Joey enjoys playing basketball and baseball. He’s a sixth-grader, and he wants to be an exotic animal vet when he grows up.
He likes to build with Legos and he loves science, but he’s not a fan of math. He’s teaching himself how to play the guitar, he plays trombone in the school band and he’ll spend summer afternoons riding his bike around his small town and swimming at the pool with his friends.
To many, the 12-year-old is living the quintessential South Dakota childhood.
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But Joey is one of the South Dakota children feeling targeted and attacked each year by the South Dakota Legislature. He’s transgender.
Joey is surprisingly politically aware and conscious for a sixth grader. Although he “passes” as a typical pre-teen boy, he is not publicly out as a transgender person, and South Dakota Searchlight is not using his real name. Still, he and his family members are outspoken advocates for LGBTQ issues. He makes calls to state legislators, he writes cards, he attends rallies; but that’s because he doesn’t have a choice
At least one bill a year has been introduced at the state level since 2015 – when he was 4 – targeting his rights and the rights of people who are like him.
The latest bill, which will become law on July 1, is a ban on gender-affirming health care for South Dakota minors. A provision in the bill allows children already receiving care to receive systematically reduced treatment until 2024.
It’s frustrating for him, he says. He doesn’t understand why he can’t continue doing something that’s helped him, and he feels powerless at times. Because even though he understands what’s happening, he still had to attend class during the legislative session, waiting until the end of the school day to ask his mom, “What happened?”
After 13 years in the state – Joey’s entire life – his family is planning to leave, said his mother, who requested anonymity to protect her job and her family’s safety.
“This town has been an amazing, supportive place and community, and we always felt we could look past what was happening in Pierre – the partisan politics, the culture wars – because people were accepting here,” she said. “But it’s gotten worse at all levels.”
Legislator: This is ‘why we were sent to Pierre’
Those who oppose gender-affirming care say it’s not appropriate for minors. Sen. Al Novstrup, R-Aberdeen, was a prime sponsor of the bill that banned such care. He said minors are not capable of making informed decisions about their own medical care and that treatments can have permanent physical and psychological effects.
He cited a lack of research on the impacts of treatment, specifically brain development, and the example of western countries such as Sweden, which has pulled back on gender-affirming care.
“The side of common sense says doing a transgender at age 12 is a trainwreck,” Novstrup said. “It’s a very, very bad decision. Probably the worst they’ll make in their lifetime.”
Rep. Bethany Soye, R-Sioux Falls, said she introduced the bill to protect children from “harmful and irreversible medical practices,” which include puberty blockers, hormone therapy and surgery for minors
But medical experts say gender-affirming surgeries for minors are rare, and that drugs are only administered after years of therapy to analyze the condition of the child.
Once it’s safe for the child, puberty blockers can be used to delay puberty, and hormone treatments can be used later on for teenagers. Both are more common than surgery, said Amanda Diehl, a physician for the Iris Clinic in Rapid City, which serves LGBTQ youth.
Such medications have been available in the United States for more than a decade and are backed by major organizations including the American Medical Association and the American Association of Pediatrics.
“When a patient starts puberty blockers, they’re more at risk of being kicked out of the home, being beaten up at school or being fired from work,” Diehl said. “We’re making sure this is a safe and correct time for them. We’re very, very meticulous that this is safe for them mentally and in their social, emotional and educational lives.”
But Soye said the treatment can be damaging, especially if children choose to detransition in the future. She said one of the “chief responsibilities” of the government is to “protect the weak and vulnerable.”
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Novstrup calls the treatment child abuse, saying that “if doctors and parents can’t make the right decision,” the Legislature will.
“That’s why we were sent to Pierre, to make those types of decisions,” he said. “The Legislature can say no, you don’t have that authority. We think it’s a bad idea.”
‘He’s a boy through and through’
On the western side of the state, Diehl estimates she has about 12 patients affected by the gender-affirming care ban. Joey’s family said they know about 20 families on the east side of the state who are affected.
Multiple studies have shown that transgender youth are more likely to consider or attempt suicidethan other children their age. However, they are less at risk for depression and suicidal behaviorswhen they’re able to access gender-affirming care.
Diehl said one of her patients expressed suicidal thoughts the day after the ban was passed. Other patients have become more anxious and depressed since it was signed by Gov. Kristi Noem in February.
“You can’t even quantify what it’s like to be a parent with a child who says they want to kill themselves,” said Diehl. “It might not be today, but you worry that it’s tomorrow or next month or next year. You’re always worried. It’s unbelievable anticipatory grief. You’re always wondering, are they OK today? Or are they just pretending?”
Although Joey’s sex at birth was assigned as female, he’s known since he could express himself that his gender is male. His parents thought he would simply be a tomboy, so they told him that “there are no boy or girl things, you can play with whatever you like.”
“For a while he was like ‘uh huh,’ but then he was clear: ‘That’s not me. I am a boy and you’re just not hearing me,” his mother recalled
Joey has identified as male since age 4, fully transitioned to male pronouns at 5 and began puberty blockers at 9, when he began showing signs of puberty. Now he’s waiting to receive another implant of slow-release hormone blockers to further prevent the effects of female puberty. He plans to begin hormone therapy in the next few years and currently has no interest in surgery, though that’ll be a decision he’ll make as an adult, his mother said.
His friends and their parents accepted the transition in preschool. Since then, they’ve forgotten and see him as he is, his mother said. His grandparents also had questions, but have since supported him. After researching and working with medical professionals, both his mother and father were supportive.
“He hasn’t really been targeted by his peers or classmates – just adults,” she said. “You’d never know. If you just met him, he’s a boy through and through.”
Seeking trans care can cost over $14,000 for one treatment
The new law has families across South Dakota scrambling to secure care for their children. Some Minnesota clinics have a year-long waiting list, and Colorado clinics are filled as well.
It’s not just South Dakotans seeking care. Several other states, including North Dakota and Iowa, have banned the care as well. Nebraska is waiting for the governor’s signature on the ban, and Montana and Wyoming are also considering a ban. That means “refuge” states like Minnesota and Colorado don’t have enough doctors to meet demand.
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Children seeking care have already gone through months, often years of counseling to determine if the treatment is needed. The process is slow, patient and careful, Joey’s mother said. Receiving treatment earlier through medication means less invasive treatment later.
“If you have to wait until you’re 18 to receive treatment, you’re probably going to need surgical intervention, really invasive procedures – things you probably wouldn’t need if you just had access to puberty blockers,” she said.
The puberty blockers target sex hormones, including testosterone and estrogen, to ward off physical changes such as development of breasts or a more defined adam’s apple. Essentially, Joey’s mother describes blockers as a “pause button.” If he stopped taking the medication, puberty would resume.
According to the Mayo Clinic, use of puberty blockers provides “time to determine if a child’s gender identity is long lasting.” If Joey continues with his transition, he would continue using hormone blockers and replacements for the rest of his life. If he doesn’t have access to puberty blockers until he’s 18, his likelihood of receiving surgery as an adult increases.
Joey’s family is able to get into a clinic in Kansas City, which is two states away, since he was a patient there during his prior implant, when the care he needed wasn’t available in South Dakota. Last month, they drove to Kansas City and back in one day for an appointment, fitting in appointments with the endocrinologist, nurses and counselors. They made it back in time for Joey’s band concert that night.
But Kansas City is out-of-network. The implant cost $14,000 out-of-pocket in 2019. Out-of-pocket costs for bloodwork and other appointments cost over $400 each. The family is saving up to ensure they have enough money. The next puberty blocker will likely be the last one needed before Joey can start supplementing with testosterone with a new physician wherever the family moves.
And they’re up against the clock. The Missouri Legislature is also considering a gender-affirming care ban for minors. Meanwhile, the state’s attorney general put forward temporary emergency rules to ban the practice in the state. The rules do not apply to Joey, his mother said, because there are some exemptions for people already receiving care.
“When your kid is going through puberty, you don’t have time to wait,” she said. “It’s a complicated and frustrating process.”
She equates treatment to other instances of medical treatment for children, such as pediatric cancer. While gender dysphoria doesn’t kill the same way cancer does, it can contribute to life-threatening mental illness.
“In making that decision with physicians, I won’t have 100% of the information I want in order to make that decision. Some treatments can come with potential negative side effects,” Joey’s mother said. “But you look at the research, and you make the decision that’s best for your kid. Why would they think parents would do anything else when it comes to trans kids?”
Regarding the possibility of Joey detransitioning when he’s older, his mother said she’d rather have a son who changes his mind than not have one. And she wants to make sure he feels supported by his parents.
“These children are political targets,” she said. “Our families are being used to score political points.”
Even though the family invested over a decade into their community – including promotions at work and volunteering for local organizations – it’s time to leave, Joey’s mother said.
“Our votes feel like a waste. Legislators don’t listen to us when we call,” she said. “We’re looking at leaving, but not because that’s what we really want to do. We won’t belong here with the way things are going, and we want to end up in a place where our kids will want to stay or come back to someday.”
That’s how things are going to go, Soye and Novstrup said. Soye added that she anticipated other families will move to South Dakota because of the ban. Novstrup said he’d “love everybody to stay in South Dakota.”
“These are children of God, they’re my brothers and sisters,” he said. “But I can’t change all of my rules to make South Dakota fit what you want to fit. I have to try to do what’s best for the children of South Dakota.”
Finding support: Transformation Project raises $5,000
The Transformation Project, an advocacy group based in Sioux Falls, offers support for travel expenses, lodging or other costs associated with out-of-state travel through its South Dakota Trans Resilience Fund.
The group has already raised $5,000. Susan Williams, executive director of the organization, hopes to raise $50,000. Joey’s family has not received support from the fund yet. There are also grants available to pay for care, Joey’s mother said
In Minnesota, the phone has been ringing for months from out-of-state people at OutFront Minnesota, an advocacy group based in Minneapolis. While its work has focused primarily on Minnesota state and local policy, its mission has extended beyond its border to support the “continuity of care,” said Kat Rohn, executive director.
“Folks are weaponizing these policies against good science and medicine,” she said. “This is new for people in terms of familiarity, but it isn’t new in terms of medicine.”
The organization’s goal is to support people in states with bans to organize, live, work and build community in those states.
“The choice between access to care and living in the state that you know and love is heartbreaking, and we can’t just sit by as folks are forced to make those choices,” Rohn said. “LGBTQ+ folks will continue to be in those states; trans kids will be born in South Dakota who need support. The answer can’t just be ‘move to another state.’”
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Joey’s mother recognizes that. Every ally who shows up at a rally or parade or writes in to legislators has helped support Joey, boost his spirit and helped his family make it through, she said. Even if Pierre “isn’t listening,” those children notice when people show up for them.
But that’s not enough to convince Joey’s family to stay.
“I worry about those we leave behind. We definitely realize that South Dakota only gets worse if people don’t stay and fight,” Joey’s mother said. “But fighting the good fight sometimes feels like you’re slamming your head against the wall, and we just don’t have time to wait.”
