Publisher Health

FAYETTEVILLE, Ark. — For years, Zara Banks had been looking forward to her 14th birthday — the moment, last June, when her life would no longer be on pause.

Ever since Zara, a transgender girl, was 8, she has been certain she wanted to grow up to be a woman. After conversations with her parents and sessions with a therapist, she began transitioning socially: changing her name to Zara and pronouns to she/her. When she turned 9, she began treatment with puberty blockers, drugs that would place her physiological development in limbo until she was old enough — 14 according to her doctor — to begin estrogen therapy and develop a feminine body.

But last spring Arkansas enacted a law, the first of its kind in the nation, barring physicians from administering hormones or puberty blockers to transgender people younger than 18. The bill, called the Save Adolescents from Experimentation (SAFE) Act, overrode a veto by Gov. Asa Hutchinson and was to go into effect on July 28, about a month after Zara’s birthday. It is now on pause because of a legal challenge from the American Civil Liberties Union.

Zara has been able to get hormones while the court case proceeds, but worries about what the future holds. “I was just really happy, after finally waiting so long, to get something that I’ve needed for a very long time,” she said, sitting in her suburban backyard with her parents, Jasmine and Mo Banks, amid buzzing cicadas.

In recent years a growing number of American teenagers have come out as transgender and sought medical care to better align their bodies with their gender identities. Even as the medical community grapples with how best to provide such care, states across the country have introduced legislation banning it outright; medical groups have condemned these laws as dangerous.

Leading medical associations, including the Endocrine Society and the American Academy of Pediatrics, recommend that such care be made available to patients under 18. Still, clinicians remain divided over best practices. Last month an international group of experts focused on transgender health released a draft of new care guidelines recommending a more cautious stance on minors, who typically cannot give full legal consent until they are 18.

Puberty blockers and hormone therapy, the two treatments primarily given to minors, are most effective around the ages of 8 to 14, as they can prevent the need for future surgeries in adulthood; for example, a transgender boy who took puberty blockers might not need a mastectomy later. There are risks to the drug therapies, including slowed bone growth and fertility loss, but evidence suggests that denying the care to adolescents who need it raises the risk of depression and suicide.

The push to outlaw such care altogether gained momentum last year as Republicans across the country adopted the issue. Arkansas and Tennessee are the only states that have passed such laws — Tennessee banned gender-affirming care for children who have yet to reach puberty, a population that does not currently receive such care — and 19 more states have considered them, according to the Williams Institute at the U.C.L.A. School of Law.

If upheld, the Arkansas law would also prohibit doctors from referring patients to other medical professionals for drugs or surgeries in gender-affirming care, even out of state. Any physicians who provided such care could lose their licenses or be subject to civil litigation. The law would also allow private insurers to refuse coverage of such care to transgender patients of all ages.

A week before the law was to go into effect, however, it was temporarily blocked by a federal judge in response to the A.C.L.U.’s legal challenge. The trial is set for July. Transgender adolescents and their families are now living with uncertainty.

“It’s pretty excruciating as a parent to be told by the state that it will become illegal to give your child what she needs to exist,” Jasmine Banks said.

Zara added, “It’s not, like, other people’s decision who I am and what I’m not.”

A year on the defense

Sabrina Jennen, 16, who lives in Fayetteville, has been thinking about ghosts — whether they exist, and what it would be like to encounter one.

“People are much scarier than ghosts,” she said on a gusty day in Gulley Park, a sloping green space near her neighborhood.

Transgender teenagers are generally prescribed gender-affirming hormones after they have gone through mental health assessments and displayed persistent distress from the gap between their bodies and their gender identities.

Sabrina came out to her family in July 2020 at age 15. She saw a therapist, received a diagnosis of gender dysphoria and had many conversations with her parents, Lacey and Aaron Jennen. By last January, she felt ready to start hormone therapy. Then the SAFE Act was passed.

“It felt like my life was being signed away,” Sabrina said. She stayed awake at night imagining her future. “If it went into place, it would truly be the death of Sabrina,” she said. “I wouldn’t be able to live and be myself.”

When the bill passed, her parents asked if she wanted to be a plaintiff in the A.C.L.U. lawsuit. She did. “If it’s not me, it’s going to be someone else,” she said. “And if it’s not someone else, it’s going to be nobody.”

In March 2021, Representative Robin Lundstrum, a sponsor of the bill, compared gender-affirming surgery to “mutilation” in a committee hearing on the bill. Representative Alan Clark, another of the bill’s sponsors, described hormone therapies as “experimental.” (Ms. Lundstrum and Mr. Clark did not respond to numerous interview requests.)

(The latest suggested standards of care recommend 15 as the minimum age for chest surgery and 17 for genital surgery, with each patient’s case considered individually. No doctors in Arkansas currently perform any gender-affirming surgery on minors.)

Dylan Brandt, 16, from Greenwood, is another plaintiff. He and his mother, Joanna Brandt, were in the State House during a hearing on the bill.

“It was hard to listen to because they were saying awful things again about me and so many other people,” he said.

Dr. Michele Hutchison, a pediatric endocrinologist who treats transgender adolescents in Arkansas, was one of several medical experts who testified in opposition to the bill. She told legislators that several of her young patients had attempted suicide after learning of the bill.

Ms. Brandt, who also spoke at the hearing, called the experience “heartbreaking.” Dylan stood behind her; as she testified, Ms. Lundstrum approached and began talking to him, he said.

“She looked me in the eye and shook my hand, and then 10 minutes later got the House to vote to take my rights away,” Dylan said. “We’re kids just trying to live our lives, and they’re trying to make it harder, and I don’t quite understand it.”

Gradually getting better

Last spring, the Rev. Clint Schnekloth, the pastor at Good Shepherd Lutheran Church in Fayetteville, began hearing from young members of the congregation who were fearful of what the SAFE Act might bring. Several parents of gender nonconforming children reached out.

“One of the families said, ‘My child is having suicidal ideation that’s coming out of the anxiety around these laws,’” Pastor Schnekloth said. “So I thought, what can we do?”

He started Queer Camp, hosting 86 children for a week in July. It offered camp activities involving birds, bugs and sports, as well as a name-changing clinic and“transition closet,” where children could donate clothes that no longer fit their gender presentation and pick new outfits, said Conner Newsome Doyle, the camp’s director.

Sabrina, who attended the camp, picked a black prom dress from the closet. She recalled that the camp was the first time she had been surrounded by queer and transgender people her own age. “It definitely felt safe,” she said.

In school in Greenwood, Dylan said he experienced so much bullying that he finally left and spent several years being home-schooled. Last fall, he returned with great anxiety.

“I walked into the building for the open house and I just felt like I couldn’t breathe,” he said.

But things were different this time. One day in art class, he recalled, a classmate said something transphobic to him, and a girl in the back of the class intervened. “I don’t know who she is, but she went off on him,” he said.

During Pride weekend last summer in Fayetteville, Zara spoke against the bill in front of hundreds of people at Arkansas’s first Trans March. She practiced her lines at home and in the car ride there. “I just don’t like public speaking normally,” Zara said. “It’s just the fact of, like, the state we’re currently in.”

The trials ahead

Some families in Arkansas have considered leaving the state to ensure their children will have access to gender-affirming health care. Last summer George and Emily Spurrier, who lived in the state for 16 years, moved to New Mexico to make sure their son Cas, 17, would be able to continue hormone therapy. In August, Camille and Homero Rey moved with their young transgender son, Leon, from Texas — which considered, but did not pass, a bill that would have classified gender-affirming care for minors as child abuse — to Maryland.

For other families, moving is not an option.

Zara’s parents grew up in the South and lead a mutual aid organization that distributes funds to people in need in Arkansas, including caregivers and parents of transgender children. “My family doesn’t have a lot of money,” said Mo Banks, who is nonbinary. “We can’t move out of state.”

Zara would like to leave; as a Black transgender girl, she is disproportionately vulnerable to violence and discrimination. When she sees media coverage of transgender teenagers, she sees white children whose experience is fundamentally different from her own. Given how hard those teens fight to be accepted, she wondered, “What hope do we have for Black trans kids?”

She dreams of moving somewhere more accepting after high school. “I know one thing,” she said. “That when I’m able to, I will not be here anymore.”