Ban on trans healthcare drives trans youth out of state (Map)
For some trans teens in Texas, a ban on gender-affirming healthcare means finding a new home
May 31, 2023
ROUND ROCK — Topher Malone was sprinting through her final days of high school: On Friday, she led a Gender-Sexuality Alliance club meeting, then stood before a rapt audience of National Honors Society juniors eager to hear how Malone got in to Harvard.
Malone explained that her application’s strength came from sticking to a common theme throughout. Her essays told her story of queer activism and school leadership.
By every standard, Malone is a model of a successful young woman: She’s a straight-A student and class president at Round Rock Independent School District’s Early College High School, she attends national youth leadership conferences and she’s raised money to support the school group she leads.
Malone is also trans. Malone says having access to gender-affirming treatments before she turned 18 in May allowed her to embrace her true self and channel her energy into her advocacy for LGBTQ+ youth.
“I think she’s put so much effort into finding her identity but also using that to reach out to the community to actually make a difference,” said Julian Jones, one of Malone’s teachers who has known her for almost four years.
But young trans people like Malone who have blossomed with support from teachers, family members and medical professionals will soon be a relic of a bygone era in Texas. Senate Bill 14, which bans transgender youth from accessing puberty blockers and hormone therapy to address mental health issues associated with gender dysphoria, will go into effect in September unless Gov. Greg Abbott reverses his commitment to sign the legislation.
When SB 14 becomes law, Texas will join 18 other states across the country that have restrictions to transition-related care.
The bill’s passage marks the culmination of a yearslong political effort by conservative groups and state leaders that has painted gender-affirming care as “genital mutilation” of children and sought to limit access to such care.
Republicans pushing the legislation say that children have been rushed into gender-affirming treatments as part of a larger “social contagion” that has accompanied greater public visibility of transgender people.
Similar legislation failed to become law two years ago. Since then, Abbott has directed the Department of Family and Protective Services to investigate parents of trans youth, and some families fled the state. When Attorney General Ken Paxton announced in early May that he was investigating Dell Children’s Medical Center in Austin for providing gender-affirming care, patients of the clinic that provided that care lost access to their physicians.
Now the Legislature will prohibit physicians from administering the treatments to trans youth younger than 18, even though the state’s medical associations have said the available medical studies have shown such treatments are effective at treating mental health problems caused by gender dysphoria, a medical term for the distress someone experiences when their gender identity doesn’t match their body.
Under the new law, physicians who provide puberty blockers or hormone therapies to trans youth would lose their medical license.
I’m absolutely ecstatic to leave and go to a state where everyone actually cares about me and cares about my identity as a trans person ... A lot of the queer people I know, they want to escape as quickly as possible.
— Topher Malone
“It’s not a one-size-fits-all approach,” Texas Pediatric Society president Louis Appel told The Texas Tribune. “These are complicated issues that really are best dealt with in the context of the physician-patient-family relationship.”
For Malone, it’s not a political topic — it’s deeply personal. She said the animosity in her home state is driving her out.
“I’m absolutely ecstatic to leave and go to a state where everyone actually cares about me and cares about my identity as a trans person,” she said. “A lot of the queer people I know, they want to escape as quickly as possible.”
She plans to continue organizing and doing nonprofit work related to the LGBTQ+ population in Massachusetts, which is regarded as a refuge state for the trans community.
Malone said leaving the state is bittersweet because she believes Texans need to hear the voices of young Black trans people like herself.
“It does feel just a little bit like I’m kind of having to abandon everyone for my own good,” she said.
“I can’t stand it anymore”
In late March, after waiting more than 15 hours at the state Capitol with her mom, Malone got her turn to testify to a House committee against House Bill 1686, SB 14’s companion bill.
Malone told the lawmakers that she’d applied to colleges in Texas. But as soon as she received an offer from a college outside of Texas — Columbia University in New York, which came before her acceptance to Harvard — she had decided to leave the state.
“I don’t want to stay here for college anymore because of what this state government is doing to trans people like me, and I can’t stand it anymore,” Malone told the committee members.
“I’ve never had to go out and testify about why I deserve to live to legislators,” she said later.
The last major debate over SB 14 took place in the Texas House, where Democrats proposed 17 amendments to soften the bill’s impacts on LGBTQ+ youth. One proposed creating a state-run commission to study the suicide rate of children impacted by bill. Another would have required families to get two different physicians and two mental health professionals to diagnose their child with severe gender dysphoria before starting gender-affirming treatments.
All of those efforts failed.
“I hate that we didn’t have a legitimate public policy debate,” said state Rep. Ann Johnson, D-Houston, who proposed the amendment requiring multiple doctors to sign off on care. Johnson said she’d talked to families of trans youth, who agreed that creating significant barriers to getting care was better than eliminating it altogether.
State Rep. Tom Oliverson, the Cypress Republican who co-authored the legislation, said there wasn’t high-quality evidence to support the use of puberty blockers or hormone therapies for trans youth and insisted there was not a consensus in the medical community on this type of treatment.
“At the end of the day, the science is so inconsistent and of such low quality that I do not have confidence in these doctors’ ability to accurately diagnose serious gender dysphoria,” Oliverson said in opposing one of Johnson’s amendments.
Listening to the debate, Malone observed that the lawmakers seemed to pay a lot of attention to testimony from adults who “detransitioned” — those who transitioned away from their sex assigned at birth and then reversed that decision — and that most of them were from outside Texas.
One of them, Prisha Mosley, shared her experience about the lack of support from medical professionals after she detransitioned. She has testified in at least five other states as they considered similar legislation.
“They immediately decide that they’re going to negate the entirety of the 99% of people who transition,” Malone said of those who detransitioned and testified against the type of treatments she’s taking. “It goes back to that erasure, you’re erasing the experiences of people who have happily transitioned.”
That’s where the bottom line is: After this legislation, more people will die.
— Michael Stefanowicz
The debate over the legislation alone could negatively affect the mental health of LGBTQ+ youth, according a January report from the Trevor Project, a national LGBTQ+ youth suicide prevention organization. The report found that 86% of transgender youth reported mental health repercussions from the public debate and passage of bills like SB 14.
“It will definitely result in a growing and more concerning mental health crisis among trans and queer youth in the state,” said Landon Richie, a trans man and policy associate with the Transgender Education Network of Texas. “It’s robbing these young trans people the ability and opportunity to exist fully as themselves.”
Michael Stefanowicz, an Austin family doctor who has provided gender-affirming care to children and adults, said the bill’s passage will have life-altering consequences for trans youth.
Gender dysphoria that goes untreated, Stefanowicz said, can lead to suicide contemplation and suicide attempts, higher levels of substance abuse, high-risk sexual activities and homelessness.
“That’s where the bottom line is: After this legislation, more people will die,” Stefanowicz said.
Transitioning in high school
A few weeks after Malone testified to the House committee, she and some friends went shopping at Savers, a thrift store chain. She wore a shirt that read “Rise Up 2022,” a memento from her LGBTQ+ leadership conferences. She and her friends hunted for a perfect prom dress among rickety thrift store shopping carts and flickering fluorescents.
Malone said it was a relief to do something as simple as thrifting, something that made her feel affirmed in her gender, surrounded by supportive friends.
“We’re having fun,” she said. “We’re looking at different clothes. We’re finding things that just make us feel pretty.”
Malone was raised as a boy until the beginning of her junior year of high school, when she came out to her parents. Malone said it took her family some time to get accustomed to her new identity. When she began wearing women’s clothing, she said it immediately made her feel more confident and beautiful instead of unattractive and out of place.
After more than a year of socially transitioning beginning when she was 16, Malone eventually graduated from girls’ pants and shirts to skirts and dresses. It wasn’t a seamless process at school, but Malone said she never encountered outright bullying from her peers.
“It took a while, I guess, for everyone at my school to get used to the fact that I was trans now,” Malone said, using air quotes around “trans now.”
Malone and her family came to the decision to start hormone treatments in January, when she was 17.
The physical changes associated with feminizing hormone therapy, such as reduced facial and body hair and breast tissue development, take months to begin and years to complete, according to the Mayo Clinic.
Malone said she picked January to start the treatments because she wanted to begin her next chapter feeling comfortable in her body by the time school started in August, “so I can be all of what I want to be when I step on campus.”
At the same time, she began to feel that Topher didn’t feel representative of how she felt inside — feminine and Black — so she recently started using the name Safara, the word for “fire” in the Wolof language of western Africa. Malone used Topher for identification when sharing her experiences with the Tribune and agreed to use the name in this story, though she now goes by Safara.
From quiet freshman to class president
Jones, Malone’s teacher, said he met Malone when she was a student in his world geography class roughly four years ago. He said she seemed like another quiet freshman.
Since then, Malone has transformed into a vocal student leader who has earned the respect of her classmates at Early College High School, Jones said.
Malone said her high school experience shifted dramatically before and after she transitioned.
“Being closeted, I didn’t really have a lot of friends, I kinda was like a shell of a person, I didn’t really have a personality,” she said. “And that was sort of for the first year and a half of my high school.”
But when she began her junior year as a fully out trans teen, she developed new friendships. “That was amazing, because it means that they knew me as [girl] Topher,” she said.
Jones said students at the school are determined young people who forgo extracurricular activities like athletics or theater so they can earn college credits by attending classes at Austin Community College.
And Malone has become one of the leaders at school, serving as the president of the Gender-Sexuality Alliance and vice president of the Black student union. Students see her as a role model and someone who will advocate on their behalf, Jones said, which has shifted the entire school culture as it relates to LGBTQ+ people.
“The community just comes together at our school and we were so supportive of each other,” Jones said. The students in the GSA “end up being some of the happiest kids on campus,” he added.
Malone said goodbye to high school last Friday at graduation, when she received both a diploma and an associate degree from Austin Community College. The class of 2023 gathered in the auditorium, fussing with the tassels on their hats, each holding their diploma in hand.
All that was left was closing remarks from Malone, the class president.
She approached the podium in her graduate’s robe, with a rainbow of colored cords on her shoulders, one for each of her half-dozen extracurricular activities.
She told her classmates that each of them have the power to make revolutions by marching to the Capitol, meeting with politicians and taking leadership roles in their communities.
“We have the power to change our living history,” Malone told her classmates. “The question is, how?”
She ended her speech to a standing ovation.