Dylan Brand Life as a trans teenager in a small northwest Arkansas town was never easy. A high school junior who lives in Greenwood with his mother and younger brother, Brandt said he’s far from the most popular guy in town.
“The majority of people were great, but a small group made it very clear that they didn’t want me there, that I didn’t fit in or didn’t belong.”
Still, Brandt said, enduring the snubs and rudeness was worth the benefits that came with his gender transition. A thin, deep-voiced young man with an enviable beard, Brand says that after years of anxiety and confusion, his body finally feels right. “My outside is finally how I feel inside,” he explains.
Brandt and his mother, who challenged Arkansas’ ban on sex-determining medical care for minors, testified Wednesday about Brandt’s change and the devastation they feel about the state’s efforts to block it.
Amanda Dennis Bentonville, the mother of a transgender 10-year-old girl, also testified Wednesday, along with two doctors from the Gender Spectrum Clinic at Arkansas Children’s Hospital. Gender dysphoria.
Attorneys from the American Civil Liberties Union, representing the plaintiffs in the case, closed their arguments Wednesday afternoon. Arkansas state attorneys general will question some of their witnesses Friday in support of a 2021 ban on sex-determination medical treatment for those under 18. But scheduling conflicts mean they may have to pick it back up sometime in the future to complete the testimony, perhaps in the last week of November US District Judge James Moody can make its judgment on the constitutionality of Act 626.
Witnesses so far this week have been a mix of medical professionals and people directly affected by Arkansas’ ban. Earlier in the week, doctors testified about the benefits of cross-sex hormone treatments in treating gender dysphoria and the depression, anxiety and suicide risk that often accompany it.
All those who testified Wednesday spoke more specifically to what is happening on the ground in Arkansas with the Legislature’s 2021 vote to ban the state’s doctors from providing puberty blockers, testosterone and estrogen to transgender youth. Those treatments are still available to treat other conditions, but cannot be used for transgender patients under the age of 18. Act 626 also makes it illegal to refer young patients to other providers for these services. Challengers say the law discriminates on the basis of sex and that it violates doctors’ free speech rights because such treatments are not prohibited for minors with other conditions.
State attorneys have not yet begun presenting their case, but are expected to question the quality and conclusions of data and evidence on medical treatments for transgender youth. The law’s sponsors called it the SAFE Act, which means “protect adolescents from experimentation.”
The only transgender teenager to testify so far shares with Brand how confusing it is to know her body isn’t right, but to not understand it. “It’s hard to deal with the feeling in my chest when someone perceives me as more feminine, because I don’t understand why this happens.”
The onset of puberty worsened the feeling. “It was hard to look at myself in the mirror and see my body changing and know it wasn’t what I wanted.”
He came out to his mother as transgender at age 13, putting the family through a years-long and ongoing process that included therapy, lots of research, and eventually some medical interventions to stop Brandt’s periods. Eventually, Brand began testosterone treatments to deepen his voice, reshape his body, and grow a fashionable beard.
He used to avoid the cameras, but says he likes them now. “Yearbook pictures are one of those crazy things you don’t really think about until you see them and you’re proud, when you weren’t before.”
his mother, Joanna BrandShe says she’s always been supportive of her son’s gender identity, but also wary of treatments, soaking up all the information she can, confident she’s making the best decisions possible.
“As with every other medical decision I make with any of my children, I always want to put their health and well-being first. I’m just questioning everything.
She said she has no regrets about going ahead with testosterone treatments for Dylan. “I liken it to feeling like he’s been holding his breath for years and he’s finally able to breathe and relax. The changes I’ve seen in him are remarkable. The deeper the voice, the bigger the chin, the more aligned his outward appearance is with the person he knows himself to be, he’s lit up. I love it. Everyone around noticed it.
Dennis’s daughter reported a similar spark with Brooke when Brooke first began using she/her pronouns and presenting as a woman. Dennis says she now feels a lot of angst and fear as her daughter approaches puberty, and that transgender youth may struggle with body changes they don’t want. The Dennis family’s situation is particularly timely because, despite Judge Moody issuing an injunction to prevent Act 626 from taking effect in July 2021, the Gender Spectrum Clinic at Arkansas Children’s has shut down medical treatment options, at least until this trial is completed. Any new minor transgender patients pending a court ruling in this case.
Leadership at Arkansas Children’s has made the decision to continue puberty blockers and cross-sex hormone treatments for existing patients, but not to offer those medical interventions to new patients beginning in February of this year, Dr. Michelle Hutchison Said. A former director of the clinic and initially a plaintiff in the case, Hutchison moved to New Mexico a few months ago and was dropped as a plaintiff. But she returned to Little Rock Wednesday to testify.
Hospital leadership’s decision to withhold medical gender-affirming care options for patients who have not already undergone such treatments, along with a statewide blanket ban any minute, will weigh heavily on the Dennis family.
Brooke Dennis leaned against her father’s shoulder as they watched as her mother testified about her growing uneasiness over their lack of options. As the first signs emerged that her body would soon become more masculine, Brooke’s anxiety grew, her mother said. The family, whose jobs, parents and lives are in Bentonville, will travel to Colorado for any treatment Brooke needs if Arkansas forbids it, or they can move to Colorado altogether.
Neither option is good, says Amanda Dennis. They have three children firmly established in school and life in Bentonville, and aging parents in Arkansas mean they have responsibilities here as well. Logistically and financially, a simple trip to Colorado is difficult. A wholesale move out of state is on the table, but difficult to even contemplate, Amanda Dennis said. But like other families who have sued the state over the ban, the Dennises haven’t ruled it out.
After morning testimony from Hutchison and the new director of the Gender Spectrum Clinic, afternoon testimony from Amanda Dennis and Dylan and Joanna Brandt, Dr. Kathryn Stambo. Both doctors describe the progress of their patients, many of whom have overcome paralyzing anxiety and gained confidence through medical treatment to alleviate their gender dysphoria. Hutchison said he expects some transgender adolescents to die by suicide if these treatments are not available in the future.
“I’ve seen with my own eyes what happens to these children who are deprived of access,” she said. When Arkansas lawmakers began debating the issue in early 2021, she said, four clinic patients who attempted suicide at Arkansas Children’s were hospitalized, and two or three more were hospitalized at other facilities. Anxiety levels in their patients have increased significantly, she said.
Under cross-examination from state attorneys, doctors Hutchison and Stambo talked about the side effects that come with medical gender-affirmation treatments. Puberty blockers are less effective because their effects are completely reversed once patients stop taking them, Stambaugh said. Testosterone raises cholesterol and blood pressure. Infertility is possible but not guaranteed with gender reassignment.
In more than 300 cases she treated at the Gender Spectrum Clinic in 2018, Hutchison said, some patients and their families explored puberty-blocking and/or cross-sex hormones and chose not to use them. Some took small steps, such as using medication to suppress their periods, but opted for no further medical interventions, and others started hormone therapy. None expressed regret about seeking treatment for their gender dysphoria, she said. Not all young people who sought these treatments received them; Doctors postponed or refused treatments until some patients were deemed to fit the criteria.
Since the Gender Spectrum Clinic stopped treating new patients in February, Stambo said, five puberty-blocking patients and 44 people in need of cross-sex hormones have been turned away.
The judge cleared the courtroom for part of Wednesday’s hearing so state attorneys could ask Hutchison questions about the medical histories of the plaintiffs in the case.
The trial was adjourned on Thursday. Defense of the ban will begin in the state at 9 am on Friday.