Providers of gender affirming care say anti-trans bill will be a direct cause of suicide
Stacie Pace talks about gender affirming care at her clinic, Spectrum: The Other Clinic, in Hattiesburg, Miss., Friday, February 3, 2023. Credit: Eric J. Shelton, Mississippi Today
HATTIESBURG — As the owners of the only clinic in Mississippi that exclusively provides gender-affirming care to trans people, nurse practitioners Stacie and Lee Pace get a lot of hate mail. But more frequent are the emails from trans kids, who write to the clinic just to say “I’m so glad you exist.”
Stacie always writes back.
“That’s really sweet of you,” she’ll say. “Keep living. You’re so brave.”
In 2021, the same year that lawmakers banned trans athletes from competing on teams that match their gender identity, the Paces started accepting a handful of trans teenagers – 16 and 17 year olds — as patients. Today, Spectrum: The Other Clinic — the blue house on a busy street — is likely the only one in the state writing prescriptions for trans kids. But they may not be able to for much longer, if the legislative session proceeds as expected.
This year, Mississippi lawmakers have filed more than 30 bills aimed at curtailing the rights of LGBTQ+ Mississippians. Following behind Alabama and Arkansas, lawmakers fast-tracked one in particular: House Bill 1125, the “Regulate Experimental Adolescent Procedures” (REAP) Act. If passed, it will immediately ban evidenced-based “gender transition procedures” like puberty blockers and hormones for trans minors, as well as surgery, even though lawmakers could not name a single instance of that happening in Mississippi.
Gov. Tate Reeves has indicated he’ll sign the bill, calling it a “step to preserve the innocence of our children.”
Once in effect, providers who continue to prescribe hormones or puberty blockers to trans kids would lose their license. The bill permits civil lawsuits against anyone who “knowingly … aids or abets the performance or inducement of gender-transition procedures” to minors for up to 30 years. To minimize liability, the Paces think they would not only be forced to stop providing care to trans kids the day the bill is signed, they’d have to cut off contact entirely, pushing Spectrum, a beacon of hope for their patients, further out of reach.
The stakes could be life and death. Mississippi’s estimated 2,400 trans teenagers are at a high risk of suicide. Nationally, trans youth attempt suicide at a rate more than four times their cisgender peers. Research has repeatedly shown that gender-affirming care, a form of treatment that aligns patients’ physical features with their gender identity, significantly boosts the chances that trans kids will live to see adulthood.
No lawmakers have reached out to the Paces about the bill. But the couple has something to say. Sitting on a brown sofa in Spectrum’s colorful waiting room, next to a fake ficus tree draped in trans flags, Stacie delivered a blunt message to lawmakers. If there was one thing lawmakers should know about HB 1125, Stacie said, it was this.
“Kids will kill themselves — period,” she said.
“The number one thing, if this bill goes into effect? A lot of dead kids,” she continued through tears. “This law goes into effect, it is, in my opinion, the direct cause of youth suicide.”
Her tone turned sarcastic.
“And congratulations to the people that sign on to it.”
The Paces opened Spectrum thinking a bill like HB 1125 would one day be law. It was 2019, the height of Trump’s presidency, and in Mississippi, there were already limited options for trans adults seeking gender-affirming care, much less trans kids and their supportive parents. Most drove out of state to New Orleans or Mobile, and some would go once a month to an LGBTQ-focused clinic at the University of Mississippi Medical Center in Jackson.
Spectrum intervened in that reality. The Paces put the clinic in Hattiesburg, dubbed the “Hub City,” to be accessible to all corners of the state. They used their savings to paint the drab, gray walls rainbow and buy playful decor like plushie unicorns, multi-colored lamps and subscriptions to LGBTQ+ magazines. Patients drive from across the state, just to confirm a place like it exists in Mississippi.
Any provider can write a prescription for gender-affirming care, but the Paces spent hours seeking out firm guidelines from established medical organizations like the Endocrine Society and the World Professional Association of Transgender Health. They charge a $38 monthly fee, a fraction of the typical cost for endocrinology.
A private clinic, Spectrum is not beholden to grants or funding. They don’t take insurance so that if gender-affirming care is no longer covered, it can still offer services. Before Stacie or Lee write a prescription, an independent physician must confirm a patient can go on hormones. Parents and trans kids hoping to start hormone therapy have to initial a four-page-long checklist of potential side effects, then get it notarized.
“We’re not just taking anybody who walks through the door and saying, you can just go on it because we say that you’re healthy enough,” Stacie said.
Over time, the prescriptions will make a difference by changing a patient’s physical appearance. The presence of the Paces in their patients’ lives helps, too. They give out free binders, a chest-compressing undergarment, and host game nights in a tea room named for Marsha P. Johnson, trans activist who was part of the Stonewall Uprising.
In this way, the Paces try to go beyond the oath of “do no harm,” a basic promise of medical care that is routinely denied to trans people who face rejection and even violence from health care providers. According to a 2015 survey, 2% of trans people have experienced physical roughness or abuse from a provider.
“That number should be zero,” Stacie said. “It may not sound like much, but have you ever gone to your primary care doctor, and they punched you in the face?”
One of Stacie’s patients has permanent visual damage from such an incident. She’s had multiple patients who were assaulted by their parents after coming out as trans. Then there’s the chronic social discrimination that denies the existence of trans people like businesses withholding services under a religious exemption or teachers refusing to use the right pronouns.
“If you grow up and your parents and your siblings and your classmates and your teachers and the school counselor and your healthcare provider don’t believe you — even if they’re not mean to you — but you have this feeling of wrongness and nobody helps you? You get poo-pooed and your concerns don’t matter?” Stacie said. “That will kill a person inside rather quickly.”
This reality is all the more upsetting, Stacie said, because the solution is devastatingly simple. If trans kids have just one supportive adult in their life, the suicide rate drops by a third.
“Just to say, ‘I believe you,’” Stacie said. “How hard is that?”
Quick-witted and goofy, Stacie usually serves as the face of Spectrum, arguing with “keyboard warriors” (her favorite comeback is “fart face”) and filming YouTube videos on the 101s of transitioning. But it’s Lee, more quiet and contemplative, whose work is really in the cross-hairs of HB 1125.
When the Paces started admitting trans kids, they decided that Lee would be the one to work with them because of his background in family practice. He can also relate to trans youth in a more direct way than Stacie can. When Lee was 11, he told his dad, a horse-racing entrepreneur from New Orleans, that he felt like a girl. What he meant was that he didn’t want to go shrimping and hunting; he wanted to stay home with his mom. His dad thought he was gay and beat him.
Now, Lee just wants trans kids to get the loving acceptance he was denied.
“If I could be somebody that I wish I had back then, (I’d say) this has nothing to do with sex, this is gender, and sometimes it takes time to figure stuff out,” he said on a podcast earlier this year.
Lee typically starts the first visit by asking trans kids when they felt something was “different” about them (usually early childhood). His patients often talk about their dysphoria as easily as describing a tummy ache.
Then he’ll explain that the process of transitioning doesn’t happen overnight. For most trans teenagers, it typically takes two to three years for hormones to take full effect. That’s a reality, Lee says, of which trans youth are highly aware. By the time they’re seeing him, they’ve already jumped through a series of expensive and time-consuming hoops: Mental health evaluations, physical exams, lab work. Then finally, maybe, Lee writes a script, first for puberty blockers, then possibly hormones a few months later.
And that’s if their parents are on board. In the past two years, Lee has seen about 30 trans kids for a consultation; less than half had parental consent to move forward with treatment.
“I’ve never had a parent ever say, ‘My child is transgender and you must do something now and as quickly as possible,’” Lee said. “They want to know the side effects. They want to know the ramifications. They want to know a timeline. And if anything, most of them, all of them, are worried about if their child will be accepted. And they’re worried about their safety.”
Gender-affirming care, Lee said, is often about buying more time and giving trans kids the opportunity to see all the possible roads their life could take. Transitioning, Lee said, “is not just a whimsical decision that they make. It’s something that they’ve thought about in the context of life and death. Do I want to die? Or do I want to proceed and transition?”
If HB 1125 passes, he’s scared of the choice trans kids might make.
On Jan. 31, a key legislative deadline, Stacie watched on the livestream as a Senate judiciary committee discussed HB 1125.
The chairman, Sen. Joey Fillingane, R-Sumrall, breezed through an overview of the bill. The author of Mississippi’s 2007 anti-abortion trigger law, Fillingane told committee members he had researched the bill over the weekend and was going to support it because there are “parents out there, alleged parents, who are doing these things to their children, making life changing decision, some of which are irreversible.”
Fillingane’s comment echoed what many lawmakers have said when speaking publicly to support the bill, sometimes likening gender-affirming care to child abuse.
“We’re talking about these kids that can’t make these decisions for themselves,” he said, adding later, “We’re talking about minors who have no control over what is done to their bodies because some parent decides, ‘oh, I think he oughta be a she or she oughta be a he.’”
“Unfortunately, a lot of it is being driven by money,” he concluded.
In her office, Stacie threw her head back and laughed. Fillingane’s comments were so out of touch with the reality of gender-affirming care, they felt mythical to her. The Paces make less money running Spectrum than they did as registered nurses — there’s no profit in providing health care to a community that, due to widespread job discrimination, is among the country’s poorest.
She wished that just one lawmaker — Democrat or Republican — had asked her or Lee to come testify to the health care they provide every day. Maybe then, she could’ve told them what she’s heard from patients nearly every day since HB 1125 passed the House.
“I’ve had so many people, before any of this happened, who came to us and said, ‘the only reason I’m alive today is because I knew you were here,’” Stacie said. “Now these same adults are saying, ‘this would have crushed me.’”
Instead, all she’s heard is silence. So far, no leading medical organization in Mississippi has taken a position on the bill. The State Board of Medical Licensure, which would enforce the bill’s provision revoking providers’ licenses, didn’t respond to questions from Mississippi Today. The State Department of Health declined to discuss HB 1125 because “this would not be in our purview.” A spokesperson for the state-funded UMMC, home to the TEAM Clinic, said, “we have no comment for now.”
Trans Mississippians and allies are taking note. As the bill advances in the Legislature, they’re the ones protesting it, holding town halls, organizing rallies and talking every day in a mass email chain. Civil rights attorneys are rushing to deconstruct the bill and find to potential plaintiffs, hoping to replicate successful court challenges against similar bills in Arkansas and Alabama. And across the state, some of the few providers of gender-affirming care are speaking out.
On Twitter, Alex Mills, a Jackson-area pharmacist who has worked with trans youth, called on UMMC to condemn HB 1125. Gender-affirming care is a decision that “should be between the patient, their family and their healthcare provider,” he said, but HB 1125 will make trans kids feel like “it’s a crime to be who they are.”
Stacie and Lee are worried about the repercussions of going on the record. The clinic already gets regular emails calling them “evil,” “crazy” and “selfish ghouls.”
“If someone’s gonna get shot, it’s going to be me,” Lee said. “But I do want to stand up.”
They’re in the process of retaining a lawyer. They don’t plan to close the clinic, and they’ll continue to provide gender-affirming care — just not to kids.
“There’s this popular thing that people who are anti-trans like to say: Follow the science,” Stacie scoffed. “Yeah. You should give it a try.”