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It’s Jan. 29, 2026 – another hearing day at the Nebraska State Capitol. About 100 people are lined up outside a hearing room, waiting for their turn to go through a metal detector, fill out a testifier sheet and make their voices heard.
The bill on the agenda, LB732, would create a full ban on gender-affirming care for minors.
Inside the hearing room, testifiers and committee members debate discussing the safety of gender-affirming care – a range of treatments that helps individuals align with their desired gender identity.
The care can include surgical or drug-based medical procedures, psychological support, adopting a new social identity or changing one’s appearance. The bill’s proponents wonder how many children will be subject to treatments they say are not properly tested.
“Children cannot consent to lifelong consequences,” testified Nate Grasz, director of the right-leaning advocacy organization Nebraska Family Alliance. “And yet today we are being told that a child can consent to medical interventions that may permanently alter their body, their fertility and their future. This bill does not deny care. It denies the lie that children are born in the wrong body and must be medically altered to be whole.”
The bill’s opponents question how many children will suffer mentally without access to treatments that affirm their gender identities.
“Please do not force medical and mental health providers to cause harm and take away the option to provide medically and psychologically necessary care,” Karen Marker, a licensed independent therapist, asks the committee. “As a mental healthcare provider and as a mom, I promise you that providers who are caring for gender-diverse youth and their parents only have the best interest of that child in mind. If this bill passes, it will cause irrevocable harm to trans and nonbinary youth in our state.”
Down the hall, there’s another hearing for a bill that allows individuals to sue gender-affirming care providers for medical malpractice for a longer-than-standard period of time.
Most of the hearing attendees are opponents of both bills, like Jill Brown.
“I just feel like the research absolutely supports caring for trans youth,” Brown said.
Brown is a psychology professor. She brought her students to encourage them to stand up for what they learned in her class.
“All of these students have read – here's what sex is, here's what gender is, here's what gender ideology is,” Brown said. “They've even read the process of developing a gender identity – which happens sometimes very, very young. There's gender constancy by age 6. Kids know who they are. People know who they are.”
Brown also said she has a son who has expressed a transgender identity “since the time he could speak.”
“I follow my child. I respect him. I know him,” Brown said. “I know that this is something that is real for him – like there's not even a doubt in my mind this is his experience of being a human.”
Brown said what happens in the Legislature affects families like hers.
“It's horrible. I think my family has anxiety all the time. The students that I see have anxiety,” Brown said. “This is an extended web of human beings that love each other. What happens here matters deeply to people.”
The debate continues
Balancing both sides of the argument is an increasingly contentious task, especially as more state politicians and candidates take up the issue.
Both bills heard that day were introduced by Millard-area state Sen. Kathleen Kauth, a Republican in the officially nonpartisan Legislature. She has been a crusader against gender-affirming care since 2023, when debates around transgender issues were becoming politically mainstream.
“Everyone told me not to do it,” Kauth said. “It seemed pretty simple to me – you don't do this. It apparently was like the third rail of politics, but it got the debate started, and it got people talking about it.”
She introduced the Let Them Grow Act, which passed in 2023 and restricted access to “gender-altering procedures” for individuals under 19.
“They call it gender-affirming care. That's a really nice way of saying they're messing with a child's natural sex. They're trying to change something that's not meant to be changed,” Kauth said.
The bill bans gender-related surgeries for minors. Drug-based treatments, like puberty blockers or hormones, can be prescribed if the child “has a long-lasting and intense pattern of gender nonconformity or gender dysphoria which began or worsened at the start of puberty.”
Those who seek out gender-affirming care often experience gender dysphoria – which the American Psychiatric Association describes as “psychological distress that results from an incongruence between one’s sex assigned at birth and one’s gender identity.”
To prove gender dysphoria, a child needs to undergo at least 40 hours of therapy on gender identity.
“You should have compassion for kids who are dealing with gender dysphoria. Kauth said. “It is horrible. You wouldn't tell someone with anorexia, ‘Well, let's put you on diet pills and sign you up for liposuction.’ You would help them work through why they feel that way.”
There are exceptions for children with sexual developmental disorders or genetic conditions. The Let Them Grow Act was passed with the Preborn Child Protection Act – a 12-week abortion ban.
Many states considered gender-affirming care bans that year. Twenty-seven states have enacted restrictions as of 2026, according to health policy organization KFF.
Kauth introduced four bills on transgender issues in the 2026 session. All were defeated as the Legislature prioritized filling a stark budget deficit.
A last stand
Pride Health Clinic in Omaha is the only remaining gender-affirming care provider for minors in Nebraska. Nurse practitioner Leslie Dvorak founded the clinic and runs it. She started her career in the military and was a provider of reproductive healthcare.
“I just have a huge passion for education and helping navigate healthcare,” Dvorak said. “The hormones are one part of it, but providing them with resources, explaining how to change their gender markers – We have a food pantry, we have a clothing closet. A lot of the psychosocial stuff is so important in the care we do.”
When the Let Them Grow Act passed, the few health systems and clinics in Nebraska that provided gender-affirming care to minors limited or fully stopped services.
The University of Nebraska Medical Center’s gender clinic still treats minors for “behavioral health issues,” but other gender-related medical services are only provided to adults. PHC said it began receiving transfers in late 2025 from the Children’s Nebraska hospital in Omaha when it stopped providing similar care.
Even as other clinics closed and more business came in, Less than 3% of Pride Health Clinic’s patients are between 13 and 18 years old – about 70 kids total.
About 80 patients are 19 and no longer considered minors in Nebraska, but many started as minors. Dvorak said any patients receiving gender-affirming care before Oct. 1, 2023, were “grandfathered in” without restrictions.
The clinic requires a letter from a therapist to see minor patients, and both parents must be present for the first appointment to sign a consent form. Dvorak said minor patients also must be seen every three months because they must continue therapy during treatment.
“My documentation has to show that we have all that and that we've done all that,” Dvorak said.
Medical treatment for minors typically does not begin until the onset of puberty. After their 40 hours of therapy and legally required waiting period before treatment starts, minors receiving care cycle in and out of the clinic each week for treatments.
Puberty blockers are a commonly prescribed treatment for youths who receive gender-affirming care.
“It's a shot they get every three months, and it stops the feedback loop, so they don't go into puberty. So it's just a pause.” Dvorak said. “For trans masculine patients, it'll stop the development of the breast, it'll stop the widening of the hips, and they won't bleed. For trans feminine patients, it's going to stop facial and body hair, stop the growth of the Adam's apple, the shoulders widening, the deepening of the voice and pause the external genitalia.”
Dvorak said there can be some bone mineral loss due to the drugs, so vitamin levels are routinely checked. After a couple years of puberty blockers, the child, parents and their doctor might consider hormone injections.
Still, she said, most of the clinic’s 2,500 patients are adults. But Dvorak wonders how the political discussions of transgender people will affect them, too.
“Where is it going to stop, and why is it okay for the government to tell you after research and in collaboration with professionals?” Dvorak said.
“Putting the brakes on”
Kauth said she believes gender-affirming care treatments aren’t safe, and kids are not developed enough to evaluate risk.
“You wouldn't let a kid go in and get a face tattoo, even with a parent coming in to say, ‘Yep, I support it.’ The law says – yeah, no, that is permanent, that is something that will negatively affect their life forever. We're going to wait till they're an adult, then have whatever you want done, done. But kids, we still have to safeguard,” Kauth said.
She said science and research does not back up the safety of these treatments. She said the studies used to justify gender-affirming care have “very circular logic,” and they are “all bad studies citing each other.”
Dvorak disagrees.
“As a nurse practitioner, we are very much in evidence-based medicine, so we're not doing things willy-nilly,” she said.
Dvorak said treatments like hormones and puberty blockers are safely used to treat conditions – such as early-onset puberty or genetic hormonal imbalances – in people who are not transgender.
“We use it in cisgender people all the time, and we don't call it experimental,” Dvorak said. “Just because the diagnosis is different and the medication is the same, why is there more risk? There isn’t.”
Both Kauth and Dvorak are concerned about the mental health of children, but from different angles. Kauth chalks up a rise in children identifying as transgender to “social contagion.”
“This is to this generation what eating disorders was to mine, what cutting was to in the '90s,” Kauth said. “It's that thing that makes you different, edgy, special. And so I think that we're getting a lot of people caught up in it.”
A 2025 report by the Williams Institute shows 25% of people who identify as transgender in the U.S. are 13-17 years old – about 700,000 kids. Kauth cited a number from Transgender Trend claiming “around 85% of children change their minds and do not continue into adulthood as transgender” after analyzing 12 studies.
But Dvorak said that rise comes from increased acceptance, and helping children address gender dysphoria can make a positive impact.
“My heart gets so happy when I have a parent say to me, ‘I have my kid back,’” Dvorak said. “And they're not depressed, or they're less anxious – they feel better. Physical changes will come, but if they can tell me, ‘I just feel better,’ that's the whole goal.”
Transgender people – including children – experience higher rates of suicidal ideation than the general population, according to 2024 survey data from advocacy group The Trevor Project. Similarly, the organization found transgender people in states with anti-trans laws had worse mental health outcomes.
Kauth said she doesn’t mind if adults in Nebraska seek gender-affirming care.
“This is putting the brakes on – putting some safety measures around it until they can truly make up their own mind and make a more adult decision,” Kauth said. “But also your adult decision doesn't get to impact the safety and privacy of everyone else.”
Kauth said that the 2023 bill was a compromise, and she does want a full ban on gender-affirming care for minors.
The national stage
Kauth’s ideas remain politically mainstream for Republicans like her.
“It’s hurting kids. It’s hurting other people,” Kauth said. “Why on earth would a party support it and push it?”
Brinker Harding, Republican nominee for Nebraska’s 2nd Congressional District, highlighted transgender issues in his primary night victory speech.
“Do we want our next 250 years to be about crippling inflation? Open borders and uncontrolled immigration. Socialist handouts?” Harding asked. “Boys in girls bathrooms? Transgender surgery for minors? This is my favorite – believing that men can get pregnant?”
“No!” the audience shouted between each statement.
Federal officials in the Trump administration have expressed similar positions.
Kauth said her constituents often come to her with concerns about transgender children on sports teams and using bathrooms.
“Everybody thinks it doesn't happen here, but it does. It happens a lot,” Kauth said. “I talk with young women who are dealing with boys in their locker rooms – kids who are playing with boys on sports teams. I've had parents calling me and saying, ‘What do I do about this?’”
She is a strong supporter of the “Fairness for Girls” ballot initiative campaign that seeks to create a constitutional amendment designating school sports teams as either female, male or coed.
“Biological males have significant physical advantages — higher muscle mass, greater bone density, and elevated testosterone levels,” the petition website states. “Allowing men to compete in girls’ sports destroys a level playing field and undermines fairness for our daughters.”
Deep financial pockets for the petition almost guarantees the topic will be in front of voters in the November general election.