Growing up Transgender in the South: Legislative Attacks, Suicide Prevention, and Advocating for a Path Forward

As a transgender woman who was able to begin receiving gender-affirming care in my youth while living in rural Arkansas, I deeply understand the stakes that the anti-trans legislation that has been proposed across the country, particularly in the South, holds for young transgender people. I began my journey with the American Foundation for Suicide Prevention (AFSP) at the age of eleven when I started participating in AFSP’s Out of the Darkness Walks all across Arkansas ten years ago after the loss of my great-grandfather to suicide. My mom, Tabitha Childers, served on the AFSP Arkansas chapter board of directors for ten years, was on the Governor’s board for suicide prevention under the Asa Hutchinson administration, and used her 20 years of experience as an ER nurse to serve our community and share the importance of suicide prevention.

For transgender kids, having access to gender-affirming health care and being in schools that support and uplift them and their identities can be the difference between life and death. Forty percent of transgender youth have attempted suicide at some point in their lives, a statistic almost four times higher than their cisgender counterparts, for a community that makes up less than 5% of the population. Over 500 anti-LGBTQ laws were proposed across the country in the 2023 legislative session, including bills to (1) prohibit gender-affirming care and (2) implement exclusionary and discriminatory school policies. Examples include:

Gender-Affirming Care Restrictions

• Montana SB 99, Tennessee SB 0001, and Texas SB 14 prohibit gender-affirming care for transgender youth, including puberty blockers and hormone therapy.
• Oklahoma SB 1777, New Hampshire HB 1660, and West Virginia HB 4857 prohibit public health insurance programs, such as Medicaid and CHIP, from covering gender-affirming related health care for minors and/or adults.

K-12 School Discriminatory Policies & Restrictions

• Kentucky SB 150, Iowa SF 496, and Pennsylvania HB 319 limit or prohibit classroom discussion on LGBTQ issues, prohibit or limit participation in questionnaires or surveys that address human sexuality, gender identity, and/or mental health (i.e., CDC's Youth Risk Behavior Survey), and allow parents to opt children out of mental health services.
• North Dakota HB 1522, New Hampshire SB 272, and Indiana HB 1608 prohibit schools from adopting a policy on respecting and accommodating a student’s gender identity and/or require personnel to “out” students

As a transgender woman, I am concerned about the number of bills across the country introduced that will be harmful to LGBTQ youth and increase risk for suicide. As someone who has dealt with their own mental health struggles and thoughts of suicide, I know how unsupportive school administrations and teachers, and lack of access to gender-affirming health care and mental health care, can further the harm that transgender youth experience. The poor mental health outcomes and increased risk of suicide attempts among trans youth across the country is reflective of the significant mental and primary health care gaps that are only worsened by harmful legislation.

I had the privilege of transitioning at a time when trans youth were not as visible in the public eye, and while there were other pieces of legislation introduced that were harmful to the LGBTQ community, gender-affirming care wasn’t being targeted or restricted. There were very few doctors in Arkansas providing gender-affirming care at the time, and their clinics were not advertised. It was through connections in my community that I was able to access this care. With the support of my mother and grandmother, my team of doctors, and my community, I was able to begin my medical transition. If you’re cisgender, the pain and mental suffering that comes with gender dysphoria is not one that I can easily describe. For youth that aren’t able to access gender-affirming services, this suffering is only worsened.

This is why the advocacy work of AFSP is so vital and necessary — in particular, its nationwide community of Volunteer Advocates, who help urge public officials at all levels of government to prioritize suicide prevention and mental health. Anyone can get involved through AFSP’s advocacy Action Center. It can be as simple as getting monthly alerts about key bills and policies that need your support and clicking a button to help voice your concern. Many volunteers get involved at deeper levels as part of AFSP’s grassroots movement to make a difference on these and other key policy priorities related to suicide prevention and mental health.

We must stand together against systemic harm against LGBTQ youth and spread awareness around these critical issues. We must demand that trans youth have access to gender-affirming care and a positive, non-discriminatory school environment.

If you’re reading this and thinking, “How can I help?” please know that there are many steps you can take to be an ally to these youth. While mass collective action is what needs to happen to address the systemic abuse that LGBTQ people face, there is still a lot that you can do as an individual. The three most impactful things you can do to support LGBTQ youth are:

1. Foster open conversations about mental health (with everyone in your life, not just LGBTQ youth)
2. Learn more from AFSP about LGBTQ mental health and suicide prevention including how to help, crisis resources, and LGBTQ suicide research, as well as public policy related to LGBTQ suicide prevention
3. Educate those around you about the attacks on LGBTQ youth and why these are harmful. Further resources can be found at thetrevorproject.org

I’ve learned a lot about grief from losing my great-grandfather to suicide. What you rarely hear people talk about are the unique emotions experienced when grieving a loved one who died by suicide. The stigma still often associated with suicide and mental health is deeply ingrained in our society. Suicide is often preventable, and my own struggles have reinforced the belief that everyone deserves access to competent mental health care, and that suicide prevention resources need to be readily accessible, especially to those who are most vulnerable. Education and awareness are tools of power, and these tools can save lives.

By banding together as a society and in our individual communities, we can advocate for a path forward and create a world where suicide isn’t a leading cause of death.

Sign up to become an AFSP Volunteer Advocate.

If you are in distress, have lost someone to suicide, or are worried about someone, you may find support here.