In the past three years alone, life as a young transgender person in the U.S. has changed dramatically. Before 2021, gender-affirming medical care was legal in all 50 states. None had even tried to ban it. Today, 22 states have passed restrictions on that care—and while several have been blocked in court or have yet to take effect, most are active law.
Treatment plans for trans minors are as unique as the teens themselves. But usually, if medically indicated for the patient, treatment starts with puberty blockers for young adolescents and sometimes progresses to hormone therapy (testosterone or estrogen) for older teens. Surgery is uncommon for trans youth, though some older teens with enduring gender dysphoria opt for chest surgery.
Health experts agree that gender-affirming medical care is an essential tool in treating gender dysphoria and helping trans youth live happy, healthy, well-adjusted lives. Dozens of medical groups—including the American Academy of Pediatrics, the American Medical Association, and the Society for Adolescent Health and Medicine—have issued statements recognizing the necessity of access to that evidence-based, time-tested care.
Some of the new laws ban gender-affirming care for all trans minors. Others allow youth who are already receiving care to be legacied in and continue their treatment, while banning new patients from initiating care. Many contain harsh penalties, such as felony charges, for providers who offer the treatments.
This fast-changing landscape has plunged families like Zeder’s into chaos, as parents attempt to keep track of laws, find new medical providers, and map out a future in which their trans children can thrive. News reports are filled with stories of families who have uprooted their lives and moved to friendlier states to protect their trans kids from laws that prevent them from participating in sports, using the appropriate restroom, and getting recommended medical care.
But families who move across state lines are the exception, said Jasmine Beach-Ferrara, executive director of the Campaign for Southern Equality, an organization that supports LGBTQ+ people in the Southern U.S. The vast majority of families with trans kids that CSE serves have no plans to relocate. Moving requires money, finding a new home (and often a new job), and a willingness to give up what may be a cherished, generations-old community. That’s a tough ask for many parents, especially if there are other children in the picture.
Early this year, CSE launched a program to help young people living in states that have banned gender-affirming care find new providers in states where it remains legal. The Southern Trans Youth Emergency Project connects families in the South with health care facilities that are currently taking new patients—usually in the closest possible state with access, or in a state where a loved one lives—and provides $500 grants to offset expenses. So far, the program has distributed more than $300,000 to about 600 people and families. The organization has also begun offering a second round of grants to families in the program, since gender-affirming care requires regular appointments.
“Our mindset is very much like the mindset you’d have in the wake of a hurricane hitting the coast,” Beach-Ferrara said. “This is a crisis. And it’s a crisis we can respond to.”
The project bears similarities to the abortion funds and practical support networks that have helped a growing number of patients find abortion providers, cover travel costs, and pay for abortion care following the overturning of Roe v. Wade. In both cases, a right-wing policy agenda has cut off access to essential, lifesaving medical care in roughly half the country, forcing patients to forgo that care or travel long distances at great expense. (Patients seeking abortions can also order medication in the mail, though that poses the risk of possible legal trouble.) Some patients in states with abortion bans have been able to get care under this system: In the year after Roe was overturned, as legal abortions all but ended in states with bans, rates increased elsewhere due to an influx of out-of-state patients and loosened restrictions that improved access in blue states. But an untold number of people have been successfully barred from terminating their pregnancies and forced to birth children against their will.
There are important differences between abortion care and gender-affirming care, however. Getting abortion medication or an in-clinic procedure does not require ongoing care; usually, patients have to make only one trip. That’s not the case for gender-affirming care, which, like most long-term medical treatments, necessitates consistent check-ins on a patient’s physical and mental health, in addition to periodic prescription refills. Even if a patient’s family is able to work out the finances and logistics for one trip out of state, they’ll need to make another trip in three to six months—and another several months later, and so on. Emergency measures are not sufficient here. Families must find a sustainable long-term solution.
As it stands, the nation’s patchwork system of laws requires trans and gender-nonconforming youth in broad swaths of the country to go to absurd lengths to fill their prescriptions. The medications they need can be prescribed in a video telehealth appointment, but at the time of the appointment, the patient must be physically located in a state where the treatment is legal, and they can get the medication only from a pharmacy in one of those states.
Zeder is a trans boy living in Austin, with whom we begin this story. The comparison with the way people in many states now have to try to get abortion care is instructive, and it makes me wonder if it’s just a matter of time before we see similar efforts to block their ability to travel out of state for any such care. The same insulting and dehumanizing language about “trafficking” would apply, if and when the same zealots get around to it. These and other related questions will be coming to SCOTUS sooner rather than later, and I have more fear than hope about it. As with an increasing number of things, it’s going to take federal action to ensure that everyone has the same rights. The scary thing is that federal action could also be taken to remove those rights for all. Elections have never had bigger consequences.