Uncloseted Media published this article on May 12.

Editor’s note: This article includes mention of suicide and contains details about those who have attempted to take their own lives. If you are having thoughts of suicide or are concerned that someone you know may be, resources are available here.

By SAM DONNDELINGER and ANASTASSIA GLIADKOVSKAYA | The first panic attack Quinn Pulsipher remembers having was at 8 years old. They describe it as “a pitch-black ghost that hugs them all over and tries to control their mind.” At the beach on vacation with their family, the wind suddenly picked up, and Quinn began hyperventilating, screaming and crying uncontrollably. Nothing could calm them down.

After that first episode, the panic attacks occurred whenever there was a storm, sometimes even when there was just a light breeze.

By the time Quinn was 14, they were “spiraling down.”

They began failing most of their classes. They rarely left their room, even avoiding going to the store with their mom.

Quinn, who is nonbinary, says the deterioration of their mental health was related to the rejection they received for their identity. At school, teachers continued to misgender them even after their records were updated. They endured cyberbullying, transphobic slurs from classmates and lawmakers across the country restricting their rights.

For those six years, Quinn cycled through five therapists who, according to their mom, Hilary, did not understand the challenges Quinn faced as a queer kid.

Hilary spent hundreds of hours searching for help — filling out intake forms, sending emails and calling therapists across Utah — only to get to the scheduling stage and repeatedly hear that providers “weren’t willing to treat a trans kid.”

The therapists who agreed to work with Quinn often failed to understand how being transgender intersected with their anxiety and depression. Some confused gender identity with sexuality. Others dismissed the idea that Quinn’s gender identity could be connected to their worsening mental health.

One night, after a teacher refused to use their pronouns, Quinn reached a breaking point. They came home and cried for hours.

“The feelings were too much,” they told their mother. “I shouldn’t have to fight for my pronouns and name to be used.”

“They kept repeating, ‘I just can’t do it anymore,’” Hilary told Uncloseted Media and Fierce Healthcare. “So I flat-out asked if they were suicidal, and they said ‘yes.’ I was terrified. I prepared myself for the possibility that my child might not be alive when I checked on them.”

Hilary scheduled an emergency appointment with a nonbinary therapist Quinn has now started seeing after getting off a six-month waitlist.

“It didn’t fix everything,” says Quinn. “But what helped was talking to somebody who got it. [My therapist] is just so kind, respectful, calm and accepting. I don’t know any other way to describe just how amazing it is to have someone like this.”

“I feel so lucky we found [their therapist] when we did because I could have lost my kid,” Hilary says.

As almost 1 in 4 American teens identify as LGBTQ, affirming therapy can be life-saving. Yet availability is shrinking. Access to mental healthcare for LGBTQ youth dropped from 80 percent to 60 percent from late 2023 to late 2024, according to the Trevor Project. And in 2025, though 84 percent of LGBTQ youth wanted mental healthcare, 44 percent of them could not get it.

Over four dozen interviews with transgender teens, their families, clinicians and researchers reveal a fragmented health system plagued by long waitlists, prohibitive costs, parental consent complications and a shortage of affirming providers. Clinicians receive little to no formal education on LGBTQ health, often leaving young patients to repeatedly explain their identities in spaces intended to support them. Many LGBTQ youth say they have encountered provider homophobia and transphobia. These barriers are compounded by political hostility and school environments where bullying is pervasive.

“It’s really a wall of barriers and there’s these layers and layers of obstacles that, taken together, make accessing care feel impossible,” says Lana Lipe, a licensed clinical social worker and private practice therapist serving queer patients in Indiana.

“Not only is the need growing, but there’s not enough resources,” adds Jenna Glover, chief clinical officer at Headspace.

The journey to affirming providers

On every major mental health and suicide risk indicator, queer youth struggle more than their heterosexual peers. Analysis of 2023 national data found that queer youth are more likely to experience persistent feelings of sadness or hopelessness (66 percent versus 31 percent), poor mental health (54 percent versus 22 percent) and suicidal ideation (41 percent versus 13 percent). They were also more likely to attempt suicide (20 percent versus 6 percent).

Experts stress that the mental health struggles of queer youth are not inherent to their identities. Rather, they exist because of the minority stress they experience. Six in 10 LGBTQ teens experienced bullying in the past year. And those who did reported significantly higher rates of attempted suicide.

“They’re struggling because of what’s being done to them, and what isn’t happening for them,” Lipe says.

Finding affirming providers is difficult in part because there is no mandated LGBTQ cultural sensitivity training for mental health professionals in the U.S. And when training is offered, experts interviewed for this story agree that it’s not sufficient.

“We know that affirming care saves lives,” Lipe says. “The question isn’t whether we can do better; it’s if we’re willing to.”

From 2009 to 2010, medical school curricula included an average of only five hours of LGBTQ-related content, one study found. By 2022, that average had increased to 11 hours, which some maintain is still inadequate. Dustin Nowaskie, a psychiatrist and founder of OutCare Health, a nonprofit offering LGBTQ health resources and provider training, has argued that med schools should require 35 hours of LGBTQ training.

“This leaves the burden of educating providers to patients,” Ellesse-Roselee Akré, assistant professor at Johns Hopkins Bloomberg School of Public Health, told Uncloseted Media and Fierce Healthcare. “It has an impact on people’s willingness to receive care, people’s willingness to continue getting care and contributes to a lot of people finding alternative ways to self-medicate and treat their health themselves.”

Daniel Trujillo, a trans teen from Arizona, was lucky enough to find an affirming therapist.

As early as 3 years old, Daniel expressed his gender identity in drawings. His parents were paying attention and helped Daniel socially transition at 8 years old, which included a haircut and new clothes. Soon after, they found Daniel an affirming care team, including a psychologist for whom they paid out of pocket.

“They had had years of experience navigating how to support transgender youth and how to talk us through things we didn’t know, and help us better understand the needs of our child,” says Daniel’s mother, Lizette Trujillo.

Daniel, now 18, saw his therapist for about eight years. “During my tween and early teen years, it felt really important to have someone to help identify things I was going through,” Daniel says. “As I got older … it was more just someone to debrief with.”

The Trujillos, who have long advocated for trans rights in legislative sessions, moved to Spain in 2025 to keep their family safe due to the current political attacks on trans rights in the U.S. The move meant Daniel could no longer see his therapist.

“The political climate has made it harder and scarier for parents to say that they support their children,” Lizette says.

One way that LGBTQ patients can find providers is through online directories. GLMA, the national association of LGBTQ and allied health professionals, maintains a public list of over 5,000 queer-affirming providers, which it says is the largest online directory of its kind.

To be approved, providers must attest to their approach to LGBTQ care, thereby signaling their commitment to an affirming practice. GLMA reviews each provider’s online presence for anti-LGBTQ activity or affiliations, including social media posts and ties to Southern Poverty Law Center-designated hate groups. In cases where a provider has a limited or no online footprint, GLMA may request professional references. Providers are also asked questions to test their competency in LGBTQ topics and training.

“To be an affirming provider means that you are meeting patients exactly where they are,” Alex Sheldon, GLMA’s executive director, told Uncloseted Media and Fierce Healthcare. “It’s more than just checking a box that says, ‘I’m not going to outright discriminate against you.’ We ask for folks to go a little bit further in their exploration of their own educational ability. … Did you receive LGBTQ-specific training in medical school [or while you pursued your doctorate]? Have you published any LGBTQ related materials? Do you do research in the space?”

In a survey of 375 providers, the findings of which have not yet been published and were shared with Uncloseted Media and Fierce Healthcare, OutCare Health found nearly half of providers stated that the current political climate has made them feel more cautious about being publicly visible as an LGBTQ-affirming provider. “We have witnessed … a shrinkage of LGBTQ+ providers and practices,” Nowaskie wrote in an email.

There are many ways to deepen knowledge. Providers can voluntarily engage with medical association-accredited trainings from organizations like OutCare Health or Violet, which offer provider training on marginalized populations. Companies can either mandate these trainings or offer bonuses to clinicians for completing them.

Violet’s training revolves around a few key questions including whether providers feel confident in their knowledge of a given identity and whether they know what therapies are appropriate. Violet can then track if the training led to changes in provider behavior and patient outcomes.

Violet has seen steady interest in its LGBTQ health training: across 2024-2026, over seven hours of education per provider were completed each year, suggesting sustained engagement. And the number of providers who completed LGBTQ education grew 51 percent on the platform, from over 7,600 to nearly 11,600.

Headspace’s Glover says LGBTQ education should not be a specialization: “It should be a general part of education that any provider should be able to provide this level of care.”

Schools can be a source of pain or support

The lack of affirming providers has real-world effects. It took Ella Sutton, a 15-year-old trans girl from Fredericksburg, Va., years to find an affirming therapist to help with her anxiety and depression and to deal with the daily bullying she experienced. Ella’s mom, Angela Sutton, says that many therapists who use the tag “trans-accepting” themselves still lack expertise.

“They say LGBTQ-affirming and LGBTQ-welcoming, but … do you know how to deal specifically with gender dysphoria, body dysmorphia, all of the unique and complex things that go along with being trans? Ella is still having to explain who she is over and over again. They don’t even have that concept or grasp of it because, where’s the training?” Angela says.

In 2024, Ella and her family left Florida, where she had been bullied for being trans to the point of fearing riding her bike outside. After researching Bloomington, Ill., Angela felt it would be a safe home for her daughter, joking that half of the 1.6 percent of the population who identify as trans in the U.S. live in Bloomington.

But a few months into seventh grade, Ella was beaten unconscious in a school hallway.

In footage of the attack as described in a lawsuit, another student — who had been overheard saying she would “bully this girl until [she] transfers” — approaches her from behind, pulls her hair and forcefully and repeatedly slams her head to the ground until Ella loses consciousness. She then punches her in the face until someone pulls her off.

“She has officially lived the purest form of hate,” Angela says. “She was only four feet tall and 50 pounds at the time. She is a kid.”

After the attack, Ella was diagnosed with a concussion, a potential traumatic brain injury and post-traumatic stress disorder, according to the family’s lawsuit against the school. She says the trauma left her feeling unsafe and severely disrupted her education and well-being.

“I was just really depressed and I was always in bed. … I couldn’t eat more than a few crackers a day. All I did was sleep,” Ella told Uncloseted Media and Fierce Healthcare. “[The hate and bullying] just kind of makes you feel like a burden and like you shouldn’t be like the person that you are, even if that’s who you should actually be.”

When done right, schools can offer crucial opportunities for community, resources and support, but they are increasingly a breeding ground for bullying and political threats. Queer students reported their school climate felt more hostile during the 2024-25 school year due to an anti-LGBTQ political climate, a Glisten survey found, and over two-thirds of respondents faced harassment or assault because of their gender identity or expression.

Some states have instituted explicit policies to repress LGBTQ identities. In Florida, schools must abide by so-called “Don’t Say Gay” laws that restrict K-3 classroom instruction on sexual orientation or gender identity and prohibit all employees in K-12 public schools from using students’ preferred pronouns. Teachers must also report changes to a student’s name, pronoun use or restroom use to parents, which effectively outs children who haven’t told their parents about their identity. In Ohio, teachers are required to notify the parents if a student requests to identify as a gender that doesn’t align with their biological sex.

And even in Massachusetts, a blue state with the country’s only Commission on LGBTQ Youth, schools have become tight-lipped in their support, whether out of fear of losing funding or retaliation from parents. “Almost all districts [have] some anti-LGBTQ activity,” the commission’s executive director, Shaplaie Brooks, says. Examples include parents opting students out of LGBTQ-inclusive education; rejection of parent advisory councils meant to ensure LGBTQ inclusivity; bullying from students and rejection from educators; and administrators requesting flag removal or other material signaling affirmation.

Not ‘the next Nex Benedict’

Angela didn’t want Ella to be “the next Nex Benedict,” referring to the nonbinary 16-year-old who was beaten unconscious by kids in a school bathroom and later died from the injuries.

Even before the bullying started, she created an extensive integration plan with Ella’s junior high school. All was going smoothly until a teacher accidentally deadnamed Ella while taking attendance, even though the records were updated. From there, bullying “spread like wildfire,” according to Angela. And once it began, Angela exchanged over 60 emails with school administrators to ensure that the bullying would stop, but to no avail.

The school did not respond to Uncloseted Media and Fierce Healthcare’s request for comment.

Beyond attacks on queer rights, some lawmakers are deprioritizing mental health in general. In 2025, just a month after President Donald Trump ordered the closure of the Department of Education, the agency ended $1 billion in grants meant to train and support mental health professionals who work in schools. And in Indiana, Republican legislators removed teacher training requirements related to social-emotional learning and cultural competency.

Schools are the most common institutional entry point into mental healthcare for youth. But staffing models vary wildly. Some districts have well-staffed health centers, while others share a single provider across multiple schools. Half of all U.S. schools cite inadequate access to a licensed mental health professional as a top factor limiting their ability to provide mental health services to students, according to KFF, a nonprofit research organization.

The share of schools reporting inadequate funding for mental health services has grown since 2021 and resources vary by state. In California, public school students on private or government insurance qualify for free therapy and counseling. Meanwhile, Alabama ranks last nationally in mental health access, with many rural districts struggling with staffing shortages and inconsistent funding. Last June, 16 states successfully sued the DOE over terminated grants, with funding restored for those states by a federal judge in October.

Even organizations trying to support schools are hitting roadblocks. Bring Change to Mind, co-founded in 2010 by actress Glenn Close, operates a national student-led high school club program focused on mental health. In 2025, the organization found that 92 percent of registered club participants said they take better care of their mental health as a result.

Bring Change to Mind had spent seven years building out its high school program in Indiana with the support of the state education department. The organization also launched a middle school pilot at the agency’s request. But in 2025, its DOE funding was not renewed. “I have to find money elsewhere, until things change,” says Pamela Harrington, the organization’s executive director.

And last month in Minnesota, administrators shut down student attempts at Benilde-St. Margaret’s to start a mental health club, despite Bring Change to Mind offering seed funding. The school is near where a shooting took place last year, and the club was intended to support students struggling with the tragedy.

Harrington has also noticed that many students have stopped self-identifying as LGBTQ over the past several years. Registration for the organization’s annual student summit is down, even though participation is up. “Some students don’t feel safe registering,” she says.

Crisis care is another first entry point for many

All of these barriers may be contributing to a surge in youth going to the hospital in a mental health crisis. From 2011 to 2020, despite an overall decrease in pediatric emergency department visits, the portion of mental health-related ED visits by kids and teens soared, with the sharpest increase for suicide-related visits.

In New York state, Northwell’s Cohen Children’s Medical Center sees a disproportionate number of kids who are queer. Whether it’s bullying, depression, anxiety, trauma or suicidality, “all the rates are much higher for these kids, they’re much more vulnerable,” says Vera Feuer, the former vice president for child and adolescent psychiatry at Northwell, who left the organization in April. “Because community access is so difficult, we are often the first mental health providers that these families ever see,” says Feuer, who is now the chief clinical officer of the Child Mind Institute.

She says the main reasons kids end up in the ED for mental health are suicidality and self-harm, or behavioral problems like aggression. Conflicts involving sexuality or gender identity are often part of the trigger, and can get worse in a hospital environment if staff are not properly trained. “Feeling like you add value to the people around you versus feeling like you’re a burden, are really important components of suicidal crises,” Feuer says.

Many patients in the ED deal with trauma. And while evidence suggests that trauma-informed care has a positive impact on patients, the approach isn’t always used in EDs. The psychiatry team at Northwell is trained to be trauma-informed and affirming, which could look like wearing a Pride badge, asking a patient their pronouns or determining if they want to disclose their identity to their parents.

Feuer says even in cases of significant self-harm, some parents are “in utter denial” about their child’s identity. They might see the behavior as attention-seeking and be more concerned about their school test the next day. “The parent is also in crisis, and their brains don’t work particularly well when they’re with us,” she says.

When Ella was admitted to Carle Foundation Hospital in Illinois after the attack at school, Angela says she was offered “zero resources.”

Speaking generally about the hospital’s policies, Holly Cook, director of the Carle Foundation Hospital ED, wrote in an email that the ED has multiple protocols in place for patients experiencing mental health crises, including referrals to the outpatient psychiatric team and community mental health resources. “The top priority … is keeping the patient safe, treating the patient with dignity and helping to explain the processes as they occur,” Cook wrote.

But Angela says none of those supports were offered to Ella after her hospitalization. She says they were left without referrals for counseling, trauma services or clear guidance about where Ella could receive ongoing emotional support.

“The hospital ER doc was aware of the situation,” Angela says. “They didn’t even give me the proper ‘victim information’ paperwork that includes those types of resources. … We got nothing regarding mental health resources from the hospital. … I ended up finding resources on my own for crisis counseling because I just really needed somebody to help my kid.”

A Carle Health spokesperson declined to comment on Ella’s case, citing HIPAA, and reiterated the hospital’s priority of patient safety and dignity.

In other parts of mental healthcare, resources are strained. Last year, the Trump administration cut the LGBTQ-specific option on the 988 suicide hotline, even though suicide rates dropped 11 percent below projections since its rollout. And the 10 states with the largest 988 service uptake saw rates drop 18 percent below projections.

All of this is occurring when research demonstrates that LGBTQ youth who are able to access affirming mental healthcare report lower rates of suicide attempts.

Angela, aware that her daughter needed urgent support after she was attacked, found Project Oz, an Illinois nonprofit that provides survival aid to youth. They provided crisis care weekly to Ella, which helped her process the trauma of the attack. But the care was limited to six weeks due to their care model.

“She really listened and included my [trans identity] in the care,” Ella says. “I wish I had a little bit more time because I got to a point of recovery but it wasn’t complete. I get it could only be six weeks, but it takes time to process this stuff.”

“My biggest barrier to mental healthcare has honestly been people not understanding,” she says. After searching for years, Ella has found a trans therapist that Angela says “sees all the trans youth in [their] town.”

After working with him, Ella’s self-harm has reduced from an average of once a month to only once in the past six months.

“I’m happier. I’ve worked through my struggles a lot more and [don’t] keep it in the back of my mind because that’s what I used to always do. I would just avoid my problems.”

Parental consent Is a significant barrier to care

Ella was fortunate to have her mom in her corner. For many LGBTQ youth who need mental healthcare, getting their parents on board can be a barrier. Family rejection has among the strongest associations with suicidality and poor mental health in LGBTQ youth.

Jessica Schleider, an associate professor at Northwestern University, came across this in her research as director of the school’s Lab for Scalable Mental Health.

When she initially required parental consent for teen participation in youth mental health research, it led to homogenous samples. But when the researchers secured university approval to waive parental consent for future studies, “samples suddenly became about 80-85 percent LGBTQ, from 5-10 percent,” Schleider says. Through follow-up studies, it became clear that fearing parents was often the reason teens avoided care.

This revelation prompted Schleider to lead a study analyzing parental consent laws for mental healthcare around the country. In 2024, she found that a third of states have laws prohibiting teens from independently consenting to therapy. In these states, the study found teens with depression were significantly less likely to get treatment. Things have likely gotten more restrictive since then, per Schleider.

“Parental rights movements have really been sweeping recently, and a lot of these laws are getting more stringent,” says Schleider. The movement hinges on a “push for parents to be involved in every facet of their children’s lives to their detriment,” Schleider adds.

Trans youth are much more likely to experience homelessness than their peers and are overrepresented in foster care. Getting kicked out of their home for identifying as LGBTQ further complicates access. Will they have an ID? Will they know their Social Security number? What about transportation? “We have a healthcare system that’s built on forms and insurance cards,” says Lipe, the private practice therapist in Indiana. “When you don’t have those things, getting access to long-term care or even just routine care becomes impossible.”

Schleider says states, both red and blue, don’t realize the extent to which parental consent laws create barriers to accessing care. “It reflects how these structures and systems are all built, which is without youth input,” she says.

Astrid, a 17-year-old in central Florida who didn’t want her last name included for safety concerns, says that her mental health struggles are fueled by her parents’ rejection of her trans identity. She says these struggles are compounded by the fact that it’s been difficult getting her parents on board with seeking consistent care.

Astrid has experienced depression and anxiety and has self-harmed since she was 10. As therapy helped lessen her gender dysmorphia and body dysphoria as she transitioned, it was a blow when her family had to change insurance and their provider was no longer in network.

“I just can’t have this fight with my parents again,” she told Uncloseted Media and Fierce Healthcare. “It took so long to convince [them] to let me try therapy. … They just think I should occupy myself more, and it will distract me.”

As a result, Astrid has not been in therapy for the last two years.

LGBTQ youth who report living in very accepting communities attempted suicide at less than a third of the rate of those who live in very unaccepting communities, per the Trevor Project. “That’s why chosen family, chosen community is so important,” says Glover. “That’s the basic safety net that we need.”

With his family’s and care team’s support, Daniel Trujillo never experienced suicidality, his mother says. “He’s proof of what happens when you affirm and you love someone,” Lizette says.

Freedom of speech makes it harder to police harm

Once parents are on board, navigating the network of providers and discerning who may be affirming or rejecting still remains a challenge. To demonstrate this, Avery, an 18-year-old from Mississippi, opened up his laptop to Psychology Today, a therapy provider directory, to find a therapist. Avery, who is questioning his gender and has been in and out of therapy for six years to help with his anxiety, depression and suicidal ideation, filters for “transgender” therapists, and only a handful in his area appear. When he adds another filter looking for therapists who work with trans people with autism, zero results turn up.

“There’s a big difference between mental healthcare and good mental healthcare,” says Avery, who asked to use only his first name for safety reasons. “A lot of queer people are dealing with complex cases. I have autism and I want to be able to work with someone who understands that as well as my gender.”

Avery describes a long history of therapy providers who were unequipped or dismissive of his gay identity. Several therapists avoided engaging with his gender questioning altogether, leaving him feeling ignored.

There were more extreme scenarios. He says one therapist used a form of Eye Movement Desensitization and Reprocessing, a type of psychotherapy often used for PTSD, suggesting that his sexuality was something he could change.

“He said, ‘Have you considered that identity is culturally constructed and that you could just construct an identity that’s not gay?’” Avery says. “It made it hard to trust therapists for me.”

With Colorado’s ban on conversion therapy being overturned by the Supreme Court on free speech grounds last month, therapists now have more legal protections to use nonaffirming language with clients. Beyond that, the ability for LGBTQ-affirming therapists to practice freely in certain states is being challenged. In March, Texas’s attorney general issued a legal opinion declaring that the prohibitions outlined in a law that makes it illegal for healthcare providers to “transition” kids also apply to certain mental health providers. This limits what they can say in sessions.

“They want to make any mental healthcare for trans kids that is affirming punishable but they are saying free speech protects conversion therapy, so that is hypocritical in our minds,” GLMA’s Sheldon says. “It is going to be a very challenging landscape for mental health providers.”

If you find it, can you afford it?

Even when you identify an affirming provider, finding one that takes insurance is another battle. According to the Trevor Project, affordability was the top reason queer youth couldn’t access care in 2025, with 46 percent reporting they could not afford it.

Many therapists don’t accept insurance, citing difficulties in becoming in-network with payers and low reimbursement rates.

“We’re quite literally pricing kids out of survival,” Lipe, the therapist in Indiana, says.

Aaron Martin, a licensed marriage and family therapist with a virtual private practice in San Francisco, accepts several commercial insurance plans. And his reimbursement rates are not only low but also sometimes delayed. For over a month, Martin was owed over $1,000 by a major insurer. Chasing them down by phone meant wasted time that could’ve been spent seeing patients. “It becomes this really awful game,” Martin says. “It makes a lot of sense why providers are just opting out [of insurance] altogether.”

The Savannah Pride Center offers therapy for free or as low as $5, regardless of insurance status. But getting in is challenging. Parental consent is required, and there is a waiting list. “We definitely saw an uptick in clients right after the election,” Michael Bell, the center’s executive director, says.

The path forward

To combat the shortage of providers, especially in more rural areas, experts interviewed for this story agree that telehealth has emerged as a powerful medium to support queer patients. Use of telehealth for mental healthcare has increased in schools, though some schools are parting ways with virtual providers as federal COVID-19 relief funds expire.

“Technology is here,” says Ashwin Vasan, a physician and epidemiologist and the former commissioner of the New York City Department of Health and Mental Hygiene. “Let’s make it better. … When you do that, you can actually steer it towards meeting the needs of the most vulnerable.”

Virtual providers like Charlie Health are seeing the positive impact. In 2025, 43 percent of Charlie Health’s patients identified as LGBTQ, many of whom struggle with suicidal ideation. “Virtual care can really meaningfully change access and safety equations,” says Caroline Fenkel, co-founder and chief clinical officer at Charlie Health. For example, for trans youth who have not had top surgery, being able to log on virtually where they only have to show their face can feel more comfortable.

Though telehealth can help in some cases, policy change is needed. Akré, of Johns Hopkins Bloomberg School of Public Health, says the barriers trans youth face are systemic, not individual. “Our mental healthcare system as it’s designed, is not really meant to accommodate individuals with diverse identities,” she says.

Echoing Akré, Lipe notes chronic stressors like poverty and disability don’t have an easy fix: “We don’t currently have solutions that match the complexity of that problem.” Some social needs are addressable, like transportation to care. “Anything we can do to help reduce those barriers, so that they can access those types of services, is critical for upstream prevention,” Lipe says.

While expanding LGBTQ-specific training for providers is often cited as a solution, Akré argues that education alone won’t fix the problem. “It doesn’t change behavior at scale — policy does.”

In addition to mandating training requirements, Akré recommends stronger accountability for discrimination in care and clearer reporting systems so patients aren’t left “reporting into a black hole.” Without those structural changes, she says, trans youth will continue to navigate a system that too often requires them to fight for care at the very moment they need it most.

When it comes to schools, Glisten, a national nonprofit advocating for LGBTQ students, says queer kids feel safest when reports of bullying are taken seriously. Glisten recommends that bullies should be held accountable, with parent involvement, and schools should support students in organizing gender and sexuality alliances.

In the absence of sweeping policy changes, non-therapy tools remain a key access point. Schleider’s lab runs Project YES, a free online mental health support tool that offers referrals to local or crisis resources. Within the tool, users can access Project RISE, designed for LGBTQ youth, which teaches skills to overcome internalized stigma.

“I definitely believe that’s our best bet, particularly for these historically stigmatized groups, where changing laws and policies is going to take too long,” Schleider says.

For Quinn, things are still hard, but their affirming therapist has changed how they move through tough moments.

After years of shutting down when things felt overwhelming, Quinn’s biggest change, according to their mom, is their ability to express what they want and need.

“[Their therapist] was kind of the catalyst for us to find a gender clinic and start on estrogen and puberty blockers,” Hilary says.

Quinn says they feel more themselves and feel more engaged with life. Their mom has noticed.

“I went to Costco the other day, and they wanted to come with me,” Hilary says. “That didn’t used to happen. I get to see my kid again.”

Neither the Society for Adolescent Health and Medicine nor the American Academy of Child and Adolescent Psychiatry, which publish clinical guidelines for providers, responded to multiple requests for comment.

U.S. Sen. Edward Markey (D-Mass.) is urging acting Attorney General Todd Blanche and William Marshall III, director of the Federal Bureau of Prisons, to reverse a policy affecting transgender inmates that lawmakers say is “endangering” their “health and safety.”

Markey, along with U.S. Sens. Jeffrey A. Merkley (D-Ore.) and Mazie K. Hirono (D-Hawaii), sent the letter that the Washington Blade verified on Monday.

The letter is a direct response to a change in prison policy that went into effect in February 2025, rolling back Biden-era protections for trans inmates. The senators described how President Trump’s Executive Order 14168, titled “Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government,” forced a policy shift they argue is rooted more in political rhetoric than in medical research or evidence-based correctional practices.

In the letter, the lawmakers wrote “On Feb. 21, 2025, the BOP issued a memo to implement President Trump’s EO, requiring BOP staff to ‘refer to individuals by their legal name or pronouns corresponding to their biological sex,’ banning the use of funds for any ‘items that align with transgender ideology,’ and suspending clothing accommodations, pat search accommodations, and support programs offered to transgender individuals.”

“In a second memo, issued one week later, the BOP banned the use of federal funds for ‘any medical procedure, treatment, or drug for the purpose of conforming an inmate’s appearance to that of the opposite sex.’ These changes have resulted in the denial — or threatened denial — of hormone treatment and gender-affirming accommodations for transgender individuals in BOP custody.”

“On Feb. 19, 2026, the BOP escalated its attacks, issuing a program statement titled, ‘Management of Inmates with Gender Dysphoria.’ It prohibits incarcerated people from receiving gender-affirming care, even if paid for with private funds. This practice forces incarcerated people to discontinue care, regardless of medical recommendations.”

The senators continued, “The agency has repeatedly enacted policies that strip transgender individuals of their gender identity and dignity. This includes requiring staff to refer to transgender individuals by pronouns that ‘align with their biological sex’ rather than gender identity and to confiscate gender-affirming items, such as undergarments, clothing, cosmetics, and wigs.”

“These policies risk triggering mental health crises, including increased suicidality, among incarcerated people with gender dysphoria. The BOP’s repeated guidance to roll back gender-affirming protections — despite a federal court order finding that the BOP’s actions to discontinue gender-affirming care are likely unlawful — generate confusion about the current state of regulations and convey the BOP’s indifference to court orders and the rule of law.”

“By stripping away appropriate medical and psychiatric care, safety protections, and measures to provide dignity, the BOP is exposing transgender individuals to significant harm.”

The Marshall Project, a nonprofit newsroom focused on the U.S. criminal justice system and immigration enforcement through data-driven reporting, also reported on the policy change. The outlet spoke with Shana Knizhnik, an attorney with the American Civil Liberties Union, about the impact of the changes.

“It’s clear that this new policy is a ban on gender affirming healthcare,” Knizhnik, who works for the nationwide chapter of the ACLU said. “This is a policy that disregards the medical needs of our plaintiffs.”

The letter also asked the BOP and the DOJ specific questions regarding why the policy went into effect, as lawmakers suggested the changes appear politically motivated rather than based on new medical evidence regarding treatment for trans inmates.

The senators requested answers to these trans policy-specific questions by May 21, including:

“Does the BOP plan to monitor and assess the impacts of recent policies that eliminate gender-affirming medical and psychiatric care?”

“Since January 20, 2025, how many transgender, nonbinary, intersex, and gender-diverse individuals have been transferred to a different facility to meet the EO’s goal of housing individuals ‘according to their biological sex?’”

“Given that the BOP has stopped enforcing Prison Rape Elimination Act regulations related to gender identity and collecting data on gender identity, how will the BOP protect the physical and emotional health and safety of incarcerated transgender individuals?”

“How does the BOP plan to monitor and assess the impact of eliminating protections against sexual violence for this population?”

“Does the BOP plan to institute a specific process by which transgender individuals may seek assistance or lodge complaints regarding harms they experience from the recent BOP policies and actions implementing President Trump’s EO?”

“Describe the specific criteria the BOP intends to use to determine whether it will allow a ‘social accommodation’ for gender dysphoria.”

Markey also included a personal statement to the Blade explaining why he is using his position on Capitol Hill to push for more information and advocate for reversing the policy.

“This administration continuously shows their contempt for trans people and a total disregard for their rights and humanity. As part of this cruel campaign, the Bureau of Prisons has systematically stripped health care access and basic protections from trans people, abandoning its duty to the people in its custody. I won’t stop fighting until this administration’s hateful anti-trans policies are reversed and trans people’s rights are secured.”

The Blade reached out to the DOJ and the BOP for comment but had not received a response at press time.

Former U.S. Rep. Barney Frank (D-Mass.), who served in the House from 1981 until his retirement in 2013 and who became the first member of Congress to voluntarily come out as gay in 1987, has resurfaced in the news over the past two weeks after announcing he has entered home hospice care and plans to publish a new book on, among other things, how Democrats can and should regain control of Congress.

According to media reports and an interview Frank conducted this week with the Washington Blade, his book, entitled “The Hard Path to Unity: Why We Must Reform the Left to Rescue Democracy,” calls on the Democratic Party’s progressive left leaning members to be more strategic in pushing for laws and policies initially considered “politically unacceptable” to most U.S. voters and the American people.

Frank told the Blade he believes the LGBTQ rights movement has succeeded in advancing most of its agenda seeking protections against discrimination by initially pushing less controversial advances such as the end to the ban on gays in the military and non-discrimination in employment before taking on the more controversial issue of same-sex marriage.

While acknowledging that Congress has yet to pass a national law banning discrimination against LGBTQ people in employment, housing, and public accommodations as 22 states and D.C. have already done, he points to the two landmark U.S. Supreme Court decisions, one legalizing same-sex marriage nationwide in Obergefell v. Hodges in 2015, and the other declaring sexual orientation and gender identity are protected categories for which employment discrimination is prohibited under existing federal law in Bostock v. Clayton County in 2020.

Frank notes that while some in the LGBTQ community are fearful that LGBTQ rights are under attack and may be pulled back under the Trump administration, he believes Republicans in Congress at this time will not attempt to repeal any existing LGBTQ protections, especially those regarding marriage rights and employment protections secured by the Supreme Court rulings.

He says transgender rights are the remaining LGBTQ issue that have yet to be adopted rationally, and he fully supports ongoing efforts to advance trans rights. But like his criticism of the progressive left among Democrats, Frank says the efforts to advance trans rights could be jeopardized by the highly controversial issue of “male to female transgender people playing in women’s sports.” 

He added, “That’s the most controversial, the most difficult. It affects the fewest number of people.” While he says trans rights supporters should continue to advocate for that, “they should not make it a litmus test and say well if you’re not for that you’re not a supporter of the rights of transgender people. There are places where people are supportive, and we want to encourage that.”

Frank, 86, told Politico he has entered home hospice care as he deals with ongoing congestive heart failure. He said he is remaining in his home in Ogunquit, Maine, where he has lived with his husband, Jim Ready, since retiring from Congress in 2013.

“I’ve been doing some writing. I wrote this book,” Frank told the Blade. “I’ve relaxed. Meanwhile, my health has been failing. Jim has been a saint in taking care of me,” he said. “And so, I take it easy.”

Frank spoke to the Washington Blade in a phone interview from his home on May 4.

Washington Blade: We’re hearing some interesting reports about the book you’ve been writing. Can you say when it will be published?

Barney Frank: Sept. 15 is the publication date.

Blade: Some of the reports about the book in the media have said you want the far left within the Democratic Party to be more cautious.

Frank: No, I’ll give you this. The job is to defeat populism to keep democracy. Clearly you have to know what caused it. I believe that the essential cause in the surge of populism was economic inequality and the failure of mainstream liberals to address inequality. And beginning in the ‘80s economic growth became less and less fair in its institutions. And that led to all this anger.

So, the mainstream left finally figured that out after [Bernie] Sanders and Trump in ’16.  So, we then – because I was working to make that change – got the Democrats to pay attention to economic inequality. And Joe Biden’s program did. The problem is at that point, people on the left who had correctly been critical of the failure to address equality said, OK, that’s not the only problem you guys are missing. There are all these other problems.

And they jumped from being right on the question of inequality and equality to believing in a lot more social changes, some of which were just unacceptable to the public. And the mistake they make is they don’t distinguish – there are a lot of issues I’ve been for in my life, but I had to assert that they were not currently politically survivable.

So, you do two things. Those that are politically survivable work to get them done. Others, you become an advocate. But you don’t make the most controversial part of your agenda litmus tests and drive away your allies. You will remember that on marriage that was an issue and in 2000 they insisted you will be for marriage.

So, my thesis is that while the mainstream understood its mistake on inequality, the most militant and ideological of our left misunderstand public opinion and they are pushing the public to — and they are insisting on acceptance of things that are not politically acceptable.

Blade: Having said what you said, how do you see that impacting gay rights or LGBTQ rights? 

Frank: Well in the first place, gay rights – one of the things I want to address – is this fear that gay rights are going to be taken away – rights for LGB people. Nonsense. We’re not going to lose any of those rights. If they tried to undo marriage, for instance, the political reaction they would get would be abortion type sentiment. They are just not going to do that because it causes them too many political problems.

The problem is advances we hope to make in the area of transgender people. But there is no chance of losing – I can’t think of a single right that is in jeopardy. They are not going to reintroduce the ban in the military. They’re not going to tell people their marriages are cancelled. Again, the Republicans are not even trying to do that because they know there would be a terrible backlash. 

With regard to LGBT there is one analogy. And that is the most controversial issue we faced over the years on what was the gay-bisexual agenda was same-sex marriage. And we left that until the end. And you remember we did the military. We did ENDA. We moved on to everything else, and it wasn’t until the very end that we went into marriage. [NOTE: ENDA did not ultimately pass.]

 I think the analogy to that is male to female transgender people playing in women’s sports. That’s the most controversial, the most difficult. It affects the fewest number of people. And I believe had we deferred on marriage — people who believe that’s important should advocate for it. But they should not make it a litmus test and say well if you’re not for that you’re not a supporter of the rights of transgender people. There are places where people are supportive, and we want to encourage that.

Blade: You said you don’t think we will lose any rights, most of the laws related to nondiscrimination are from the states or municipal laws that were passed.

Frank: Tell me what you think will be lost. You and I always have this problem. I’ve always felt you were cynical and skeptical. Tell me what right we now have that’s in jeopardy.

Blade: One would be if the Supreme Court reverses its decision on same-sex marriage.

Frank: If they do, Congress would now step in on that, which would be the passage of Tammy Baldwin’s bill.

Blade: But what I was going to ask you next is in all the years you’ve been in office and as of now a federal LGBTQ rights bill has not been passed by Congress yet. Is there a chance of that happening?

Frank: I do not think it will happen because the members of Congress do not want to be in the position of voting to cancel people’s marriages. There are valid marriages throughout the country. And the notion that Congress will pass a bill invalidating those, no they won’t. They won’t do anything that’s as disruptive and that will cause a strong reaction. Have you seen a federal bill to do that? I haven’t.

Blade: No, and I am sorry if I’m not putting the question across correctly. I’m talking about the bill that bans discrimination based on employment, public accommodations and other areas for LGBTQ people that Congress has not yet passed. You co-sponsored that for many years.

Frank: I know that, and the Supreme Court did that one. No, I don’t think that – oh, all right, that’s a different question than marriage. If the Supreme Court reverses itself on that – I don’t see any sign that they’re going to, then I think you would see the federal bill passed.

 [He is referring to the 2020 U.S. Supreme Court decision that employment discrimination against gay, bi, and trans people was equivalent to sex discrimination, which is prohibited under Title VII of the Civil Rights Act of 1964.]

Blade: Are you talking about marriage?

Frank: For both for marriage and for non-[discrimination] – I don’t think a marriage bill would pass nationally. To distinguish, I don’t think a bill striking down marriages would pass. Too much violent reaction. As to employment discrimination, where they haven’t acted yet, if the Supreme Court changes that – I think that’s extremely unlikely – then I think Congress would step in.

Blade: Are you saying we may not need an LGBTQ non-discrimination act by Congress for the states that haven’t passed that?

Frank: I would be in favor of that, yes. But again, I think you and I – you have always been pessimistic. There is a political time now that works in our favor. And as I said, on abortion, they burned themselves very badly on abortion. And yes, I’m still for a national anti-discrimination bill. But I do not think the right wing wants to be caught taking rights away that already exist. Because that’s a lot harder than denying them in the first place. And I don’t see any movement for that. You tell me what you are worried about. What bills are you worried about? 

Blade: I was simply saying they haven’t yet passed a federal non-discrimination bill. 

Frank: No, what’s going to change on the Supreme Court? I don’t see a pretty quick reversal on the Supreme Court. So, I think people are just – they have to have a cause. And they are inflating the likelihood that we are going to lose some rights when I see no evidence of it. And in fact, I see a lot of political reasons why those in Congress don’t want to do that.

I’ll tell you there are a lot of Republicans who would vote for same-sex marriage. For example, the leadership would say for Christ’s sake, don’t bring that up. They don’t want to take a position on it. And they got burned on abortion, badly. 

Blade: To the extent that you are observing this, do you think the LGBTQ rights organizations are doing what they should be doing?

Frank: Well, I think some are stressing the negative too much. Because when people believe nothing good ever happens, they may get discouraged. I think they should be concentrating on the transgender issue. And I know the most controversial parts are protecting people’s rights to medical care, their rights selecting their own gender. And that’s what I would be working on. 

And yeah, it would be nice to pass the national bill. I don’t think that’s going to happen. Well, if the Democrats get the House, the Senate, and the presidency, maybe it will happen. But I don’t see the urgency of that because I don’t see any movement to reverse the Supreme Court’s decision.

Blade: What message would you have for the LGBTQ community?

Frank: My message is one, we’re in good shape. And two, that what remains in the transgender issue – who is first? Which are those of your issues that are the most politically acceptable. And you work your way through and as you win on some of those the resistance on the tougher ones will diminish. And the other issue is we are – the problem is the stand to protect the rights of transgender people. But the rights for lesbian, gay, and bisexual people, I do not think they are in jeopardy and I do not think a lot of resources should be spent on being what I think is a very small threat.

Blade: For those states and municipalities that do not have laws protecting LGBTQ people from discrimination, do you think attitudes are changing so there would be little or no discrimination?

Frank: Oh, no question. First of all, I think it’s very unlikely that any of the rights they have will be taken away. And secondly, if they had to take some positive steps to take away protections they would not do it. And I think that ship has sailed in our direction and isn’t going back. In the end, you cannot underestimate there’s a big political difference between denying people their rights in the first place and taking it away from them after they’ve enjoyed it.

Anything is theoretically possible, but I don’t see any evidence that’s likely to happen.

Blade: We’re coming up to the midterm elections this year, but is there anyone coming up in the next presidential election who you might be supporting?

Frank: Oh, I think at this point we’re going to have a fairly open Democratic process. And it’s very clear at this point the way American politics is going it will be a basically supportive Democrat against a basically opposed Republican. And I’ll be supporting the Democrat. And so, this Democrat would be the best one, the most electable. And which one, I haven’t decided that. I want to see how people will fare when they start running.

But I think it is inconceivable that the Democrats would nominate someone who is not fully supportive.

Blade: Some people might be asking what you have been doing since you retired from Congress.

Frank: I’ve been doing some writing. I wrote this book. I’ve relaxed. Meanwhile, my health has been failing. Jim [husband Jim Ready] has been a saint in taking care of me. And so, I take it easy. In terms of what I do, I have two rules, two pieces of advice for people who retire. One is that you should  make up two lists. One is you should have a bucket list, a list of things you want to do before you’re through. But more important than the bucket list is a list that rhymes with bucket. That’s a very important list. And that’s one that I increasingly defer to.

Blade: And what is the one other than bucket?

Frank: It rhymes with bucket. What rhymes with bucket?

Blade: Oh, OK.

Frank: That’s the list I follow.