It’s increasingly difficult for transgender youth to get the health care they need. Over the past two years, a swath of U.S. states have made it illegal for minors to receive gender-affirming treatments like puberty blockers and hormone treatments. That’s fostered a dangerous climate for trans kids and their parents and created a new class of health-care refugees. Some can cross state lines to receive treatment, but doing so is much more difficult than crossing the border for, say, an abortion.
When Florida Judge Robert Hinkle blocked the state’s attempts to ban minors from receiving gender-affirming therapies, he stated the obvious: “The statute and the rules were an exercise in politics, not good medicine.”
There’s a misconception — pushed by right-wing politicians — that gender-affirming care is experimental or easy to get. But use of puberty blockers and hormone therapies is supported by major medical organizations like the American Academy of Pediatrics and the Endocrine Society and only prescribed after a long process. Kids typically need to have socially transitioned (for example, using a new name or pronouns) for at least a year, have the consent of their parents, and undergo a psychological evaluation.
The results are overwhelmingly positive for patients. One recent study, the largest of its kind in the U.S., found that trans teens are happier when taking medicine that allows their external appearance to match their gender identity. Meanwhile, several other studies have found that nearly all transgender teens who start hormonal therapy continue it into adulthood. The very few who detransition basically say being “out” was too hard — they didn’t have the support to continue living as their authentic selves.
According to the Human Rights Campaign, 20 states have already passed bans and seven more are considering them. While lawsuits could block some of those laws, HRC estimates 44% of trans youth have already or are at risk of losing access to gender-affirming care.
As with abortion, the emerging patchwork of health-care restrictions will force patients to travel to sanctuary states. But there are critical differences between abortion and gender-affirming care that make traveling for the latter even more difficult. Many trans youth will have to go without — or their families will be forced to move.
While traveling for an abortion can be onerous, it’s typically a one-time event. Gender-affirming care is ongoing. A trans teen (or, if laws continue to creep, an adult) would need to make regular trips out of state, for years. And while someone already taking gender-affirming medicines might be able to minimize travel to simply fill prescriptions, a new patient might need more frequent visits.
And with abortion, an extensive infrastructure has emerged to help abortion patients travel across state lines, helping with bus fare and train tickets, hotels, meals, medical costs and legal questions. The support network for trans patients traveling across state lines is nowhere near as robust.
“While they are being attacked by the same well-funded, well-organized machines that attack abortion organizations, they don’t have the same resources or infrastructure,” says Jennifer Pepper, president and CEO of the Choices Center for Reproductive Health, which has locations in Memphis and Carbondale, Illinois, where it offers hormone therapy for patients 16 and up.
Planned Parenthood of Illinois, which with a parent’s consent can provide hormone therapy for teens that are 16 or older, has been working to meet anticipated demand from trans people coming from neighboring states — the same way it does for abortion. “The thing we’re talking through is, how do you do that for care that is not just a one-time thing?” says Mallory Klocke, who directs the organization’s gender-affirming hormone therapy program. “And how do you do that sustainably?”
Even before the bans, access to care was a problem. It could take months or even years to get an appointment at a clinic serving adolescents.
Hussein Abdul-Latif, a doctor at University of Alabama at Birmingham, was until recently the only endocrinologist in the state treating kids and adolescents with gender dysphoria. Meanwhile, the states surrounding Alabama — Mississippi, Tennessee, Georgia and Florida — have in the past six months all passed laws barring doctors from prescribing puberty blockers or hormone therapy.
Alabama also passed a similar ban, but it’s on hold as a lawsuit winds through the courts. So Abdul-Latif has been fielding calls from doctors in neighboring states wondering if he can take their patients. And while he has the capacity to treat some, there is another complication: A large percentage of trans teens are insured by state Medicaid, meaning they cannot carry their coverage with them to Alabama. “That’s a group that would have a really hard time crossing state lines to access care,” he says.
Even if families successfully jump through the hoops, the toxic political climate is making it hard to feel like their kids are safe. Abdul-Latif said that even with care still available, several families in his practice are considering moving or have already left the state.
One of those families includes the parents of a trans girl. That family, who asked me to withhold their name out of fears for their child’s safety, drives four hours each way to bring their nearly 6-year-old daughter to see Abdul-Latif. And while the care at Children’s of Alabama has been excellent, they fear that by the time their child reaches an age where she might choose to start puberty blockers, treatment will no longer be legal in Alabama. They are now considering a move to Colorado or another state that is more welcoming to their daughter.
Their relocation discussions have taken on new urgency as Republican politicians fan the flames of transphobia. Some people in their community have seemingly been emboldened by the hostile political environment. The family has been subjected to cruel and threatening comments in public and was asked to leave their church. One neighbor went so far as to report the parents to child protective services for allowing their child to play outside in a dress.
These laws targeting a tiny portion of the population are putting kids at risk — physically, emotionally and mentally. As with abortion, it makes perfect sense for doctors and health-care organizations to prepare to serve health-care refugees. But we should continue to hope that sanity prevails and higher courts affirm that parents and doctors, not politicians and culture warriors, know what’s best for kids.
