The transgender pride flag. Photo: Unsplash // Alexander Gray

SALT LAKE CITY — As a third grader in Utah, mandolin-playing math whiz Elle Palmer said aloud what she had only before sensed, telling a friend she planned to transfer schools the following year and hoped her new classmates would see her as a girl.

Several states northeast, Asher Wilcox-Broekemeier listened to punk rock in his room, longing to join the shirtless boys from the neighborhood playing beneath the South Dakota sunshine. It wasn’t until menstruation started, and the disconnect with his body grew, that he knew he was one of them.

Both kids’ realizations started their families on a yearslong path of doctors, therapists and other experts in transgender medicine.

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Now teenagers, their journeys have hit a roadblock.Republican lawmakers across the country are banning gender-affirming care for minors. Restrictions have gone into effect in eight states this year — including conservative Utah and South Dakota — and are slated to in at least nine more by next year.

Those who oppose gender-affirming care raise fears about the long-term effects treatments have on teens, argue research is limited and focus particularly on irreversible procedures such as genital surgery or mastectomies.

Yet those are rare. Doctors typically guide kids toward therapy or voice coaching long before medical intervention. At that point, puberty blockers, anti-androgens that block the effects of testosterone, and hormone treatments are far more common than surgery. They have been available in the United States for more than a decade and are standard treatments backed by major doctors’ organizations including the American Medical Association.

The new laws have parents scrambling to secure the care their kids need. They worry what will happen if they can’t get the medications they’ve been prescribed, especially as their kids start puberty and their bodies change in ways that can’t be reversed.

“My body’s basically this ticking time bomb, just sitting there waiting for it to go off,” said Asher Wilcox-Broekemeier, now 13.

Elle remembers her first day at the school after she transferred. Before leaving, she came downstairs in rainbow sparkle-embroidered cowboy boots her mother worried would only spur bullies. Taunts from kids at Elle’s prior school drove her into depression so deep she had suicidal thoughts.

But on that first day, a boy told Elle he loved her boots. Some kids bullied her, but classmates and teachers were far more supportive than at her prior school. Elle discovered new passions in hip hop and drama class, and she settled into a new school and a truer version of herself. She started to see a therapist as her uncertainty about how she fit in the gender spectrum grew more pressing.

Elle came out as a transgender girl in fifth grade. Now in seventh, she planned to start hormone treatment this summer so potential side effects wouldn’t interfere with her life during the school year, especially her team’s extracurricular math competitions.

But then Utah’s Republican Gov. Spencer Cox signed a gender-affirming care ban in January. In a compromise, the law let kids keep taking medications if they were already on them. So Elle’s mom rushed to get her treatment months earlier than planned, as did other parents.

The waitlist at one Utah clinic swelled to six months. Doctors were confronted with difficult decisions about who to get in for appointments.

Elle’s medication arrived in the mail just before Utah’s law went into effect. A small stick implanted in Elle’s forearm is slow-releasing hormone blockers to prevent the effects of male puberty from taking hold. Eventually she may be prescribed estrogen, and she and her parents will have to navigate the next steps, and whether they’ll find doctors to continue her care.

At least for now, they have a reprieve.

“It feels like we can breathe again now,” Cat Palmer said.

There’s no relief for Asher Wilcox-Broekemeier’s family — not yet.

When Asher began menstruating, he felt a terrifying disconnect between how his body was changing on the outside and how he felt inside.

Elizabeth began researching online to understand what was going on with her son, while Asher’s father, Brian, looked to doctors for expertise. With referrals from his longtime pediatrician, Asher met with therapists and doctors who helped explore his history, personality and feelings over his whole life.

Nearly two years ago, doctors prescribed puberty blockers and birth control to slow breast development, regulate menstruation and lower the pressure of his disconnect with his body.

He’s 13 now, and finds solace in music to ground him in a world of occasional bullying and constant mistaken pronouns. He practices Blink-182’s “All the Small Things” on guitar, plays trumpet in the school band and is rehearsing various singing roles for the Cinderella school musical. When he’s not thinking about testosterone to lower his voice or eventually getting top surgery, he looks forward to playing in the high school marching band next year.

Asher still struggles with moments of gender dysphoria. Friendships that were once strong fizzled after Asher came out as transgender. Parents have disinvited him from their houses out of fears he’s a “bad influence.”

But his parents have noticed his emotions stabilize through his treatment.

“From a parent’s view, I see him as being able to be himself authentically, which is wonderful for him,” Elizabeth said.

Now he and his parents worry they’ll have to start over.

In February, South Dakota Republican Gov. Kristi Noem signed a law banning the medications and procedures that doctors have increasingly prescribed for transgender teens.

Asher’s current doctors in South Dakota won’t be able to prescribe his medications, so the family is looking for a new doctor in neighboring Minnesota, where the Democratic governor has signed an executive order explicitly protecting gender-affirming care for minors. They’re hoping to find a clinic close enough they can drive to appointments and don’t have to pay for hotel stays.

The planning has been time-consuming. Logistical questions to their current South Dakota doctors for referrals have gone unanswered. They want to beat whatever onslaught of patients from other states enacting similar bans will bring to providers in Minnesota, but also want to maintain as much normalcy for Asher as they can.

The sudden twists in Asher’s trajectory makes him question why his health care is of concern to politicians.

“Even though trans people don’t make up a big percent of the population doesn’t mean that we’re not part of it still,” Asher said.

The full consequences of the bans on care for minors aren’t yet clear.

Dr. Nikki Mihalopoulos, an adolescent medicine doctor in a Salt Lake City specialty clinic with transgender teens, worries the new laws will make families too scared to seek help and doctors too scared of losing their licenses to provide care.

In the middle are kids like Elle and Asher.

Multiple studies have shown that transgender youth are more likely to consider or attempt suicide and less at risk for depression and suicidal behaviors when able to access gender-affirming care.

Both sets of parents are trying to shelter their kids from the stress and anxiety caused by the recent changes in the laws.

After years of worrying about their kids’ safety and mental health, they still fear what could happen if they can’t find the drugs their kids have been prescribed.

“My kid being OK is my number one priority. I know what the suicide rate is. I do not want my child to be a statistic,” Cat Palmer said of Elle.

By SAM METZ and AMANCAI BIRABEN