On March 2, Tennessee Gov. Bill Lee kept his promise to sign SB1, a controversial bill effectively banning access to gender-affirming care for trans minors. Since last November, Republican lawmakers have proposed over 20 bills targeting LGBTQ2S+ Tennesseans, specifically, the accessibility of gender-affirming healthcare for trans youth.
The most extreme bill is also the most far-reaching and dangerous. SB1, a bill sponsored by Republican State Sen. Jack Johnson (District 27-Williamson County), not only bans trans youth under age 18 from accessing puberty blockers, hormone replacement therapy (HRT) and gender-reassignment surgery, but also carries numerous legal implications. This includes, but is not limited to allowing courts to impose a USD $25,000 penalty per offence while granting the state attorney general authority to bring action against a healthcare provider who performs a gender-affirming procedure within 20 years of the violation.
The bill would also ban the use of telehealth and force all trans minors currently undergoing treatment to stop by March 2024. SB1 overwhelmingly passed the Republican-controlled house and senate in February, and now that the bill has been signed by Gov. Bill Lee, it will be enshrined into law on July 1.
While drafting SB1 and other anti-LGBTQ2S+ legislation, Tennessee lawmakers have consistently defied the recommendations of every major medical association despite the scientific and medical consensus that trans healthcare is safe and saves lives.
“There is strong consensus among the most prominent medical organizations worldwide that evidence-based, gender-affirming care for transgender children and adolescents is medically necessary and appropriate. It can even be life-saving,” writes Moira Szilagyi, MD, PhD, FAAP, 2023 immediate past president of the American Academy of Pediatrics on the AAP Voices Blog.
An earlier version of the bill sought to ban gender-affirming care for trans youth and criminalize any violations as “child abuse.” Although removed in the current version, it still had a chilling effect on the parents of Tennessee trans youth who otherwise might have spoken publicly in opposition of the law.
Heather Thomas, a Nashville resident, and mother of a 23-year-old trans son, is the exception.
“This law is about bigotry. It just doesn’t make sense,” Thomas tells Xtra. “They’re not following science. They’re not following all of the statistics. The person that wrote the bill is my [state] senator in my district. I met with him twice prior, and what he told me the first time I met with him is not what he did,” she says.
Thomas testified before the Tennessee Senate Health and Welfare Committee in opposition to SB1 in early February. She described her once-outgoing child whose gender dysphoria resulted in debilitating anxiety, depression and suicidal ideation.
“Every morning, I’d pray that when I opened the bedroom door, he’d be alive,” she says. “We could have lost him easily. And fortunately, we didn’t. We tried to give him all the care we could—therapy and antidepressants, but it just didn’t work.”
For trans youth, having access to gender-affirming care is a matter of life or death. Yet Republican lawmakers continue to ignore the science in favour of misinformation and debunked talking points.
Thomas says if she and her husband had known the benefits of providing gender-affirming care early for their trans son, she’s sure his experience with gender dysphoria throughout primary school would have been less life-threatening. Thomas tells Xtra that she fears for other Tennessee trans youth whose access to gender-affirming care is no longer an option under the new law.
“The really cruel part of this law is that kids already on hormones or blockers will have to come off,” Thomas says. “So they’re already in their transition. They’re happy, healthy kids. And now they will have to go backward, and parents are petrified. Why hormones now? Why blockers now? Because they may not make it to adulthood.”
The stakes are high
Olivia Blake, 31, a Nashville resident native and founding board member of the LGBTQ2S+ non-profit Inclusion Tennessee, is a divorced mother of three who came out as a trans woman in 2021. Blake says the fear she and other trans people are experiencing in Tennessee due to the proposed anti-LGBTQ2S+ legislation cannot be understated.
“The level of fear is palpable,” Blake says. “There’s a constant conversation around, ‘Are you gonna stay?’ ‘Are you gonna go?’ ‘How will we get our hormones if we can’t get them from the clinics?’ For some of us working through getting surgeries scheduled, there’s a fear around—‘Am I going to be able to do that here in this way that I’d planned?’ There’s all this uncertainty and fear.”
Vanderbilt University Medical Center, one of a few healthcare facilities in the Nashville area where trans people can receive gender-affirming care, had its website temporarily forced offline last September after being targeted by an extremist far-right campaign. And after angry protests and Republican demands, Vanderbilt paused trans-related surgeries on Oct. 7.
Blake says the pending legislation, and growing anti-LGBTQ2S+ bias from Tennessee politicians has consumed her life.
“I don’t think people understand the stakes,” she says. “Rights are being taken away, and it won’t just stop with trans people.”
“There’s an intense amount of cruelty coming from our state legislature in a capacity that is not civil in any way,” says phil cobucci, executive director of Inclusion Tennessee.
“Imagine how it feels being a young person here in the South, and you hear legislators who are supposed to be caring for you, and or at least writing legislation to protect you, and all they’re doing is diminishing you, acting cruel and trying to take away from your existence,” he says.
Dozens of bills targeting trans individuals were filed in the Tennessee legislature almost immediately after the November 2022 election. The bills, which Tennessee Equality Project, a leading advocacy organization working to advance LGBTQ2S+ equality, has labelled as the state’s “Slate of Hate 2023,” aim to restrict everything from access to gender-affirming care for minors (SB1) to preventing teachers from being required to use a student’s pronoun if the pronoun is not consistent with the student’s biological sex (SB466) to the restriction of drag performances in public spaces if a minor is present (SB3).
Blake says one of the harmful messages conservative politicians in Tennessee and across the country continue to propagate is the false belief that trans people are a danger to children.
“I’m a prime example of someone for whom it’s actually made me a better parent to present in the way that feels natural to me,” she says. “People living in their truth is good for children because it alleviates all those issues. It’s made my children’s lives better.”
As quickly as she found joy in the truth about her identity as a trans woman, Blake says grief also enveloped her as she and other trans Tennesseeans became the target of relentless legislative attacks.
“This life I had been building on the other side of the closet now just seems out of reach or at least unknown,” she says. “It’s cruel from a party that says they’re pro-life, pro-children, pro-family, to have this smashed down. It is just cruel.”
Moral judgments and exit strategies
“I’ve lived here my entire life, and this is probably the most I have felt unwanted in my own state,” says Ray Holloman, 32, chair of the Tennessee Transgender Task Force (TTTF), a non-profit organization focused on reducing new HIV acquisitions among trans people.
A Black trans man, Holloman transitioned at age 26 after struggling for years without the language, resources or gender-affirming care to treat his gender dysphoria.
“If I had known what it meant to be trans when I was 10 or 15, I wouldn’t have spent so many years hating myself and being suicidal,” Holloman says. “I was miserable for 26 years of my life. In the last seven years, I’ve really regained a lot of my life back.”
Until January, TTTF was listed as a Tennessee Department of Health (TDH)–affiliated group and received financial support from a grant from the CDC. But shortly after an article referencing the organization was posted on extremist media, TDH announced it was revoking funding due to TTTF’s alleged focus on “gender-affirming treatment, abortion and other extreme gender ideologies.”
Far-right conservative activist Matt Walsh and fellow activist Landon Starbuck have been instrumental in fuelling anti-trans bigotry nationwide and in heated public exchanges with Democratic lawmakers in Tennessee. They have hijacked the proven medical necessity of gender-affirming care, renaming it “child mutilation.”
Holloman says politicians should listen less to extremists who are not medical care experts, but have made a career of targeting LGBTQ2S+ people. Holloman wants lawmakers to listen to trans children and their parents and continue allowing them to make personal medical decisions.
“A 16-year-old can’t get any medical treatment without their parent’s consent,” Holloman says. “So, if a family has made a decision, then why are we taking that decision away from families? This is life or death for a lot of them. We wouldn’t withhold cancer treatments from a child until they’re 18. Minors can get liposuction. They can get a nose job. We don’t regulate any of that body modification.”
According to a 2020 Plastic Surgery Statistics Report, 13 percent (44,686) of total rhinoplasties performed that year were on minors between the ages of 13 and 19. Ear, eyelid, cheek implants and breast augmentation surgeries were also popular among this age group.
“What would it be like if we ascribed the same moral judgments around someone’s hip replacement? It seems so silly, right? Well, this is the same thing,” Blake says. “It improves quality of life and your ability to exist in the world how you want. It carries risk like any intervention, but those risks are medically appropriate.”
Now that SB1 has been signed into law, it remains to be seen if Blake, Holloman and other trans Tennesseans will be forced to relocate to a more progressive state to access life-saving care. Because of the increasingly intolerant environment for trans people in Tennessee, Thomas says her son is leaving Nashville.
“I know where he’s going will be a place that’s affirming and happy for him,” Thomas says. “But why should anyone be chased out of their state? He was born here. He’s lived here his entire life. I don’t believe that our state as a whole feels this way, but when people don’t pay attention and they just vote party line—this is what you get.”