Editor's Note: On June 18th, the Supreme Court ruled to uphold Tennessee's gender-affirming care ban in U.S. v. Skrmetti. Read more on what this means for trans youth and their families here.
Eleven days before the state of Missouri ended health care for young people with gender dysphoria, then-15-year-old Kai came out to her parents as transgender. Kai's mom, Esther, tells Teen Vogue that when she went to check on her new daughter before bed that night, it was the first time she’d seen her child truly happy.
A highly significant Supreme Court decision is approaching, and the lives of trans teens and their families hang in the balance. United States vs. Skrmetti will decide, once and for all, whether state bans on gender-affirming treatments are constitutional. If the court sides with Tennessee, its ban and other similar laws will remain in place. Nationally, access to gender-affirming care has also been threatened by a presidential executive order and the Republican-dominated Congress, but these efforts have thus far fallen short of a full ban.
Advocates say that safety and stability for trans youth and their families are at stake in the Skrmetti case. If the conservative-leaning Court upholds state care bans, loving families fear that their children could be removed by state child-protective services. (Due to the seriousness of these potential legal threats, this story uses pseudonyms for trans youth and their families in states with bans.)
Why have some families decided to risk everything for these treatments? The answer, families say, is as simple as love. Those Teen Vogue has spoken to describe how decisions to seek gender-affirming treatments sprang from the trust trans youth have placed in their parents — and the drive of parents to do what’s best for the health of their children.
Kai first began questioning her gender identity many years before she told anyone. “I'd say between the ages of seven and 10, I had these recurring thoughts of, What if I was a girl? What if I wore more feminine clothing?” she tells Teen Vogue on a video call. “It really ramped up, the older I got. The older I got, the more frequently I experienced those thoughts.”
Kai’s family members were LGBTQ+ friendly, but she attended a religious private school where she says she encountered negative attitudes toward gender and sexuality. These messages led her to push down all thoughts about gender. As hard as she tried, though, the thoughts wouldn’t leave her.
In the spring of eighth grade, as Kai's body was changing to become more masculine, she found herself actually dreaming of hormone therapy. “I had this dream where I took estrogen, and I was happy. The changes weren't instant, but they were happening, and I was happier for it,” she recalls. “I woke up, and I had to go to work, and I was like, Oh sh*t, I can't run away from this. I'm going to have to confront this head on.”
Kai’s parents say they knew nothing of this inner struggle, but they did see the effects. Kai had meltdowns at school, and in eighth grade, she was discovered while hurting herself in a school bathroom. She was rushed to the emergency room. Afterward, her parents got her on medication and found a new therapist.
For Kai, getting help needed to start with coming out. After revealing her secret to her new therapist, she worked up the courage to ask her parents to talk, with her therapist’s encouragement. Kai, her mother, and father gathered in the parents’ bedroom. “I remember just being stunned and in silence for two minutes," Kai says. "And then something clicks — like, it's going to have to come out. And I'm like, 'Okay, so basically I'm trans, and I've been thinking this for years, and da-da-da-da-da.”
Kai’s parents were stunned in that moment, but they did their best to be supportive. After a group hug on their king-size bed, Esther asked for some time to talk with Kai’s father, saying she’d come by Kai’s bedroom to check on her in a few minutes. It was there, in her daughter’s bedroom — only a few minutes after learning she had a daughter — that Esther saw something she never expected:
“I opened the door, and she was just beaming. She had her headphones in and was just kind of be-bopping and, like, dancing,” Esther recalls. “I'd never seen her smile like that. She'd been suffering with depression, [harming] herself, anxiety for years, and just had this heaviness to her. And it was just gone. There was a lightness.”
This moment of revelation is what opened Esther’s mind to eventually approving medical options for Kai. She did hours of research, spoke with other parents and experts, and had Kai formally assessed. This had to happen outside of their home state, far from the world-class gender clinic at St. Louis Children’s Hospital, which had ceased offering medical options due to Missouri’s gender-affirming care ban for minors.
Despite lengthy travel times for out-of-state treatment, the family persevered, eventually finding a clinic in Illinois to evaluate Kai and prescribe medications to increase estrogen and reduce testosterone levels in her body.
Estrogen and testosterone therapy are just two of the treatments that fall under the umbrella of gender-affirming health care. Healthy human bodies of all sexes make estrogen and testosterone, known as sex hormones, naturally; however, female bodies usually have higher levels of estrogen and male bodies have higher levels of testosterone.
Adjusting those levels to be closer to those of another sex causes changes typical of the puberty of that sex. This includes obvious things like breast growth (with estrogen) or facial hair (with testosterone), but also more subtle changes, like fat distribution, scent, and skin texture.
According to the Trevor Project’s 2022 National Survey on LGBTQ Youth Mental Health, most trans youth come out after turning 13. For those who come out even younger, there are other medication options, which are often referred to as “puberty blockers,” drugs that pause puberty. These reversible medications are used to give younger adolescents more time to explore their gender without the potentially harmful effects of going through what feels like the wrong puberty.
Puberty blockers — which are generally used to address early puberty in children — have been the subject of widespread misinformation that paint the drugs as experimental and dangerous. Families of trans youth, including very supportive ones, aren’t immune to the effects of this propaganda.
Jennifer Harris Dault, who plans to help her 10-year-old trans daughter access puberty blockers when it becomes necessary, absorbed the message that puberty blockers would pose a serious, lifelong change to her child’s bone health. In truth, because bone density increases during puberty, puberty blockers pause those changes. The long-term effects of the drugs on bone density are still being studied; however, bone density has been found to fully rebound for trans boys and mostly rebound for trans girls after they start hormone therapy.
Says Harris Dault, “I remember just being astounded when the doctor was talking through everything that happens and reporting that [a trans girl’s] bone density changes to [be more like] that of a cisgender woman." She remembers asking the doctor, "Wait — isn’t…? Wouldn’t [being similar to a cis girl] be the goal?”
Harris Dault continues, “The more I learned from people whose career was knowing how medications interact with the body, and what their actual purpose is, the less scary things became.”
Although adults (and some teens) also access surgical options to further masculinize or feminize their bodies, it’s a myth that medical transition is primarily accomplished through surgery. A KFF/Washington Post survey published in 2023 found that only 16% of trans adults report having had gender-affirming surgery. But for those with severe gender dysphoria, such procedures can be life-changing.
That’s the case for Reese, a 17-year-old trans boy in Texas, who had chest-masculinization surgery (also known as “top surgery”) as a teenager. Reese is now a thriving junior at a large public high school. When he was 10 years old, though, his family feared they might lose him forever.
Reese came out as a boy to his parents at age nine, but he’d always been highly masculine, insisting on having a boys’ haircut and wearing a boys’ uniform at his elementary school. His parents accepted this was how he was and never tried to force him to be feminine, but they didn't know anything about transgender children.
Thinking back, Reese’s mom, Melanie, says she knew adult trans people took medical steps, but she hadn’t thought it could be an option for a child. “My kid had been telling me all about this sort of thing. You know, talking about top surgery, talking about [testosterone], talking about all these things. I was like, ‘Okay, buddy, sure,’” she remembers. “I hadn't really taken it seriously. I just thought that's something that, like, we'll cross that bridge when we come to it.”
That changed when her 10-year-old confessed to having taken an overdose of over-the-counter medications after getting his period triggered intense gender dysphoria. During the days that followed, Melanie spent hours at Reese’s side in the ER, where she met medical professionals who were both trans-affirming and disaffirming.
The difference, Melanie says, is that the affirming professionals offered her actual solutions: “Someone said, 'Look, great news. It's super easy to not have a period. We have nailed the medicine on that. We've got lots of different methods and ways of accomplishing that.'”
This hopeful attitude stood in stark contrast with a non-affirming provider who suggested long-term psychiatric hospitalization. “The actively transphobic therapist who came through raised the same issue [of Reese’s period]: ‘Look, this is going to be an issue that your kid has to deal with every 30 days, so basically you just need to accept that your kid is going to need to be institutionalized,’” is how Melanie remembers the conversation.
But Melanie wasn't having that. “I just absolutely refused to even countenance the idea that there was nothing that could be done for my kid,” she says.
In youth transition, as in all trans health care, individualized treatment is key. The affirming experts Melanie spoke with didn’t describe a single, one-size-fits-all transition plan; instead, they suggested starting small by stopping Reese’s periods with well-known birth control methods, starting therapy, and waiting to see how he responded.
This slow, careful, individualized practice is the opposite of the rushed process anti-trans activists have often described to justify the care bans that are at the heart of the Supreme Court case.
After stopping Reese's period and a long stretch of therapy, the family eventually decided testosterone was right for him. Each step seemed to help Reese’s mood and adjustment, but his chest continued to be a major source of dysphoria. His mother noticed that he avoided showering, wore multiple binders, and slept with a binder on — even developing skin problems because he never took his binder off.
“I remember that those conversations happened. I remember even saying, ‘I need top surgery,’” Reese says. “And my mom was, obviously, like, ‘No.’ Not because she was unsupportive but because I really was just incredibly young.”
Reese appreciated his family’s support during that time, but he still struggled. “I was very, very depressed,” he says now. “I don't even think I was expressly suicidal, if anything, because I didn't want to hurt my family…. I didn't want that to happen again, not because I wasn't suicidal or depressed again, but because I almost felt like it would be ungrateful.”
After extensive research and consultation with experts, Reese’s parents and doctors decided that the step of chest-masculinization surgery, though very rare for a minor, was necessary due to the severity of his dysphoria, which was presenting a clear risk to his medical and emotional health.
Today, Melanie is incredibly glad they finally went forward with the surgery, but she says the decision to okay the procedure for her child was agonizing. She spoke with multiple experts and read some of the medical literature on chest masculinization. Fears about whether Reese might regret the decision loomed large, but looming even larger, she recalls, were her concerns that his low quality of life was causing him to miss out on being a teenager.
Now 17, Reese is thriving. “I am doing fantastic. I go to a school that I love, I have a bunch of friends, my grades are fantastic. I'm just doing great,” he tells Teen Vogue. “I'm excited, and I'm figuring out what I want to do after high school and into a post-secondary school — all that. But as for the transness," he adds, "it's not a big deal anymore. It's not a thing. It's just sort of been addressed.”
These stories represent the reality of many trans youth accessing health care in the US — a reality that is characterized by careful consideration, individualized care, and remarkable transformations. The Supreme Court is expected to announce whether states can ban families from choosing these treatments in June.
If you're in crisis or experiencing suicidal ideations, help is available. You can reach the suicide and crisis lifeline at 988. To reach an LGBTQ+ trained crisis counselor, dial 988 and press 3. You can also text with an LGBTQ+ trained counselor by sending the word PRIDE to 988, or you can chat online here. You can also reach out to the Trevor Project's crisis services here, by calling 1-866-488-7386, or by texting “START” to 678678.
