feature photo provided by JustFundKy

When Sirene Martin read the news that Kentucky had officially banned Medicaid coverage for gender-affirming care, her heart sank. Martin, a 26-year-old trans woman, says that being able to start hormone replacement therapy (HRT) five years ago was life-changing. The process was, as she recalls, painful at first — an excruciating second puberty in which her body transformed into something new and, ultimately, resplendent. Martin felt as if, for perhaps the very first time, she was becoming in touch with her physical form. She had to learn how to carry herself in this new body: from how she stood up and sat down to how she moved through the world.

“It was sort of like relearning how to walk, in a way,” she tells QueerKentucky. “Having access to hormones, and knowing that over time, slowly, I was going to start recognizing myself in the way that I always have known myself to be, has been instrumental to my growth. Hormones have allowed my mind to be freed up so that I can focus on things that everyone else focuses on, just daily life.”

photo provided by Sirene Martin

Under Kentucky’s Medicaid ban, Martin isn’t sure how she will continue to access the medication that has allowed her to be transcendently herself. Martin works as a curatorial assistant, and because her employer doesn’t cover her health care, she is insured through the state’s Medicaid program. After Republican lawmakers overrode Democratic Gov. Andy Beshear’s veto of a bill stripping coverage for HRT, surgical care, and other transition treatments, the new law — which impacts both youth and adults — will take effect in June. Beshear has vowed that he will not implement the Medicaid ban, but should be unable to impede it, paying for hormones out of pocket would set Martin back $150 every refill. She doesn’t think she could afford that added expense.

When Martin contemplates what it would be like to lose her hormones, anger radiates through her chest. While she says the feeling of being wedged “between a rock and a hard place” is not unfamiliar or unsurprising to her, Martin is nonetheless shaken by the needlessness of her imposed suffering. “The anger is obviously righteous, but even more, it’s volatile,” she says. “People don’t understand that this is an attack on our lives — not just on our ability to access medical care, but our ability to be human beings on the earth.”

Trans Kentuckians say they are reeling from the combined impact of the state’s recent spate of laws targeting their everyday lives. The legislative onslaught began in 2023, when GOP lawmakers — over Beshear’s objections — forced through a sweeping omnibus bill that some observers deemed to be among the most harmful pieces of anti-trans policy in U.S. history. In addition to restricting gender-affirming medical treatments for trans youth under the age of 18, SB 150 also bars any mention of LGBTQ+ identities in K-6 classrooms, blocks trans youth from using school bathrooms that correspond with their lived identities, and impedes disciplinary action against teachers who misgender trans students. It also mandates that schools inform parents if they learn that a student is trans, potentially outing youth to unsupportive families.

Legislators have continued to up the ante in 2025, introducing at least 18 bills targeting the trans community, according to the Trans Legislation Tracker website. Among them, Republican lawmakers are pushing bills that would deny gender-affirming care to incarcerated trans people and force them to be housed in accordance with their sex assigned at birth. This year, Kentucky also became the first state in U.S. history to overturn its own conversion therapy ban, by passing a bill that effectively nullified a 2024 executive order from Beshear restricting the discredited, harmful practice. Beshear, again, attempted to stop the latter effort, but Republicans wield a veto-proof supermajority in the legislature.

Sources tell Queer Kentucky that, taken in aggregate, these decisions have made being a trans person in the Bluegrass State significantly harder. Sage Barr, an 18-year-old student, says the state’s shifting political tides have significantly heightened their daily anxieties. They are concerned about what others emboldened by anti-trans rhetoric might do to them, especially with President Donald Trump now back in office, and scared about what laws might be coming next. “I sometimes can’t focus on homework on conversations with friends or family because I’m so worried about what’s going on, about America turning into 1930s Germany,” Barr says.

photo provided by Sage Barr

Others agree that Kentucky, despite its progressive bubbles, has become more hostile to their existence in the wake of recent legislation. As the resident of a rural community, 28-year-old Beck Jensen says the differences are subtle but unmistakable: a marked increase in “ma’ams” from strangers and prolonged stares in public. Jensen, a self-described “nonbinary butch lesbian,” says that the shopkeeper at a thrift store kept attempting to guide them over to the women’s section while shopping for a Halloween costume inspired by the 2005 queer neo-western Brokeback Mountain. “Before I was used to people always being really friendly with me,” Jensen tells Queer Kentucky. “Now I feel like I have to watch my back a little bit more.” 

But that passive aggression, for all its sinister undertones, is less immediately pressing than the tangible impact of Kentucky policy. After booking their first appointment the same day that SB 150 passed, Jensen plans to start testosterone as soon as possible, but as a Medicaid recipient, that treatment will only be covered for the next two months. Because Jensen earns a very modest wage from their day job as a zookeeper at a nonprofit sanctuary, friends have offered to share their hormones to ensure Jensen’s medical transition isn’t interrupted. Deciding whether to accept their kindness means choosing between their own wellbeing and others’ health, Jensen notes.

“They might need those backup reserves, and I don’t want to take medication away from somebody,” they say. “Some of my friends are full-on trans men, and if they were to stop, they would regress in their treatment. That might be more endangering for them than it would be for me.”

Carma Marshall, 35, says that she has begun rationing her medication in preparation for losing her Medicaid coverage in June. While she hopes to be able to afford the cost of HRT without insurance, Marshall knows there are times she may not have the money. Going without, Marshall says, is simply not an option. She fears what would happen if she were no longer able to meet society’s normative expectations of femininity, if her body hair started to grow back thicker or her shape were to suddenly be a little less womanly. Marshall already has some experience with the harassment that could result: While testifying against anti-trans legislation earlier this year, Marshall was verbally accosted by a GOP lawmaker outside the women’s restroom at the Kentucky state capitol building. 

photo provided by Carma Marshall

Being able to assimilate, Marshall says, is key to escaping the violence that disproportionately affects Black trans women, but it’s not merely about surviving. Her medical transition has allowed her to thrive: Before she began taking steps to be the woman that she had been all along, Marshall was a shut-in who barely left her home. She was scared of “how the world would see me and treat me,” Marshall recalls. Now, she is a co-chair Louisville’s Transgender Wellness Coalition, helping other vulnerable members of the community find their own strength and resilience. Marshall refuses to be shoved back inside again, not after how far she’s come.

“We all deserve dignity and the pursuit of happiness in this slice of American pie that we’re all trying to live,” she tells Queer Kentucky. “For them to now say that we’re not worthy of that — or that we’re crazy for trying to pursue that — is absolutely ridiculous.  If you want to hate me, that’s fine. You can hate me, but let’s try to work together so that we all can make it in this really difficult world.”