For Karen, staging her family’s Austin home to be sold felt like a series of small paper cuts.
Packing up her daughter Jessie’s things particularly stung. Karen boxed up stuffed animals and peeled posters off the walls, including one of Jessie’s favorites: it says “Trans Girls are Girls” in the blue, pink, and white colors of the trans pride flag. Jessie, 10, who is transgender, had seen the poster at a rally last summer with her mom while protesting the surge of anti-trans rights legislation in Texas. She loved it, so Karen and her husband Chris got it for her as a birthday present. “As soon as she walked in the door, I heard her shout, ‘Where’s my poster?’” Karen recalls. She worried Jessie might not understand why it had to come down, or think it was a judgment on her identity.
But it’s to protect that identity that Karen and Chris are rolling up the poster and moving her family out of Texas. Over 30 anti-LGBTQ bills, 13 of which would have specifically affected trans youth, were filed in Texas’ 2021 legislative session, according to a tally by the LGBTQ advocacy group Equality Texas. One bill, banning trans youth from playing on sports teams aligned with their gender identity, went into effect in January 2022. Then in February, Republican Texas Governor Greg Abbott directed the state’s family protective services agency to investigate parents who may have provided their trans children with gender-affirming care.
Karen and Jessie are not alone in facing a wave of state government attempts to preempt or restrict trans rights. Some 1.4% of U.S. youth age 13-17, or around 300,000 teens, are trans, according to a June report by The Williams Institute at UCLA, which researches sexual-orientation and gender-identity law and policy. In the past two years, many of those young people have seen their rights curtailed, as conservative state lawmakers nationwide have unleashed a torrent of legislation targeting LGBTQ youth and their parents. By March 2022 lawmakers had already introduced roughly 240 anti-LGBTQ rights bills, about half of which specifically target trans people, according to a NBC News analysis. They include policies that limit whether trans youth can play sports, use a bathroom aligned with their gender identity, study LGBTQ issues in school, or access medical care to affirm their gender. At least 25 anti-LGBTQ bills have been passed this year in 13 states, according to the LGBTQ advocacy group Human Rights Campaign, and ten such laws aimed at education in six states went into effect on July 1.
The result is a growing gulf between red and blue states on trans rights that has created a small group of political migrants like Karen: families of trans children leaving their increasingly unwelcome home states for bluer ones that offer explicit protections against discrimination.
TIME spoke with 10 families who are in the process of moving or have already moved out of states where gender-affirming healthcare for youth has been restricted: Texas, Alabama, Arizona, and Arkansas. Other families want to leave, but are unable to for a litany of reasons including family obligations, job security, or the high cost of an out-of-state move.
Supporters of the anti-trans rights bills say they are acting in the best interests of children. Some argue that gender is determined by the sex on a person’s birth certificate, and many anti-trans legislators take the position that offering gender-affirming care to minors is irresponsible.
Karen and Chris side with the majority of the American medical establishment, including the American Medical Association, American Academy of Pediatrics, and American Psychological Association, in believing that gender-affirming care is not only appropriate, but can be medically necessary for the health of trans and gender expansive young people. Jessie is not yet at the age where her parents are discussing what gender-affirming medical care might be right for her, but if they stayed in Texas, providing their daughter with such healthcare could open them up to a child abuse investigation.
“There are no good choices when the situation that these politicians have created is a nightmare,” Karen says. But she knew if they stayed, they’d lose the ability to choose for themselves what’s best for their daughter. And they feared for her safety—TIME is withholding Karen and Chris’ last name and referring to Jessie and her brother Lucas, 9, by pseudonyms because the family has security concerns amid increasing anti-LGBTQ rhetoric in the U.S. On June 6th, Jessie and her brother stood in the driveway, hugged their grandparents goodbye, and began the five day-long drive to their new home in Portland Ore., where gender-affirming care is legal and lawmakers codified LGBTQ inclusive school curricula into law last year. Sitting among moving boxes in her new bedroom in Portland on June 19, Jessie says it was the right decision. “I felt safer to move,” she says. “Like, much safer.”
‘Am I going to die?’
The day Karen realized they had to leave came in early March, shortly after Texas’ Department of Family and Protective Services began investigating families of trans children.
As they were driving around Austin, Karen asked Jessie if she wanted to join her at a protest downtown. “I just heard this little 10-year-old voice behind me ask, ‘Am I going to die?’” Karen says. Jessie had tears streaming down her face. Karen asked why Jessie would say that, and Jessie replied, “Because everybody here hates me,” Karen recalls.
Karen had spent the last three years advocating against anti-trans laws in the state. By 2021 it had become like an unpaid full-time job, as she met with lawmakers, testified, and protested laws that would restrict Jessie’s rights. One of the bills in the most recent legislative session would have prohibited physicians from providing gender-affirming care to young people—an issue top of mind for Karen and Chris as Jessie nears puberty.
Gender-affirming care is a model of care that can include a spectrum of social, psychological, behavioral, or medical interventions designed to support and affirm a person’s gender identity, according to the World Health Organization. It can support youth experiencing gender dysphoria, which is the feeling of discomfort or distress that might occur when a person’s gender identity is inconsistent with the sex they were assigned at birth. What care looks like can vary; in young children, gender dysphoria can be treated with non-medical social and behavioral interventions, like changing one’s name, pronouns, or clothing. During puberty, a young person experiencing gender dysphoria may also begin receiving gonadotropin-releasing hormone (GnRH) analogues—known as “puberty blockers”—that can pause the continued development of a puberty incongruent with their gender identity. When they get older, some adolescents may begin taking gender-affirming hormones, such as testosterone or estradiol. It is rare for a person under 18 to undergo surgical intervention, but some may decide to pursue “top surgery”—surgery to change the appearance of one’s chest—while they are still teenagers.
There is broad consensus among providers and major U.S. medical associations—including the American Medical Association, American Academy of Pediatrics, the Endocrine Society, American Psychological Association, American Psychiatric Association, and the World Professional Association for Transgender Health—about the medical necessity and appropriateness of gender affirming care for youth. While there is some debate within the field about when different interventions should begin, providers agree those treatments are often essential and many expert organizations have noted harmful effects of denying access to these services, according to Kaiser Family Foundation (KFF).
A peer-reviewed study published in the Journal of Adolescent Health on Dec. 14, led by researchers at the LGBTQ suicide prevention nonprofit The Trevor Project, found that the use of gender-affirming hormone therapy was associated with nearly 40% lower odds of recent depression and attempting suicide in the past year among transgender and nonbinary youth from ages 13 to 17. A study published in the peer-reviewed journal PLOS One on Jan. 12 found that access to gender-affirming hormones in adolescence was associated with better mental health outcomes for trans adults, based on data from the 2015 U.S. Transgender Survey by the National Center for Transgender Equality, which surveyed over 27,000 trans adults in the U.S.
In 2021, GOP lawmakers in Texas and 20 other states introduced laws designed to ban doctors from providing gender-affirming medical care to minors. Arkansas enacted the first of such laws that April; the next year, at least 15 other states introduced a total of 25 bills that would restrict access to gender-affirming care for youth, per KFF. In April of this year, Alabama enacted the most extreme anti-trans bill yet, making providing young people with gender-affirming care a felony.
In February, Texas Attorney General Ken Paxton issued a legal opinion stating that gender-affirming care constitutes child abuse, which the American Academy of Pediatrics strongly condemned. Abbott’s directive came a week later, which the Biden Administration said put “children’s lives at risk.” LGBTQ advocates argued the move was political, pointing out that it came shortly before the state’s Republican primary, where both Paxton and Abbott faced challengers. (Both incumbents ultimately prevailed.)
Paxton’s and Abbott’s offices did not respond to requests for comment on this story.
For Chris and Karen, the directive altered their risk assessment for raising their trans daughter in Texas. The night after Jessie asked whether she was going to die, they sat in their kitchen talking in circles. Was it safe to stay here? Could they pick up and start over somewhere else? Could they afford it financially? How would they have health insurance? They sent the kids upstairs so they wouldn’t listen, but of course they eavesdropped. Eventually Jessie came back downstairs and handed her mom a card she’d drawn. “Super mom!” the card read, with a drawing of Karen in a superhero cape. “We can fight this together.”
“It should not be something she has to fight,” Karen says, her voice catching. That night, she and Chris decided they would go.
They picked Portland because they had some friends there and knew the state had strong nondiscrimination laws and policies for LGBTQ people. Chris arranged with his architecture firm that he would continue his work remotely from Oregon. The family staged and sold their house. They spent three tense months waiting for the move date to arrive. The kids went to school each day with a piece of paper saying they did not consent to be interviewed, told to hand it to any child protective services agent who might approach them.
‘Our rights shouldn’t depend on our zip code’
When Paxton’s office issued the February opinion stating that gender-affirming care constitutes child abuse, it conflated puberty blockers and hormone therapy with surgical procedures—which major medical associations say are rarely performed on minors—and said the opinion addressed the mixing of medicine and “misguided ideology.” Days later, Abbott called on “licensed professionals” and “members of the general public” to report the parents of trans youth to family protective services if it appears their children had received gender-affirming care.
Texas’ Department of Family and Protective Services (DFPS) never opened an investigation into Jessie’s family. But DFPS confirmed to TIME that investigations were opened into at least eleven families starting in late February. (Some of those investigations are currently paused while litigation plays out.)
The Briggles—Amber, Adam, and their 14-year-old trans son and his sibling—are one of those families. (DFPS told them their investigation has since been closed.) Amber says they’ve considered moving out of Texas, but it would be extremely difficult for them. She’s a small business owner and Adam is a tenured college professor—if they left, they’d lose their jobs and health insurance. She also worries about pulling her kids out of the crucial social and emotional developmental years of high school and middle school. “We shouldn’t have to leave,” Amber says. “Our rights shouldn’t depend on our zip code.”
Cardelia Howell-Diamond, a minister in Cumberland Presbyterian Church in Alabama, who has three sons, two of whom are trans, feels similarly. They’ve built a support network in their home state. “The thought of having to recreate that somewhere else is terrifying,” she says.
Heather, who is withholding her last name for fear of harassment of her children, says she respects families who want to stay and fight, but she thinks she needs to leave Alabama with her 15-year-old trans son Robert. “The atmosphere here is already tense,” she says. “Could you imagine what it will be like closer to the election?” They’re planning to move to Illinois, and have turned to GoFundMe to ease the financial burden.
Kimberly Shappley, whose 11-year-old daughter is trans, says she decided to leave Texas in May when a leaked Supreme Court draft opinion signaled the high court was poised to overturn 1973’s landmark abortion decision Roe v. Wade. While her daughter’s rights might be under attack in Texas, she’d figured they’d be upheld if litigation reached the Supreme Court. Now, she’s unsure. A registered nurse, she’s looking at states where she can keep her license that are also friendly to trans kids. She’d been planning on New Hampshire, until she saw a state lawmaker had introduced its own bill in March that would classify gender-affirming care as child abuse.
This isn’t even the first time Shappley has moved for her daughter; she and her family moved from Pearland, Texas, to Austin in 2018 after her daughter’s previous school refused to let her use the girl’s bathroom. They thought the city’s progressive reputation would help protect them. “But the city of Austin isn’t going to be able to save us,” Shappley says. “I just don’t see Texas being better for trans kids anytime soon.”
Families with trans kids who’ve already left their state don’t know when they’ll be able to go back. Emily and George Spurrier used GoFundMe in April 2021 to help them quickly move to New Mexico from Arkansas after the state enacted its gender-affirming care ban. Their 17-year-old trans son was already receiving gender-affirming medical care, and they worried abruptly stopping his treatment could be devastating. Camille Rey and her three kids, one of whom is trans, moved from Texas to Maryland in 2021 after the first gender-affirming care ban was introduced in the state legislature. Mike Taylor moved from Texas to Hawaii with his 10-year-old twins, one of whom is trans, in early 2020 when the first wave of anti-trans bills began to crash.
“My heart’s in Texas,” says Taylor, who has continued his job as a South Texas radio host remotely. “I would love to go home at some point for good… I feel I was forced to [become an] expat from my own state, and that’s heartbreaking.”
‘It made me feel safer’
When Karen’s family reached Oregon in early June, they all felt some sense of relief. They blasted “Edge of Town” by Middle Kids as they crossed the state line after five days of driving.
“It made me feel safer, but also sad,” Jessie says about the move. Emotions may be mixed, but both kids are focusing on the positives: Jessie says she loves how beautiful Oregon is. Her brother Lucas can’t wait for a cold winter.
Karen’s family has found a haven, but the battle over the rights of trans youth is far from over, in the political arena or the legal one. More bans on gender-affirming care could be on the horizon as rightwing candidates leverage the topic to rally their base. The conservative advocacy group American Principles Project says it has raised up to $9,000,000 for a midterm ad campaign this fall that will criticize gender-affirming care for minors, along with other issues impacting trans children.
Alabama and Arkansas’ gender-affirming care bans are currently blocked and tied up in litigation, but the issue is not settled. In a brief filed June 27, Alabama’s Attorney General cited the Supreme Court’s recent overturn of Roe v. Wade in defense of its felony ban, arguing that gender-affirming care is not “deeply rooted in our history or traditions”—as Justice Samuel Alito wrote about the right to an abortion—so the state has the legal authority to ban it. In Florida, where teaching about LGBTQ issues in primary school is now banned, The Department of Health issued guidance in April advising against any gender-affirming care for young people, even social transition like changing one’s name or pronouns, and has proposed a rule change that would ban Medicaid from covering gender-affirming care for people of any age. In response to the wave of anti-trans policies, President Joe Biden issued an executive order on June 15 directing the U.S. Department of Health and Human Services to “work with states to promote expanded access to gender-affirming care,” which could tee up even more litigation in the future.
In the meantime, Karen’s family is settling into their new home, free for now from the burden of battling their state government. They’re in the process of unpacking, slowly unwrapping pieces of their old life. In the basement is a stack of what still needs to be hung on the bare walls: Karen and Chris’ wedding portraits, a Kurt Vonnegut poster, drawings by the kids, and Jessie’s blue, pink, and white poster that says “Trans Girls Are Girls.”
On June 19, the family went to Portland’s Pride festival on the waterfront in their first outing together in the new city. They held hands, squelching through the mud after a downpour, and weaved through the rainbow-clad crowd. They approached the booth of the TransActive Gender Project, which works to support trans youth in Oregon, and Karen introduced Jessie, sharing that they’d just moved from Texas.
“Welcome,” the staff member said, addressing Jessie. “We’re so glad you’re here.”
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Write to Madeleine Carlisle/Portland, Ore. at email@example.com