Shortly after South Dakota passed its gender-affirming care ban for trans minors last month, Elizabeth Broekemeier rushed to see whether her insurance network would cover treatment in neighboring Minnesota for her 13-year-old son. He’s been using the puberty blocker Lupron for about a year, and the recently passed legislation will make it impossible for him to access it in South Dakota by the end of this year—effectively forcing him to detransition.
“It really was just a gut punch, especially since legislators were presented with the facts and opponents of the bill were medical professionals, medical organizations. And for them to still really blindly follow extremist ways, it’s actually quite frightening,” Broekemeier told VICE News days after Republican Gov. Kristi Noem signed the bill into law.
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Broekemeier found two in-network doctors who provide gender-affirming care in Minneapolis, meaning her insurance would cover their services. But she hasn’t heard back from them yet, and is unsure whether they’ll accept new patients. If and when she does get in, Minneapolis is about a four hour drive from her home in Sioux Falls, South Dakota.
“It’s a matter of my son having to miss school or either myself or my ex-husband having to take time from work to travel,” Broekemeier told VICE News. “But honestly, if Minnesota doesn’t pan out it’s scary to think about because I don’t know what we would do other than my child being forcibly detransitioned.”
Now, families like Broekemeier’s are left facing a difficult decision: find a way to get gender-affirming care out-of-state, or stop care altogether. And for some, there’s no meaningful choice to be made, because travelling out of state is not an option.
“People are scared. Parents are considering leaving because they’re like, ‘this is not going to get better.’ These are options that people are considering. It’s fear and it’s sadness and it’s grief,” April Carrillo, chair of LGBTQ advocacy organization Equality South Dakota told, VICE News. “We know how expensive moving is. Like, what the fuck are these families going to do?”
“People are scared. Parents are considering leaving because they’re like, ‘this is not going to get better.’”
South Dakota’s gender-affirming care ban is one of at least five anti-trans bills introduced in the state this year alone. The move is in lockstep with several other Republican-led states that have introduced bill after bill legislating away trans rights, banning drag shows and books about LGBTQ issues, and barring trans girls from playing on girls’ sports teams. But it’s also an example of how the rhetoric written into anti-trans bills is becoming bolder and more aggressive: South Dakota is the first state in the U.S. to explicitly force trans youth who are already using puberty blockers or hormone replacement therapy to wean off the treatments—in other words, to detransition.
“We have seen a continuous escalation of laws targeting the trans community, and trans youth in particular,” transgender researcher and activist Erin Reed told VICE News. “Early on, the bills—like in Arkansas—were bad enough in and of themselves. But the language within the bills has escalated and [legislators] continue to refine these bills so they are harder to challenge in court and more cruel towards trans people.”
Before the ban passed, Broekemeier testified against it, alongside medical professionals. But even after experts, families, and trans people themselves spoke out, the South Dakota senate passed House Bill 1080 in a sweeping 30-4 vote.
Republican legislators continue to pursue anti-trans legislation even though science isn’t on their side: Numerous medical governing bodies, including the American Medical Association, American Psychological Association, the American Psychiatric Association, and the American Academy of Pediatrics, have endorsed gender-affirming care for minors as medically necessary. Far-right pundits and some Republican politicians falsely equate gender-affirming care to “sterilization” and “castration,” and tout its supposed dangers. But extensive medical evidence shows that gender-affirming care isn’t harmful; it’s life-saving.
Studies show that trans people are more likely to experience mental health struggles, including anxiety, depression, PTSD, and thoughts of suicide, than cisgender people. Nearly half of all LGBTQ youth have seriously considered suicide. But, experts say, some of these issues can be mitigated with gender-affirming care, which includes puberty blockers and other therapies. These interventions are safe and effective, and are correlated with better mental health outcomes for trans people. Teens who are able to access gender-affirming therapy typically also have better mental health outcomes than trans people who have to wait until adulthood to transition.
And yet, after South Dakota Gov. Kristi Noem signed the gender-affirming care ban into law, GOP State Rep. Fred Deutsch tweeted a picture of himself toasting beers with fellow Republican policymakers. “Signed HB1080 into law to protect gender-confused children,” Deutsch wrote. His Twitter account has since disappeared. (In leaked emails obtained by VICE News that reveal interactions between anti-trans lobbyists and lawmakers, Deutsch, known for his push to restrict abortion rights, is repeatedly CC’d and exposed as a key player in anti-trans legislative pushes in South Dakota and other states, including Florida.)
As Republican lawmakers celebrated, trans people and their families felt anger and fear. “Today it is much more a feeling of desperation,” Broekemeier said two weeks after Noem signed the bill. “Obviously I’m still really angry about what’s going on, but now it has turned more to the panic of ‘oh my god, what are we doing to do?’”
JC, whose identity is being withheld for privacy reasons, grew up in South Dakota and came out as trans at 13. Gender-affirming care in the form of hormone replacement therapy helped JC transition before he turned 18—something that trans youth, including JC’s friends, won’t be able to access starting July 1, when the bill goes into effect. Healthcare providers who violate the law will risk losing their professional licenses and could face civil lawsuits.
“I was 16 when I started hormones. They were absolutely life saving for me,” JC told VICE News. “I would not have made it through high school if I wasn’t able to go on testosterone. My dysphoria was absolutely crippling. In school it was very difficult because people just saw me as a tomboy until I started taking hormones. I was constantly misgendered.”
“I would not have made it through high school if I wasn’t able to go on testosterone. My dysphoria was absolutely crippling. ”
Today, JC, 19, is a college freshman, so the ban won’t take his healthcare access away. But his friends who are still in high school will be affected.
“A lot of them are still under 18 and some of them are getting gender-affirming care and it’s going to just devastate them,” JC said. “I have one who is on testosterone. He’s been on testosterone for about a year now and he will be forced to stop.”
“At the end of the day, [the gender-affirming care ban] is not going to make my son not trans anymore,” Brockmeier said. “It’s just going to make his life much more difficult, his mental health will be affected. All of these kids, their mental health and quality of life will be affected.”
In the meantime, South Dakotans are protesting the ban—even though they know that it won’t necessarily change the minds of the GOP politicians who voted for it. “Us being at a rally is not going to change like what happened. But we can show each other that there are people that care and community,’” Carrillo said.
Many people in South Dakota, a state of only about 900,000 people, are also already seeking work-arounds to the ban by connecting families with each other and useful resources. Aviana Knochel, 29, is an activist who is helping facilitate conversations on Discord and Reddit—two platforms youth are using to seek out support and resources at a time when Twitter is inundated with more hate than ever, they said. For example, some people in the state are considering setting up shuttles for trans youth who may need to access out-of-state care, or fundraising for families who may need financial support to get their kids to other states for care, Knochel said.
“I don’t know how to fully articulate how fucking awful and devastating this is,” Carillo said. “ There are trans children, I work with folks who do have trans kids, I see trans youth, and to know that the state they live in basically goes, ‘Hey, you don’t exist.’”
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