Protesters advocating for transgender rights and healthcare stand outside of the Ohio Statehouse Jan. 24 in Columbus, Ohio. Patrick Orsagost/Associated Press

EDITOR’S NOTE – This story includes discussion of suicide. If you or someone you know needs help, the national suicide and crisis lifeline in the U.S. is available by calling or texting 988. There is also an online chat at 988lifeline.org.

Transgender youth in the United States have been flooding crisis hotlines since the election of Donald Trump, who made anti-transgender themes central to his campaign. Many teens worry about how their lives could change once he takes office.

During his presidential bid, Trump pledged to impose wide-ranging restrictions and roll back civil rights protections for transgender students. And his administration can swiftly start work on one major change: It can exclude transgender students from Title IX protections, which affect school policies on students’ use of pronouns, bathrooms and locker rooms.

One ad that aired over 15,000 times crystallized Trump’s stance on rights for transgender and nonbinary Americans: “Kamala is for they/them. President Trump is for you.”

For one Alabama teen, the ad seemed to paint transgender and nonbinary people as a threat to society. The weekend before Election Day, the 16-year-old teen, who identifies as nonbinary and uses the pronouns “he” and “they,” called a crisis hotline at the Rainbow Youth Project. The group that serves LGBTQ+ young people has received more than 5,500 calls to its crisis hotline in the past 10 days, up from the 3,700 calls it typically gets every month.

The teen was in despair and struggling with suicidal thoughts, according to his mother, Carolyn Fisher. She said she hadn’t realized the depth of her child’s depression and how painful it was for him to see political ads that felt like a personal attack.

With the help of crisis counselors, Fisher said her teen has begun feeling better. But bullying at school has gotten worse, with some students telling her child Trump is going to make him “go back in the closet,” Fisher said.

“The kids who have taunted him are now proud of themselves, and they rub it in,” she said.

Opposition to transgender rights was a focal point of Trump’s campaign: Republican ads attacking political opponents over transgender or LGBTQ+ issues have aired over 290,000 times on network TV since March 2023, according to data from the media tracking firm AdImpact.

The messaging may have resonated with many Americans. More than half of voters overall – and the vast majority of Trump supporters – said support for transgender rights in government and society has gone too far, according to AP VoteCast, a survey of more than 120,000 voters nationwide.

President Biden’s administration expanded recognition of transgender rights just this year. Interpretation of Title IX, a landmark sex discrimination law, is largely up to the executive branch, although court rulings can affect enforcement.

Originally passed in 1972, Title IX was first used as a women’s rights law. This year, Biden’s administration said the law forbids discrimination based on gender identity and sexual orientation, but Trump can undo that. Biden’s new guidance had limited implementation in any case: After a spate of lawsuits, courts had issued injunctions pausing the rule in 26 states.

“Title IX will be a top priority. It is emblematic of all the culture war issues that have been created over the past few years surrounding gender identity versus sex,” said Candice Jackson, a lawyer who led the Education Department’s Office for Civil Rights in the first Trump administration.

Trump also has said he would ask Congress to pass a bill stating there are “only two genders” and to ban hormonal or surgical intervention for transgender youth in all 50 states. Most Republican-controlled states already have banned gender-affirming health care for transgender youth under age 18 or 19, and several have adopted policies limiting which school bathrooms trans people can use.

While Biden’s election-year guidance did not extend to transgender students in sports, Trump has promised to end “boys in girls’ sports.” The administration likely would “approach these issues from a traditional understanding” of what Title IX has meant, “with a biological, binary understanding of sex,” said Bob Eitel, who served during the first Trump administration as a senior counselor to the education secretary.

In the U.S., 3.3% of high school students identify as transgender and another 2.2% question their gender, according to a U.S. Centers for Disease Control and Prevention survey released last month.

The survey found 72% of transgender and gender-questioning teens experienced persistent feelings of sadness and hopelessness in the past year. These teens also reported higher rates of bullying at school compared with peers. About 1 in 4 transgender students said they had attempted suicide in the past year, the CDC said.

LGBTQ+ advocates are mobilizing to address the despair they see rising among transgender and nonbinary youth. The Rainbow Youth Project, for one, has increased virtual peer groups and town halls so LGBTQ+ youth can connect. Another organization, It Gets Better, has focused on reaching young people online through social media platforms like Twitch and YouTube to create supportive environments even if legal protections are rolled back, said Brian Wenke, the group’s executive director.

Across the country, particularly in conservative areas, LGBTQ+ youth are discussing whether it would be safer to live somewhere else.

Jude Armstrong, a transgender high school senior in New Orleans, has led protests against Louisiana laws that regulated pronoun usage and discussions of gender and sexuality in the classroom. With the potential for federal changes on the horizon, Armstrong, 17, said he has thought of going to school in the United Kingdom, but worries about leaving behind the queer culture and history he loves at home.

“How do you feel like you’re protecting your own community when you’re leaving that community and going to another country?” he asked.

Alejandro Jimenez, a sophomore at Texas State University, dreams of being a theater teacher in Texas. He knows how important it is for trans kids to see someone like them in the classroom. Now, he’s not sure if he’ll stay in his home state.

Already, tensions have risen on his campus in a way that makes him feel unsafe. The day after the election, two protestors held up signs that said, “Homo sex is sin” and “Women are property.”

“I feel it’s my duty to stay here, but I’m scared of being pushed out,” said Jimenez, who is transgender.

Under the new Trump administration, advocates worry efforts anywhere to accommodate transgender and nonbinary students could face scrutiny. Trump’s platform called for pulling federal funding for any school pushing “gender ideology, or other inappropriate racial, sexual, or political content on our children.”

“It sounds really dystopian to say that trying to be more inclusive could actually result in punishment from the federal government. But that is a risk,” said Elana Redfield, federal policy director for the Williams Institute at the UCLA School of Law.

With so much uncertainty, Eli, an 18-year-old trans college student in New York, stressed the importance of community, especially online for youth who feel concerned right now.

“You are not alone,” said Eli, an ambassador for It Gets Better, who asked to be identified only by his first name for safety reasons. “We will come out the other side. There are queer adults who have lived long and happy lives, and you will get there too.”