One doctor's perspective on Georgia's new trans health care ban

What they're saying: "For me, it's been absolutely exhausting. For my patients, it's devastating," said Izzy Lowell, a physician who started her gender-based medical care practice QMed in Atlanta six years ago.

• Her team is working around the clock and has blocked off sessions for walk-in visits this week ahead of the deadline.
• "If people need it, we will stay up until midnight June 30," Lowell told Axios.

Lowell's mainly virtual practice now treats people in 25 states. Half of them have bans in effect or coming into effect, she said.

• Because she started her practice here, Georgia has been "especially bad," she said since the majority of her minor patients are Georgians.

The big picture: Bans in other states have run into legal trouble, including in Florida where a judge blocked two laws restricting gender-affirming care and in Arkansas where a judge overturned a similar ban.

• A lawsuit challenging Georgia's law is expected this week, Georgia Equality Executive Director Jeff Graham told Axios.

Zoom in: The "most devastating" situations she has seen are 10-year-olds to 12-year-olds who are "just under the age where they could start care," are "desperate to start," and yet medically it's too soon for Lowell to start hormone replacement therapy.

• Keeping them on puberty blockers until age 18, which the law allows, is "not a viable medical solution" and "absolutely ill-advised," she said.
• "My patients are regular happy people," Lowell told Axios. "They're just trying to go about their lives, and they can't do that without the right hormones."

Be smart: Puberty blockers suppress sex hormones and pause pubertal changes. Cross-sex hormone therapy can be a next step for patients who develop sex characteristics associated with their preferred gender, Axios' Oriana González reports.

• Puberty blockers are considered reversible, while only some of the effects of hormone therapy are reversible, depending on the stage of treatment.
• Georgia lawmakers said this year that they exempted puberty blockers as a "compromise" because the effects are not permanent.
• However, as Lowell explains, keeping patients on puberty blockers for more than 2–3 years is not medically advisable.

Threat level: "The law motivates poor care by starting people sooner than they should," she said. Minors already receiving hormone replacement therapy as of July 1 will be grandfathered in.

• "That's an absolute thing I've seen is people asking to start hormone therapy younger than appropriate, which is exactly the opposite of what the law intends," Lowell said.

Context: This is the first new anti-LGBTQ law in Georgia since the state's voters approved a constitutional ban on same-sex marriage in 2004, Graham said.

• "I'm very concerned that this could be the start for even more anti-LGBTQ legislation passing here in Georgia," he said.

What's next: Most of Lowell's patients are adults. But for minors, she said, things will just get "more and more difficult." She will continue to serve Georgia minors, but they will have to plan to travel out of state to access hormonal treatment, she said.

• That will cut off care for those who can't afford to do so.
• Some families are considering moving to different states, she said. But "not many people can do that."

What we're watching: Lowell has hope that the onslaught of laws targeting transgender Americans will eventually reverse course. But it's not likely to happen because any decision-makers change their minds, she said.

• Rather, she said, it'll be because young people will grow up.
• "I think the next generations see gender completely differently," she said. "I think that people who are teenagers, 20-somethings now, when they're in charge, this will go away."

Go deeper: How gender-affirming care works in the U.S.