such as the color pink. When she reached 10 and approached puberty, Putnam and their co-parenting partner explored their care options. That began with counseling. After at least six months of mental health treat- ment, a psychiatrist diagnosed Nabi with gender dysphoria, which the American Psychiatric Association defines as a psychological distress that often begins in childhood for some people whose sex assigned at birth doesn’t match their gender identity. Nabi began puberty blockers. The injec- tions will delay puberty until a patient is old enough to start making medical deci- sions for themselves and “does not cause any permanent physical changes,” Kravitz said. If a patient stops taking blockers, the puberty process “starts right back up.” They are not handed out like candy. It took two years for Nabi to receive approval for her blockers. Even then, it took months before she could even start receiving injec- tions. Putnam spent hours on the phone with PCH and the insurance and drug companies in what they called “a big medical quagmire of processes you get stuck in.” Their insurance company kept denying the medication and before ship- ping them, the drug company wanted the money. Out-of-pocket puberty blockers can cost as much as $10,000 a year. “You can’t go somewhere, walk in, get a letter, come out and get a blocker the next day. That’s not how it works,” Putnam said. “They want to get to meet the family. They’re going to really spend time with your child. It’s murky (and) if you’re not persistent, you may not get it.” In the spring of 2024, after months of waiting, Nabi started receiving her puberty blocker shots, which are administered every three to six months. For a trans girl, the next step in their gender-affirming journey is hormone replacement therapy with estradiol, which is offered in the form of pills, a patch or an injection. Nabi started estradiol in December. She calls the drug “FemThron3000.” It’s an apt name. Estradiol, an estrogen steroid hormone, is often paired with androgen blockers to specifically block testosterone. Using it leads to breast devel- opment, skin softening and improvement of mood in trans girls. Trans boys receive testosterone, most often by injection, which results in a deeper voice and the development of facial and body hair. Think of it as guiding puberty in the right direction. Without that treatment, trans kids barrel the wrong way down the hormonal highway. They become unwilling passengers in their own bodies, the mental effects of which are scary for them and their parents. “It’s heartbreaking to hear your kid sob herself to sleep at night because her insides don’t match her outsides,” Melissa Button said of her daughter. “The thing she fears most is growing into a man.” What comes next? Hormone replacement therapy can be a literal lifesaver for trans kids. Trans kids are four times more likely to commit suicide than their cis counterparts, according to a National Institute of Health study. A study published by the medical journal Cureus showed that more than 73% of trans participants reported a history of suicidal ideation. Yet for those who had received gender-affirming care, that percentage dropped to 43%. When access is cut off, by Trump or by providers like PCH who are cowed into not offering it, a corresponding spike in depression and suicide rates among trans youth is sadly to be expected. “Stopping care is going to kill people,” Kravitz said. “I truly believe that it’s going to kill kids.” Here’s what happens to a trans kid forced to stop puberty blockers or hormone replacement therapy. A trans girl forced to stop blockers would go through male puberty — her voice would deepen, her body and facial structure would undergo changes and she’d develop body hair. Trans boys would begin to develop breasts and would menstruate, which Kravitz said are “two of the most distressing things to trans guys.” Their vocal deepening and facial hair develop- ment would also stop. PCH said it would work with pharma- cists to wean children off puberty blockers or hormones if they are currently taking them, according to the publication LOOKOUT. But these physical changes can be “very distressing” for trans youth, Kravitz said. What’s more worrisome, Leach said, is the negative mental health effects that come with ending gender- affirming care. What happens in gym class to the trans girl — who has identified as a girl since preschool — who gradually starts to present as male? What barbs and bullying can she expect from her fellow teenagers? What about the trans boy who is forced to start wearing a bra or uncomfortable binders to flatten his chest? Will the noto- riously cutthroat halls of middle and high school offer him kindness and understanding? Trans youth are already in the midst of a mental health crisis. The Trevor Project, a suicide prevention and crisis intervention organization for LGBTQ+ youth, saw a 46% increase in demand for its crisis services after Trump’s inauguration. After Trump’s win in November, the volume of crisis lines increased by 700%. On the day after Trump was elected, Nabi stayed home from school depressed. Another parent — Tempe resident Karen, whose last name Phoenix New Times is withholding to protect her child’s identity — said her 14-year-old trans son cried when he heard the news. Even before the election, some parents with trans kids started to speed up care. At the direction of PCH providers, Nabi’s final counseling session before she could start receiving hormone replacement therapy was moved up to Nov. 5 — Election Day. Karen said her 14-year-old trans son successfully sought to speed his testos- terone regimen to ensure he received treatment before Trump took office. Trump’s broadside against gender- affirming care now leaves trans kids and parents scrambling to figure out what to do. Even after Nabi started taking estradiol pills, Putnam frantically researched alter- native clinics leading up to Trump’s inau- guration. Many families whose children received gender-affirming care at PCH are counting their remaining pills, praying their next prescription goes through and researching backup providers. Nabi still has an estrogen prescription, which Putnam hopes remains valid. But her final puberty blocker, which was supposed to act as a bridge between puberty suppres- sion and hormone replacement therapy, is being interrupted. Since COVID-19, Nabi hasn’t stopped wearing a mask every day to hide any male features that burst through. Putnam said attendance at Arizona Trans Youth & Parent Organization meet- ings has skyrocketed since Trump issued his executive order, and the atmosphere is fraught. These are not “happy meetings,” Putnam said. “People are freaking out.” So is Melissa Button, who isn’t sure where to turn for Dempsey. With the largest provider of gender-affirming care out of the game, Melissa feels a “tremendous amount of fear.” To protect her son’s mental health, Karen still hasn’t told her son that PCH has stopped providing gender-affirming care. Since taking testosterone prescribed by PCH, her son has developed a little mustache and a deeper voice, changes she hopes will last. He’s stocked with testos- terone to be “good for quite a while,” but Karen worries he’ll be unable to continue getting the medication to suppress his period. Just getting to this point was not easy, Karen said. “My husband had a harder time than I did. It took him a good several weeks to get himself together,” she said. “He went through what some parents go through when the kid comes out as trans, kind of a grieving period for his little girl.” But now they are united in doing whatever they can to help their son. If that help isn’t available in Arizona, Karen said her family may have to trek to and from California for his care. They’ve even considered leaving the country, relo- cating to some other nation whose leaders haven’t decided to persecute transgender people for cheap political points. In Arizona, Karen and others worry — and increasingly in the U.S. as a whole — their children are not allowed. Melissa Button and her two daughters, Bailey (left) and Dempsey (right), pose in front of Phoenix Children’s Hospital on Feb. 18. (Morgan Fischer) Jezz Putnam and their 13-year-old daughter, Nabi, pose in the gallery of the Arizona House of Representatives. (Courtesy of Jezz Putnam) Turned Away from p 12 >> p 17
