Journal Club: The Voices of Trans Children
A 2025 study takes the time to interview and speak with trans children to better understand the scope of the impacts of restrictions on gender affirming care.
by Veronica Esposito
With the recent ruling in U.S. v Skrmetti, legal restrictions on providing minors with gender-affirming healthcare now stand in 25 U.S. states. (Overall 27 states have enacted bans, but those in Arkansas and Montana have been permanently blocked by courts.) This follows actions taken last year in the United Kingdom, which began restricting minors’ access to puberty blockers after the release of the Cass Review.
Recently, trans researcher Natacha Kennedy released a study examining the harsh impacts that the UK puberty blocker ban is currently exacting on transgender children. From fall 2024 through February 2025, she circulated a questionnaire in “an online forum for parents of trans and non-binary children,” receiving 97 responses. She also followed up with online interviews with a subset of 7 trans children, ages 13 to 17, who were on the verge of beginning puberty blockers in defiance of the ban, through private, legal means.
Kennedy’s study finds evidence of widespread harm to these children and their families, caused by the ban on puberty blockers. Because Kennedy has chosen to pursue in-depth qualitative research—as opposed to quantitative research, which include randomized controlled trials as their gold standard—she is aware of the irony that her own work would likely be dismissed by the Cass Review as being of “low quality.” In quantitative research, the focus is on numerical data, which can be analyzed statistically and used to make inferences about a larger population than the study group. By contrast, qualitative research collects non-numerical data (in the case, the words of trans kids and their families), and is better at capturing nuance, narrative, and differences between individuals. Qualitative research has often been looked down upon as less objective and reliable, particularly compared to RCTs..
Kennedy rejects such characterizations of research that aims to give voice to those who are too often silenced:
Attempting to identify “objective” external criteria to gender incongruence, which is very much an internal, subjective reality, is in my view highly problematic. As a researcher I fully reject this approach and consequently this paper foregrounds the subjective experiences of young trans people and does so deliberately and purposely, indeed it regards the views of this group in this respect as taking precedence over those of others, especially those responsible for the Cass Review and for imposing the ban. As such it takes a completely different methodological and ethical starting point from that of the “gendercritical” establishment, whose approach has always been to deny this subjective, and deeply human experience, something they do not deny to other groups of patients or indeed, to themselves.
What Kennedy hears in her interviews with trans children and their parents makes for intense and painful reading. Common themes are of children who had once thrived and hoped for a better future, but are now devastated, suicidal, and hopeless after being forced to endure the wrong puberty. Here are the words of two different parents whose children lost access to needed healthcare because of the ban:
My child was suicidal and has self-harmed many times as a way to express her emotional distress at the change in her access to gender affirming care. She felt life wasn’t worth living because she couldn’t begin her medical transition as planned. She had looked forward to this for months and then with no warning it was taken away. The shock was awful for her and she could not cope.
Distraught. Devastated. Distressed. She had already been through the experience of having her healthcare access stopped after the Bell judgement—she had been due to start blockers that week and they were instantly stopped. This deeply affected her trust in adults responsible for her care, and had a knock on effect on relationships with teachers, club leaders, the GP etc.
Even among those children who were able to access the needed medication in defiance of the ban, Kennedy’s research makes clear that they have been traumatized by the adults around them who have used their lives as a political tool. They have been taught to be mistrustful, to maintain a constant state of threat-analysis, and to be pessimistic. Needless to say, these are terribly harmful lessons for young people to internalize as they develop into adults. Here are the words of two separate minors:
There’s always that lingering on your mind that something bad’s happening in the future.
Like, you’re just like nothing. Like, you’re not important. Like you’re not seen by anyone. You’re living your life with the system around you that doesn’t care for you. I remember feeling kind of really invisible and all that, like, no one cared.
Kennedy aptly sums up the harms when she writes, “the gender-affirming healthcare ban needs to be understood as something that causes persistent harm to its victims, it is not a ‘one-off’ event that can be ‘cured’ with psychiatric support, it is ongoing and its effects cumulative.”
Beyond the direct harms to these children, Kennedy describes the release of the Cass Review and the subsequent block on gender-affirming care as giving license to increased transphobia—both throughout the UK and within the offices of the National Health Service. One parent who pursued services via the NHS describes experiencing care that was transphobic at best, and possibly evidential of conversion therapy:
We found ourselves being guided by who we now suspect was a covert TERF who recommended “watchful waiting” which unfortunately at the time we did try as we thought we were working with an expert. This approach was incredibly damaging to our child and we are still recovering from that as a family.
Watchful waiting is a now-discredited intervention for gender dysphoria in youth that is pushed by right-wing groups, such as the Society for Evidence Based Gender Medicine. Under this model of treatment, parents are encouraged to simply wait in hopes that their child will naturally desist from a trans identity. It is based on myths that 80% of trans kids desist and that taking on a trans identity in youth is a social contagion.
Another parent simply said, “it’s just like hours of people convincing them that they’re not trans.” Shockingly, a third reported being told that healthcare workers at the nation’s clinic for trans children would not necessarily use the child’s proper name and pronouns. Such a lack of regard for the basics of trans-competent care is almost unimaginable.
Even more shockingly, Kennedy has unearthed evidence that current NHS staff is attempting to intimidate trans kids and their parents from procuring puberty blockers by legal means, issuing threats of calling social services and preventing trans children from accessing gender-affirming care as adults. As one trans minor put it:
[the NHS] sent my mum a threat that said if we find any, like blockers in your child’s body we will get social services involved. There’s an appointment I was supposed to go to if I wanted to stay on the list for any gender care like in my adulthood, but I’d have to go to a meeting where they could like, file a case on me and say that I’m not capable of making that decision [to transition].
This paper makes clear that the bans on gender-affirming care for trans children is creating a generation of traumatized trans people. What’s more, these bans are being leveraged against trans children and their families as part of a multi-faceted strategy aimed at inculcating fear and establishing a regime of control and suppression over trans people’s own bodies. In this, it recalls a recent essay by trans activist Gillian Branstetter, in which she powerfully lists the many indignities forced upon trans minors throughout America:
Then there are the ones I only read about in court filings and news reports, reduced to their lowest and most vulnerable moment. The girl in Virginia whose high school teachers left her on the gym bleachers during a mass shooting drill while her classmates were ordered to hide in the boys’ and girls’ locker rooms. The girl in Oklahoma forced to flee the only home she’d ever known after a local parent’s Facebook group became obsessed with stalking and threatening her. The 13-year-old in Kentucky banned from playing on the school field hockey team she started. The 15-year-old Swiftie and class president who became the focus of a police investigation—with officers interviewing her classmates about her body weight and her anatomy—because she committed the crime of making the girls’ volleyball team. The Texas teenager who, after the governor declared his health care a form of abuse, attempted suicide only to have the hospital staff treating him report his family to child services under the governor’s orders. The 14-year-old who died by suicide after a California children’s hospital denied his trans identity in the face of a mental health crisis.
This, unfortunately, is the world empowered and emboldened by the ruling in Skrmetti. As long as these bans stand, they will continue to do the kind of grievous harm that Kennedy documents in her paper. Increasingly, the trans community needs to bring tools of healing to itself, to limit the damage and build a better future for ourselves.
Veronica Esposito (she/her) is a writer and therapist based in the Bay Area. She writes regularly for The Guardian, Xtra Magazine, and KQED, the NPR member station for Northern California, on the arts, mental health, and LGBTQ+ issues.