division)
