Emiliana Edwards joked and laughed with her friends as they inflated rainbow-colored balloons to help prepare for the Sun City Pride Youth Prom, knowing that her future in the community she became a part of is uncertain as a transgender teenager in Texas.
The possibility of having to leave the state she calls home has become a potential reality for kids like Emiliana and their families as state lawmakers prepare to ban Texas doctors from providing transition-related medical treatments to anyone under the age of 18. This includes puberty blockers, hormone therapies and surgeries — though experts say they are rarely performed on children.
Senate Bill 14, which restricts transition related care for transgender minors, is headed to Gov. Greg Abbott’s desk after garnering approval from both legislative chambers and clearing its final hurdle last week when the Senate voted 19-12 to approve the House’s version of the bill. During a Fox News interview a week ago Abbott vowed to sign the bill into law.
“I’m not going to make any secret about it. I’ll be signing it,” he said. “This is about protecting children.”
If signed, the ban will take effect on Sept. 1, and require trans kids like Emiliana to stop taking the medications which her mom, Lori Edwards says have allowed her to thrive.
“Before I felt like I was putting on a mask to fit in with everyone else,” Emiliana told El Paso Matters during an interview. “When I was able to take my blockers it felt like I could actually be who I felt I really was.”
SB 14, authored by New Braunfels Republican Sen. Donna Campbell, was one of dozens of bills introduced during the spring legislative session meant to restrict the rights of LGBTQ+ Texans, which drew fierce backlash from advocacy groups from around the state. If the bill passes, Texas will join the list of over a dozen states that restrict transition-related care for trans minors, including Florida, Montana and Arkansas.
Now Edwards said her family is faced with the option of uprooting their lives and moving to a state that allows minors to receive transition-related care, or staying and traveling to nearby New Mexico for treatment. Still, she worries the latter may not be possible after 2022,the year Abbott issued an order directing the Department of Family and Protective Services to launch abuse investigations into reports of transgender children receiving gender-affirming care.
Though El Paso County Attorney Jo Anne Bernal said her office would not investigate gender-affirming care for transgender children as child abuse following Abbott’s announcement, some parents are still concerned.
“The ambiguity of the language of the bill has us worried because now we don’t know if we are okay to stay (in Texas) if I continue to get her care somewhere else,” Edwards said.
Nydia Reveles, whose 10-year-old child is gender-nonconforming, began considering leaving Texas with her family in 2022 over Abbott’s order. Eventually, the slew of anti-LGBTQ bills introduced during this year’s legislative session convinced her to pack up her family of five and start a new life in New Mexico.
“It started with Abbott’s directive to the DPS, but it just got progressively worse and worse,” Reveles said. “I was watching in shock and disbelief that Senate Bill 14 passed. That was when I said okay, we need to go,” Reveles told El Paso Matters in an interview.
Though Reveles said her son, Santi, identifies with the gender he was assigned at birth, how he expresses himself and dresses doesn’t usually align with that.
“He dresses in what is typically considered to be girl clothes, he loves what’s typically considered girl toys,” Reveles said. “He’s 10, so we want to give him space to just be. It shouldn’t be a problem for him just to wear a dress and have his hair long like he does.”
Reveles said Santi is too young to take puberty blockers or hormones but wants to ensure he and his siblings have the option to take them if they ever want to transition.
“We would consult with our pediatrician and you know, all of the people that know better than we do because we trust the experts,” Reveles said.
What is gender-affirming care?
Emiliana deals with gender dysphoria, the feeling of discomfort or distress because her gender identity doesn’t match her sex assigned at birth. Edwards said Emiliana, now 16, struggled for the first 11 years of her life until she realized she was transgender.
“She tried so hard to pretend to be the boy that everyone wanted her to be and she was miserable. In general, her peers constantly verbally accosted her and made her feel as though she wasn’t boy enough,” Edwards said. “So when she was finally able to identify herself as being transgender, she had such an increase in her self-esteem. She wore her transgender identity as a galvanized suit of armor.”
It wasn’t until Texas lawmakers started targeting LGBTQ identities that Emiliana’s mental health began to decline.
“Only now (is she) experiencing suicidal ideation. Only now (is she) experiencing mental health concerns regarding being transgender,” Edwards said. “I am right now in the process of sitting at her bedside nightly to make sure she’s okay because this bill has terrorized her to the point that she’s not. She vacillates between feeling like life is worth living and that it’s been taken completely out of her control.”
Though transgender youth show higher rates of mental health issues and suicide risk, these rates can vary based on the way they are treated.
Studies have found that transgender youth who receive gender-affirming care have lower odds of depression and suicidality, and those who take puberty blockers are less likely to experience lifelong suicidal ideation than those who want them but can’t get them.
Reveles said these findings are the main reason she wants to ensure her kids have access to gender-affirming medical care if they need it.
“We love our children and so when we saw how high the suicide rates were (for LGBTQ kids) I did everything that I can to make it clear to my children that they are accepted no matter what,” Reveles said.
Dr. Toni Ramirez, a local family medicine physician who has in the past offered gender-affirming care to minors in California, explained that it is usually a gradual process that can vary based on the child’s needs.
“The process usually begins honestly by just having conversations with the patient and the family about how they’re feeling, what their identity is, and how it’s played out over their lifetime,” Ramirez told El Paso Matters.
The care usually involves social transitioning like changing the child’s name, pronouns and the clothes they wear to suit their identity better, she said. As the child gets older, doctors may prescribe puberty blockers — a medication that stops the release of sex hormones during puberty — or hormone treatments like estrogen and testosterone. Ramirez said this takes time and requires a therapist’s approval before the medication can be prescribed.
De-transitioning in Texas
Under SB 14 trans minors receiving gender-affirming care in Texas would need to be “weaned off” their treatment in a “medically appropriate” manner.
Edwards said the measure would be devastating for Emiliana, who has already been taking hormones for over a year.
“I don’t know what it would do to her mental health at that point,” Edwards said. “If we stay and they were to take her off of blockers and take her off of the estrogen, what would happen is that she would begin to go through a male puberty after having already been through this development in a female body, which means that would leave her in between.
“I’m sure that would be devastating to anyone on this planet, but to somebody who’s already experiencing (gender) dysphoria, that could be the difference between life and death.”
“The changes that would happen to me would be irreversible and that’s something I don’t really want to go through,” Emiliana added.
During a debate of SB14 on May 12, state Rep. Joe Moody, D-El Paso, proposed an amendment that would have allowed minors to continue receiving transition-related medical care as long as they started treatment before June 1. It failed along with 18 other proposed amendments filed by House Democrats.
Seeking care amid a ban
As SB 14 progressed through the legislature, LGBTQ groups like the Borderland Rainbow Center began making plans to ensure trans kids in El Paso are supported once it goes into effect, though they are not sure what that could entail.
“We’re exploring with community partners and allies what good plans and solutions might look like,” said Ashley Heidebrecht, the director of the center’s Diversity and Resiliency Institute of El Paso.
The Borderland Rainbow Center offers gender-affirming care through mental health, social services and community outreach. Heidebrecht said the bill’s ambiguous definition of a medical provider could hinder some of that work.
“There’s some areas and language in the bill that we’re not quite sure yet what that’s going to look like as it gets implemented, and how open to interpretation it’s going to be,” Heidebrecht said.
As a border city, parents seeking gender-affirming medical care for their trans kids may look across the border to Juarez or New Mexico as a solution. Though the bill does not restrict minors from traveling out of state to access puberty blockers or hormones, it prohibits CHIP and Medicaid from covering those treatments. Even with private insurance, advocates worry that traveling out of state for care could risk their children being taken away.
“There are other bills that have been put forth this session that are in various stages in our legislative process that specifically amend the definition of child abuse to include things like gender-affirming care,” Heidebrecht said. “If any number of these other bills were to pass, that can lead to a whole host of issues for these families.”
For now, Emiliana and the Edwards family remain in limbo, unsure of what their next step will be if SB 14 goes into effect.
“At first, it was kind of this state of shock that I was in. I didn’t want to leave the memories that I made here,” Emiliana said about the prospect of leaving Texas. “But I’ve moved before and it takes time to get used to the things that happen around you. I’m hoping that I’ll be able to overcome it like I did last time.”
Reveles said the move to New Mexico has been bittersweet for her family, who is excited to start anew, yet heartbroken to leave some of the ones they love behind.
“We’re sad that we’re leaving the community,” she said. “But ultimately we want the kids to be safe, and Texas is increasingly not.”
TrevorLifeline offers 24/7 confidential crisis intervention and suicide prevention for LGBTQ youth at 1-866-488-7386.