This story is featured in CityBeat’s May 29 print edition.
Kate dropped off her daughter at a swimming pool for a friend’s birthday party when she was 7 years old, but she didn’t leave.
“I watched you swimming for a while,” Kate says to her daughter, Mikey, now 8.
“You did?” Mikey asks, her narrowed eyes glowing curiously behind wispy blonde bangs.
“I left eventually,” Kate says with the slightest smirk. “But I always want to make sure that there are safe people around who know how to advocate for you.”
Kate and Mikey, who live in Cincinnati, have asked CityBeat not to use their real names for the sake of privacy. This is Kate’s new normal; moving in and out of spotlights and shadows like a knight protecting the most precious piece on a chess board, only able to go so far at one time.
“It feels like a layer of parenting challenge that other parents don’t have,” Kate tells CityBeat. “When we were talking a few years ago about joining Girl Scouts, I had to reach out and say, ‘Are transgender girls welcome in this Girl Scout troop?’”
Mikey is a transgender child, but as CityBeat learned one afternoon in a Cincinnati coffee shop, she’s so much more. She’s exceptionally good at math, already learning algebra outside of school with her dad for fun. She spends hours playing Minecraft, digitally digging away in search of the game’s valuable redstone. She prefers Taekwondo to swimming. Her favorite shirt is green with white stripes, probably because green is her favorite color – she says it’s calming.
“I can notice things that some people don’t. Like, that kind of looks like a cloud,” Mikey says, pointing to a smudge of chalk on the coffee shop’s menu.
Nothing gets past Mikey, especially not her own true self.
“Kids, when they’re old enough, they tell the adults. She started to hint, like, ‘I would be on the girls team if I was on this [baking] show,’” Kate recalls. “Her transition started during COVID. She was in virtual kindergarten and she would unmute herself and say, ‘I’m a girl!’ to the class and then mute herself again.”
Kate admits she was a little slow to get on board with Mikey’s declarations at first, but Mikey couldn’t wait.
“One day my little kid said, ‘Mama, you keep calling me a boy and I’m not a boy!’ I said, ‘Okay! I have a daughter.’ I went to Target and I bought some pink clothes,” Kate says. “Now we celebrate that day as daughter day.”
“I still don’t like pink, though,” Mikey adds.
While socially transitioned, Mikey will have other adjustments to make in the years to come. Kate has every intention of continuing her daughter’s gender-affirming care as puberty draws near.
Gender-affirming care refers to a range of interventions “designed to support and affirm an individual’s gender identity” when their gender assigned at birth conflicts with the gender by which they want to be known, according to the World Health Organization. This can include a range of medical treatments, like hormones and surgery, though no Ohio children’s hospital performs gender-affirming surgery on patients under 18.
For children who have routinely seen a therapist, usually one who specializes in discussions surrounding gender identity, the next step can include puberty blockers, and teens who have already been through puberty may start with hormone replacement therapy. Gender-affirming care for kids is widely considered to be safe, effective, and lifesaving by every major medical association in the country and across the world, including the American Board of Pediatrics, the American Medical Association, the American Academy of Child and Adolescent Psychiatry, the National Association of Social Workers, the Ohio Children’s Hospital Association, the Pediatric Endocrine Society and dozens more.
But resounding approval from the medical community hasn’t stopped lawmakers in Ohio from trying to take away this treatment option for kids and their families.
The legislation
Since the start of 2023, lawmakers have introduced more than 500 anti-LGBTQ+ bills in state legislatures across the United States, a new record, according to the American Civil Liberties Union (ACLU.)
In Ohio, there are several bills targeting the LGBTQ+ community, including a proposed ban on drag performances outside of licensed cabarets, but three bills in particular zero in on transgender and non-binary children and teens:
House Bill 183, the “Protect All Students Act,” sponsored by Beth Lear (R-Galena) and Adam Bird (R-New Richmond), would keep transgender students from using bathrooms and locker rooms that align with their gender identity. HB 183 would require all Ohio K-12 schools and public and private colleges to mandate that students only use the bathroom or locker room that matches their “biological sex” assigned at birth. The bill similarly prohibits trans students from sharing lodging accommodations with members of the “opposite sex” during overnight field trips. The bill passed out of the Higher Education Committee on April 10 by a 10-5 party line vote; it now heads to the full House for consideration.
House Bill 8, the “Parents’ Bill of Rights,” sponsored by Reps D.J. Swearingen (R-Huron) and Sara Carruthers (R-Hamilton), would require public schools to tell parents about “sexuality content” or “gender ideology” in class materials, which opponents say could include any topics or stories that depict same-sex couples or transgender characters. HB 8 would also directly impact transgender students by requiring school districts to notify parents about “any request by a student to identify as a gender that does not align with the student’s biological sex.” The bill passed the House in June of 2023 by a vote of 65-29, with one Republican voting against the bill. HB 8 sits in the Senate Education committee where it had its fourth hearing on April 24.
House Bill 68, the “Save Adolescents From Experimentation Act,” sponsored by Rep. Gary Click (R-Vickery), bans gender-affirming care for minors in the state of Ohio. HB 68 prohibits doctors from prescribing cross-sex hormones or puberty blockers to minor patients. It also outlaws any type of gender-affirming surgery for minors, though physicians in the state widely agree that this does not take place in the state. The bill outlaws conduct that “aids and abets” patients’ access to care in other states. Patients who have already started treatment in the state would be grandfathered in and allowed to continue treatment. The bill also prohibits transgender students from playing on sports teams that align with their gender identity.
During proponent testimony on HB 68, those testifying in support of banning gender-affirming medical care for trans youth included Stuart Long, a Columbus minister.
Long accused non-Christians who opposed the bill of being “possessed” by demons.
“The only thing that makes sense is demons are influencing people, allowing their bodies to be possessed to run satanic agendas,” Long says in the April 2023 hearing.
Public Health Policy Chair Scott Lipps (R-Franklin), who voted for the bill, reportedly made it clear that Long was not on Click’s invited witness list, but Click has made his spiritual feelings on this subject known before.
Click is a pastor at Fremont Baptist Church in Fremont, Ohio. In a 2018 recorded sermon posted to the church’s YouTube account, Click disregards that people can be transgender at all.
“You’re not born that way,” Click says during the sermon. “God’s not going to curse you in the wrong body. He’s not going to curse you with desires that cannot be adequately and appropriately and biologically fulfilled correctly.”
HB 68 passed the House in June of 2023 by a vote of 64-28, with two Republicans voting against, and went on to pass the Senate in December. Ohio Governor Mike DeWine vetoed the bill on Dec. 29, saying he listened to testimony from parents and doctors who know gender-affirming care to be lifesaving for kids. The House and Senate voted to override DeWine’s veto in January. Enforcement of HB 68 has been temporarily put on hold by a Franklin County judge as a lawsuit filed by the ACLU works its way through the courts.
Attorney General Dave Yost asked the Republican-dominated Supreme Court of Ohio to immediately institute the ban outlined in HB 68, but the court rejected Yost’s request on May 22.
The temporary restraining order was to expire on May 20 but was extended until July 15, when a hearing will be held for arguments.
Kate has testified before Ohio lawmakers in opposition to the proposed ban on gender-affirming healthcare for kids, for her daughter. Kate fights like hell and she’s not letting up, but she tells CityBeat she’s preparing for the worst.
“I don’t trust Ohio politics to go the right way, so we have an appointment to establish care at the Ann Arbor Children’s Hospital gender clinic in June,” she says. “We’re gonna have to travel 500 miles roundtrip for our daughter’s doctor’s appointment. Once a year until puberty, and then it’ll probably be several times a year.”
It’s hard to say how many transgender children and teens live in the United States, let alone Ohio. After all, trans children with unsupportive parents are significantly less likely to appear on the radar of researchers and clinicians. But early insights from the 2022 U.S. Transgender Survey, a study conducted by the National Center for Transgender Equality (NCTE), show the survey collected data from 8,159 trans individuals ages 16 to 18.
Raising two transgender kids
Kat Scaglione is the proud mom of three kids, two of whom are transgender, but they were too young to show up on the NCTE survey. Her youngest, Lexi, came out as trans when she was 4. Now 10, Sacglione says there were always signs that Lexi was really a girl.
“The first thing was they had a superhero or princess day at their daycare,” Scaglione says. “She wanted to wear a princess dress. And that kind of stayed consistent until 4 when she was able to verbalize to me, like, ‘I’m a girl.’”
Her oldest daughter, Amity, now 15, came out later.
“Amity realized how hard it was and how involved it was and how stressed we were. Because, even though it was easy to accept Lexi, making some of those changes, having hard conversations with neighbors and friends and family, can be difficult,” Scaglione says. “She made the decision to just kind of keep it in – she didn’t want to add to everything else.”
It wasn’t until 6th grade when Amity started to express herself differently, talking with her mom about the possibility she may be gay, perhaps non-binary.
“Lexi has, up until this point, lived a completely normal life, I suppose, and been treated like everyone else,” she says. “And for Amity, she was doing this in the public eye.”
The watchful, oftentimes judgemental gaze of the public was what Scaglione wanted Amity to consider. Things would be different for her, she’d become a target.
“I was told, like, oh, well, you should experiment some before you make that big decision,” Amity tells CityBeat. “And I found out later that that’s really just because there are a lot of risks with embracing your true self, especially in this day and age. It was more so just out of concern for like, if this is who you want to be then you have to be ready to handle everything that comes with that.”
But Amity was ready. By 8th grade, she had started socially transitioning. Pronouns, name, clothes; Amity started changing everything simultaneously. Her mom helped to freshen up her wardrobe of t-shirts, hoodies and jeans to include new pieces that reflected pieces of herself.
“It’s not that I don’t still wear those things, I just have expanded,” Amity says. “Now I have all these fun big socks and stocking stuff. I also have a bunch of jewelry I wear now, so that’s much different.”
Next came months of therapy, the common requisite doctors require before gender-affirming medical care.
She then started spironolactone, a medication that lowers testosterone production.
So far, the physical changes from spironolactone have been minimal, almost unnoticeable to Amity. But she says her mental health has improved before everyone’s eyes.
“I hear from a lot of people that I’ve looked a lot happier since then,” Amity says.
Simply put, happiness is how gender-affirming care outcomes are measured.
Dr. Laura Mintz is an Internal Medicine-Pediatrics physician in the PRIDE Network and Center for Health Equity Engagement, Education, and Research (CHEEER) at the MetroHealth System in Cleveland and an Assistant Professor of Medicine at the Case Western Reserve University School of Medicine.
“As people go through the process of gender-affirming care and coming into alignment, you see people just blossom and grow and become themselves, Mintz tells CityBeat. “It is the most beautiful thing.”
How gender-affirming medicine works
Mintz says, like all healthcare, gender-affirming medical care is tailored to the needs of the patient, but all patients will start with parental conversation, psychological evaluation, extensive therapy, understanding of risks and benefits and social transition. Then, depending on the patient’s age, the conversation may continue with puberty blockers.
Puberty blockers
“The way that we have hormones at puberty is that it’s a cycle, where it’s a feedback loop, where the brain is signaling the organs, either the testicles or the ovaries, to spit out hormones,” Mintz says. “What [puberty] blockers do is they interrupt that cycle and suppress the activity in the brain. It just kind of shuts the whole thing down. So instead of adding any hormones in, essentially, this just puts a pause on those early puberty cycles where the estrogen and progesterone or the testosterone start being produced at the rates that produce puberty.”
This doesn’t mean that trans children never go through puberty, Mintz says. Like a car that drives in manual, patients who undergo gender-affirming care during puberty stages are in the driver’s seat.
“If they begin these blockers, what happens is that we put a pause for a while,” they say. “Sometimes that’s about also allowing the child to continue to explore their gender identity, to do things like social transition, although lots of young people are already socially transitioned by the time they get near any medication. Then when it is time for puberty, we basically add the typical hormones in of the patient’s affirmed gender. So we start estrogen and then sometimes progesterone for trans-feminine kiddos, and dose it in such a way that mimics the puberty cycle.”
Spironolactone
Not all transgender kids start medical gender-affirming care before puberty. Some trans-feminine patients who have already been through puberty may get prescribed spironolactone, which doesn’t add estradiol (typically referred to as female hormones), but suppresses testosterone (typically referred to as male hormones).
“Spironolactone is originally a blood pressure medication,” Mintz says. “But it also works to deplete testosterone in the body quite effectively. We use it obviously in lower doses in children. The idea is to stop the permanent changes that testosterone can drive in people’s bodies so that they don’t end up with effects that can’t be changed or also are disturbing and disruptive and extremely distressing.”
Hormone therapy
Mintz says patients won’t start hormone therapy until around age 16, which is a general guideline from the Endocrine Society, but every patient is different.
While trans-masculine patients may only need testosterone hormones to achieve their desired outcome, Mintz says trans-feminine patients may need medication like spironolactone to suppress testosterone in order for the estrogen hormone to drive home their desired outcome.
“If you give someone testosterone at a high enough dose, you will be eventually looking at someone who on the outside, most people would read as male,” Mintz says. “Estradiol is the most common hormone that we use for trans-feminine women and girls.”
Support from family and loved ones is crucial during this stage of gender-affirming medical care, Mintz says.
“It is a whole family system plan to, again, make sure that the child feels good in their body, good in themselves, you know, here in the world as they understand themselves,” they say.
The stakes
Advocates of gender-affirming care access often refer to the treatment as lifesaving. Transgender and nonbinary young people are at greater risk of depression and suicide compared to those who are cisgender and straight, including cisgender members of the LGBTQ+ community, according to the Trevor Project, a nonprofit suicide prevention organization that provides 24/7 crisis support services, research and advocacy for LGBTQ+ youth. The Trevor Project’s 2023 U.S. National Survey on the Mental Health of LGBTQ+ Young People found roughly half of transgender and nonbinary youth had seriously considered attempting suicide in the past year. Black transgender and nonbinary young people reported even more elevated rates of suicide risk, with 58% seriously considering suicide and 25% attempting suicide in the past year.
“I mean, think about what it would be like for you, and each individual has to think about this,” Mintz says. “To endure your body betraying you in a deep way, your body continuing to look more and more like something that feels like not you, the pain of that is astonishing. Truly, gender-affirming care really, really, really transforms that feeling.”
While transgender people in Ohio can begin the process of medical gender-affirming care once they reach adulthood, Jay VanLandingham, board president of Cincinnati’s Transgender Advocacy Council (TAC), tells CityBeat that the trauma of living in an unsupportive environment doesn’t just go away in adulthood.
“The main concern is the mental health burden as they become adults,” he says. “We’re just seeing more of an increase in depression, anxiety, real fears and real concerns, just more recently, with the legislation, with whatever might happen with the upcoming election.”
Even transgender adults who are happily affirmed can deeply feel the impacts of Ohio’s trans youth being targeted by lawmakers, VanLandingham says.
“There’s something to be said about vicarious trauma,” he says. “It may not directly be impacting adults, but when [trans adults] see it happening to trans youth, it still affects us directly – it’s an impact, psychologically.”
Kate switched pediatricians after Mikey’s doctor recommended she raise Mikey as a boy, which Kate theorized was unsolicited faith-based advice. CityBeat asked Kate what she thinks life would be like if she followed that advice. There’s a pause.
“Part of the argument around trans kids is that they’re so young. And I just want to say, if my kid grows up as a man – number one, I’d be surprised – but number two, my kid will have been affirmed their entire life and loved and driven 500 miles to the doctor,” Kate says, tears rolling down her cheeks. “Why would that ever be a bad thing? I would never regret parenting my child like that.”
One child grandfathered in, one child awaits answers
There’s only a five-year age gap between Scaglione’s two transgender kids, but there could potentially be a huge gap in their access to gender-affirming healthcare. Should the ACLU lose the fight against HB 68 in court, Lexi would need to seek gender-affirming medicine out of state.
“We’re experiencing both parts of what’s happening right now,” Scaglione says. “Lexi is really too young to receive any care.[…] With Amity, we’ve been very fortunate that she is grandfathered in.”
Scaglione says she’s been panicked for nearly a year, worried that Lexi won’t have the same options as Amity, the same chance to thrive.
“To see Amity go from a kid who was painfully shy and really self-conscious and anxious, depressed and just really struggling, and to watch her just be absolutely amazing…I mean, she didn’t talk to anybody, was depressed about going to school every day, used to have anxiety about going to school,” Scaglione says. “Now, within the first couple weeks of school this year, she joined five clubs.”
At only 15, Amity has already toured two prospective colleges where she’s interested in studying art. She posts pictures of her art to Instagram and Tumblr, mostly digital illustrations of comics. She doodles in class all the time, either on her iPad or in the margins of assignments. She said she’s starting to get a reputation for her work.
“I’ve become very well known around the school now, apparently,” she says. “The lady at the front desk of the office started asking me to [draw] stuff.”
Like most teens, Amity loves rock and electronic music. Her favorite food is still a classic PB&J. But defending her rights, defending Lexi’s rights, has forced her to mature in ways not asked of cisgendered teenagers.
“It definitely does force you to grow up, because you have to,” Amity says. “Especially when you’re a target for a group of people. I don’t want to have to dedicate my life to telling people how badly I want my rights, because it’s like, I have other things that I want to do. But at the same time, I want other people in my community to be able to receive this healthcare.”
How allies can promote community
Minna Zelch is on the leadership team of Trans Allies of Ohio (TAO), a grassroots group of volunteers who organize around helping Ohio’s trans community. TAO connects parents of transgender children with one another, with safe doctors, with the information and support they need to navigate a world that, to them, may be entirely new.
“We have all these parents now who are trying to advocate for their minor children and probably have never done this before,” Zelch says. “Maybe they’re up to speed, but chances are they’ve probably never gone to the statehouse, they’ve probably never written testimony, they really probably have never given testimony. But now they need to do this, and that can be terrifying.”
For these long days of parent testimony – sometimes as long as 15 hours – TAO will rent a room at the statehouse for parents and their kids to treat like a home base. Zelch calls this their “community care room.”
“It’s exhausting, and you don’t always know who’s an okay person to talk to. So we are just a safe place where we know people can come and just decompress either before or after testimony,” Zelch says.
Scaglione found not only relief in TAO’s community care room, but peers. Other moms and kids who shared in her experience, both the good and heartbreaking parts.
“You’re with these politicians who are just…it’s like speaking into a vacuum. They do not care what you have to say, they have not one bit of empathy for my beautiful child,” she says. “But there’s an amazing community there, too. You’re with all these other kids and parents and trans people. It’s great to go there and be in a large group of people who are experiencing the same kind of stuff. It was the first time I felt like we weren’t on an island somewhere drowning.”
Kate says she’s also found joy and strength in connecting with other parents of trans kids, but those connections don’t come as easily in day-to-day life as they do for other moms.
“I was hanging out in front of [Mikey’s] school for pickup and another parent walked up and she was wearing a shirt that said ‘Protect Trans Kids’ and I hustled over to her and I was like, ‘You have a trans kid? I have a trans kid! She’s a third grader! Oh my gosh, it’s so nice to meet another parent,’ and she’s like, ‘Whoa, my kid is cis, but I’m an ally for sure!’” Kate says, able to laugh at the interaction in hindsight.
But the path towards forging positive connections can also mean severing them, including on your kid’s behalf. Scaglione will sometimes vet other parents on social media when their kids start to get close. As a mom of two transgender children, she says it’s a matter of safety, but it can also lead to heartbreak. One of Scaglione’s two transgender kids had only one best friend at her former school – she says she was horrified when she found that child’s mom on Facebook.
“Her entire page was very violent towards LGBTQ people. This woman’s page was the level of violence where I’m like, I don’t even know if my kid is safe at her house,” Scaglione says. “[My daughter] only really had one friend at that point and I had to take that friend away. I felt horrible.”
As a trans teenager, connecting with the LGBTQ+ community can not only lead to validating friendships, but also ease you into a world bigger than you ever imagined.
Elliot Draznin is the director of diversity, equity, and inclusion for Cincinnati Pride. This year’s Pride Festival will take place June 22 at Sawyer Point Park. The Cincinnati Pride Festival is a joyous celebration – complete with live music, art installations, libations and liberation – but Draznin says it’s also a time to reflect on what kind of support the LGBTQ+ community needs in this moment.
“It’s been a struggle for a lot of people, but especially teenagers,” they say. “You’re having all these struggles, you’re seeing all of these different attacks, you know, so often it’s so difficult to just kind of exist in your own body as a teenager, let alone as a trans teenager.”
Like in years past, Cincinnati Pride will offer a family zone and a teen zone. The two are separate, but they offer similar functions: a low-intensity space for participants to engage with their community.
“It’s kind of this low barrier introduction, where you get to have the experience of Pride without it being so overwhelming, without being like, ‘Oh, my God, what is happening, like, what community am I joining?’ It’s so much more like, let’s just get together in a smaller group while we’re still at Pride and get a chance to have that lighter introduction,” Draznin says.
Kate loves taking Mikey to the Cincinnati Pride Parade. She loves showing her daughter that who she is and who she will grow up to be is not only acceptable, but worthy of celebration. Rare are the days when Kate and Mikey can live in the moment among a crowd of strangers they already know love and accept Mikey for everything she is.
“Raising my kid is the greatest joy and it’s a thrill and it’s amazing. My kid is awesome, she’s hilarious, she’s funny and kind. And we’re doing great as parents, it’s just that we live in a system of political violence and oppression,” Kate says. “So I’ve been living in this moment, and in this moment I have a daughter. She’s my daughter and she’s perfect.”
If you or someone you know is experiencing a mental-health crisis, contact the national Suicide and Crisis hotline by calling or texting 988 to get help from a trained crisis counselor. Or contact the Trevor Project for free, confidential support at 1-866-488-7386 or by texting START to 678-678.
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This article appears in May 29 – Jun 11, 2024.