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On Wednesday, the Supreme Court ruled in U.S. vs Skrmetti to uphold a ban on gender-affirming care for minors in Tennessee. The effects of this devastating decision extend far beyond Tennessee to the other 24 states that currently have similar bans in effect, and it will likely embolden others to try to establish new ones.

In light of these restrictions, many supportive families of transgender youth must choose to travel or even move out of their home states to give their children the lifesaving care that they need. This urgency is not just for getting the care quickly, however; there is also a fear that, under the Trump administration and Republican-led Congress, total federal bans of youth or even adult care may be enacted.

This is a fear I know well, despite living in Washington, one of the friendliest states for trans care in the U.S. When Trump was reelected in November, my biggest and most immediate worry was what the result meant for my access to hormones and surgery.

All my life I had felt disconnected from my body, a feeling that only got worse as I got older with increasing body image and sexual issues. I was never happy with myself but tried hiding in a shell of masculinity to escape. This never worked and had the opposite effect, driving me deeper into depression. It wasn’t until the forced solitude of COVID-19 that I really began to introspect, and it didn’t take much for the realization that I might be trans to hit me like a ton of bricks (an experience shared by many of my trans siblings). I shaved my beard and tried on a skirt, I looked in the mirror and realized, Yeah, I’m definitely trans. A month later, I started hormone therapy and never looked back.

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A year later, in early 2022, I began the yearslong process of jumping through the medical and insurance hoops—picking a surgeon covered by my insurance, approval for a consultation, waitlists, approval for electrolysis, more waitlists, getting enough electrolysis with overbooked clinics, yet more waitlists—to be able to get the vaginoplasty I was so desperate for. Once Trump took office earlier this year, I worried every day that this would finally be the one when his administration would order the ban on gender-affirming care that he had promised.

This March, after being on a waitlist for over a year, I received a phone call from my surgeon’s office saying we could finally move forward with scheduling. Since it had been so long since my consultation with them, I needed approval from my insurance again, which was estimated to take up to three months, and availability of a room for surgery was estimated as up to six months from there. The most optimistic estimate for when I would be able to receive my surgery was late July at best.

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As Trump began signing executive orders targeting LGBTQ+ people, showing the administration saw attacks on the trans community as a top priority, a ban on some adult care felt inevitable. Because my insurance was through my state’s Medicaid, I knew it was particularly vulnerable to political interference. I began to lose hope that I would ever be able to receive the care I had worked so hard for.

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It was for all of those reasons that when I received a phone call on April 8 saying I was approved for surgery as soon as May 15, I jumped at the chance. I was nowhere near ready, and I was on a trip out of my home state in Mississippi visiting my fiancée, who is there working toward her Ph.D. I had to rush through seven hourlong sessions of electrolysis in three weeks to prepare for surgery, which I was only able to afford thanks to a crowdfunding campaign. A week before surgery, my fiancée and I made the four-day road trip from Mississippi to the hospital in Oregon.

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My surgery went well, and recovery in the hospital was smooth. The night I was released to the hotel from the hospital, I finally got to see the results in a full mirror. I broke down crying, because, despite the bruising and swelling, for the first time in my life I was truly happy with who I saw. I finally felt like me.

The next day, the One Big, Beautiful Bill Act passed the House. The bill is exactly what I had feared, the kind of nightmare scenario that had driven me to accept the rushed date for my surgery. Among the many heinous provisions of the bill, the one that stood out most was the language banning coverage of gender-affirming care for people using Medicaid and the Affordable Care Act. According to the U.S. Transgender Survey, 34 percent of transgender Americans live in poverty, roughly three times the rate of Americans in general. For us, removing coverage from Medicaid is effectively a ban on adult care, since we wouldn’t be able to afford it out of pocket.

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Bans like these are scary for me as an adult, knowing that my health care could be yanked out from under me at any time. But a child without access to puberty blockers or hormones has to watch in real time as their body develops in a way antithetical to how they identify. For a trans girl to grow an unwanted beard and feel her voice drop, or for a trans boy to grow breasts and experience a period every month; for them, this is pure, real-life body horror.

After all the research showing the positive impact of gender-affirming care for kids, it should come as no surprise to know that trans kids who don’t have access to this care have a massively higher rate of suicidal ideation and attempts when compared to those who do. For some teens, the passage of these types of bans will be a death sentence (a situation made worse by the Trump administration removing the 988 hotline for LGBTQ+ youth). For the rest, it forces them into the long, difficult, and expensive road of reversing the unwanted changes that come with going through the wrong puberty.

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It’s darkly ironic that nearly all of these types of bans cite regret in regard to the effects of transition. What I can say for myself is my only regret is that I did not start sooner. I’ve had to spend so much of my time, energy, and money trying to reverse what could have been avoided, and my heart breaks for the kids who may never even get that opportunity.

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This decision by the Supreme Court is pure cruelty, without regard for the health, safety, or happiness of the children it affects. To stack the gender-affirming care ban in the Big, Beautiful Bill, should it pass into law, on top of the decision in Skrmetti would be even more devastating. At least as things stand, trans kids can hold out hope for a future in which they can be themselves, despite all the paperwork and hoops. But if this hateful administration has its way, even that will be snatched from their hands. So we should do all in our power to stop it—there’s nothing “beautiful” about hopelessness.