On March 29, 2023, the Kentucky legislature passed a law banning gender-affirming medical care for transgender youth, restricting the bathrooms trans students can use in school and forbidding conversations around sexual and gender identity in all grades, among other sections.
The next day, Ray Loux, 16, says he felt paralyzed.
“I woke up that morning, and I could not make myself go to school,” Loux, a trans high school student living in Kentucky, tells TODAY.com.
“It’s scary to think that we could make so much progress and then literally over night have it taken away.”
Before Loux was allowed to use school bathrooms that align with his gender, he says his days were saturated with near-constant fear. Instead of focusing on his studies, he would spend his time identifying the safest bathrooms to use and doing “mental math” to figure out what time of the day the restrooms were most likely to be empty.
“I would purposefully not drink water in the mornings,” Loux adds. “I ended up having health issues.”
Now, Loux says those days of fear, anxiety and physical discomfort have returned, as a result of his home state's new law.
“I have not been able to think about anything else,” Loux says. “It’s affected my grades. It’s been a drain on my mental health."
“I wish that we could just be kids and go back to how it was a few months ago when I was literally doing better than I ever have in my entire life,” he adds. “That’s gone now.”
The mental health impact of legislation targeting trans youth
Dr. Angela Kade Goepferd, the chief education officer and medical director of the gender health program at Children’s Minnesota, says Loux is not alone in his fears and anxieties over bans on gender-affirming medical care and access to gender-affirming bathrooms.
She tells TODAY.com that "every day (she's) in clinic with patients ... nearly every family" asks her questions about the potential impact of anti-trans legislation on their child's medical care.
"It's a real conversation, and we've received frantic phone calls from parents in surrounding states where bans on care have already gone into effect," Goepferd, who has been providing gender-affirming care for 17 years, adds. "They're desperate to access care for their teenagers because we know that mental health outcomes are worse for kids who don't have access to care."
Multiple studies have shown that gender-affirming medical care and social environments improve trans teens’ mental health and lead to a decrease in suicidal ideation, depression and anxiety.
A 2020 study in the journal Pediatrics found that receiving gender-affirming care earlier in life reduces the rate of depression and anxiety among transgender kids. A 2022 investigation found that access to gender-affirming care reduced the risk of suicidality in trans youth by 73%. A 2021 study found that acceptance from peers and adults reduced the likelihood of trans youth attempting suicide.
And more recent research from the Trevor Project, a nonprofit focused on LGBTQ+ youth suicide prevention, found that nearly one in three LGBTQ+ young people say their mental health is poor “most of the time or always” as a result of anti-LGBTQ+ legislation. The national survey included 28,000 LGBTQ+ people ages 13 to 24.
The same survey found that nearly two in three LGBTQ+ young people say that hearing about laws banning discussion of LGBTQ+ issues, history or people in school — like Florida’s Parental Rights in Education, aka “Don’t Say Gay,” law — harmed their mental health.
So far in the 2023 legislative session, 474 anti-LBTQ bills have been proposed in 46 states, according to the American Civil Liberties Union. At least 45 anti-LBGTQ laws have been passed in the U.S. this year, according to the Human Rights Campaign.
“We know that these anti-LGBTQ policies and debates are negatively impacting LGBTQ+ young people’s mental health,” Ronita Nath, Ph.D., vice president of research at the Trevor Project, tells TODAY.com.
“There’s a glimmer of hope, in that we found laws that protect LGBTQ young people, like one recently signed in Minnesota that banned the dangerous and discredited practice of conversion therapy, serve as a source of hope for LGBTQ young people,” Nath adds. (In 2019, the American Medical Association, the nation's leading physicians group, backed a nationwide ban on conversion therapy, writing in a statement to NBC News at the time, “It is clear to the AMA that the conversion therapy needs to end in the United States given the risk of deliberate harm to LGBTQ people.")
Kentucky lawmakers in favor of the new law have said its goal is to protect children and prevent regret later in life from receiving gender-affirming care.
“Our job is to protect children, and that’s what we’re doing here," Republican House Speaker Pro Tempore David Meade said when presenting the bill in committee. “Surgery or drugs that completely alter their life and alter their body is not something we should be allowing until they are adults."
The Kentucky law specifically bans providing surgery, hormones or puberty blockers to trans people under 18. But the Trevor Project survey found this type of gender-affirming care for trans youth isn't the norm: 11% of trans and nonbinary youth reported being on gender-affirming hormones, and 2% reported taking puberty blockers. And most gender-affirming surgery doesn't happen until after age 18, Dr. Juanita Kay Hodax, co-director of the Gender Clinic at Seattle Children’s, previously told TODAY.com.
What's more, research shows regret in trans people after receiving gender-affirming care is rare and less common than it is with other medical or surgical interventions, per the World Professional Association for Transgender Health. After receiving gender-affirming care, trans people have a 98% likelihood of continuing with it, the association said.
"There is a wide range of ways to treat youth who are transgender, and oftentimes we actually don't use medications at all. We treat them with social affirmation," Dr. Natasha Bhuyan, a family physician and national medical director at One Medical who has been practicing gender-affirming care for 10 years, tells TODAY.com.
"We support them in their journey to use their preferred pronouns, their preferred name, and we address them in a way that they're comfortable with," Bhuyan adds. "They present and dress in ways that are comfortable. That's actually a lot of what we do in gender-affirming care." The Kentucky law does not explicitly ban this type of care.
Every major medical association in the U.S., including the American Academy of Pediatrics, the Endocrine Society, the American Medical Association, the American Psychiatric Association and the American Academy of Child and Adolescent Psychiatry, supports access to gender-affirming care for trans youth.
Bhuyan says that, as a practicing physician, she sees trans youth like Loux in her office every day — voicing concern, fear, anxiety and depression over the number of anti-trans bills being introduced and passed into law across the country.
"They're living in more fear," Bhuyan says. "My patients are reporting that it's increasing their stress and anxiety levels, and it's something they don't want to think about."
The impact of gender-affirming spaces and health care
Loux, who lives with his mom, younger sibling and two friends, says he knew he was trans at 12 years old.
"I had always imagined or daydreamed about what life would be like if I would have been a boy when I was born," Loux says. "Then one day it clicked: 'Oh, maybe I am actually transgender.' It all made sense."
Before coming out, Loux says he experienced near-constant panic attacks starting at age 8. He was also “deeply uncomfortable with puberty and the thought of looking towards the future.”
“I was suicidal for a little bit just because I was unhappy with myself, and I couldn’t figure out why,” he says. “I remember having to do these exercises in school where we wrote out our goals and where we would be 20 years from now, and I was freaking out because I couldn’t see a world where I would be happy."
After coming out, Loux says he was surrounded by support from friends, teachers and his mom, who "is amazing."
“It was so nice to be able to point at myself in the mirror and say: ‘OK, this is who I am,’” Loux continues. “To be able to look towards the future with hope instead of fear and see a future for myself — that feeling was incredible.”
Loux says his mom has been supportive, but she's also fearful.
"My mom was actually scared when I came out because she knew about the higher rates of assault against trans people and she wanted to protect me from that," he says. "Then she realized that the best way of protecting me was allowing me to be who I am."
Transgender people are more than four times more likely to be victims of violent crime than cisgender people, a 2021 study from Williams Institute at UCLA School of Law found.
Now, Loux plans on being a neuroscientist, following in his mom’s footsteps.
“When kids are supported in school, when their name and pronouns are used and when they have access to the bathroom that aligns with their identities, the stress and anxiety associated with those things goes away, and they can focus on learning,” Goepferd says.
While Loux says he is once again afraid for his safety, he says he's steadfast in his authentic identity and determined to remain in Kentucky to fight the policies he feels are harming his community.
"There are queer kids born every day in Kentucky, and if all of the decent people in the state leave just because the state made a few bad choices, then where does that leave us?" he asks.
"I love Kentucky. It’s my home. It’s where I grew up and where I’ve made my closest friends, and I love Kentuckians," Loux adds. "I still need to be here for my family and for my state."