For the last two years, Koen has routinely self-administered weekly testosterone injections without a second thought.

During that time, the trans 17-year-old said his self-image and school and family life has drastically improved. His fear of needles, too, has faded.

“[Transitioning] made me look forward to things more because now I can start paying attention to the better version of myself,” said Koen, who asked to be identified by his first name because of fears for his safety. “It’s something I feel like I’ve needed for a while. I’m able to express myself more fluidly and feel comfortable doing that, which I think is a very big step for me right now.”

At the start of the year, though, a greater worry emerged.

A new law banning gender-affirming care for minors in Louisiana took effect on Jan. 1 prohibiting puberty blockers, hormone treatment, and gender-reaffirming surgery. Now, Koen isn’t sure he could continue his hormone treatment.

Louisiana is one of 22 other states that have enacted laws restricting or banning gender-affirming medical care for minors, disrupting health care needs for trans and nonbinary people.