A state law that forbids gender-affirming attention is being challenged in court as to why these trans children’s families are leaving Texas.

Lisa Stanton could feel her heart racing, her body breaking out in sweat and her palms going numb as she sat this summer in the waiting room of a Colorado emergency urgent care clinic alongside her 12-year-old transgender daughter Maya, who was crying over pain in her ear.

Stanton and her husband, along with Maya and her twin brother, had just uprooted their whole lives from Texas and, in two cars packed with all their belongings, were headed to their new home in Colorado, where they knew no one.

As they’d climbed into the mountains, Maya’s ears and throat started to hurt. So, they went to the clinic. But being back in a medical setting – filling out an ordinary health form – Stanton found herself overwhelmed by fear and anxiety she knew was rooted in the experience her family was trying to outrun, even if the care she sought now for her child was far less controversial.

“I thought to myself, ‘Why am I so scared? I’m not in Texas anymore,’” she recalled to CNN. “I kept telling myself, ‘You’re not in Texas anymore, it’s OK.’”

The mother’s panic traced, she said, to why her family and others have spent untold money, time and emotional energy routinely commuting from Texas or moving away entirely: They want to give their transgender children the kind of gender-affirming treatment that’s deemed safe, effective and potentially lifesaving by many major medical groups but has been banned by a new state law that can make these families feel unwelcome – and even targeted – more broadly in the state, several told CNN.

Senate Bill 14 bars Texas health care providers from giving gender-transition surgeries, puberty-blocking medication or hormone therapies to those under 18, with violators at risk of losing their licenses. Measures like it have been pushed in recent years – along with a record number of anti-LGBTQ bills – across US states, largely by Republicans, including some who’ve argued bans on such care protect against “irreversible” biological changes facilitated by parents.

Some critics of the therapies suggest children should wait until adulthood to transition. But that’s an outdated approach that assumes gender identity is fixed at a certain age, the American Academy of Pediatrics says, as research shows it’s healthier to value a child for who they are rather than for what they will become. And some therapies, such as puberty blockers, are reversible, while related surgeries are rare, according to an analysis of health insurance claims from 2017 to 2021.

Texas Attorney General Ken Paxton’s office considers gender-affirming surgical procedures and puberty-blocking drugs “child abuse,” he declared in a 2022 legal opinion. “‘Transing’ kids through surgery/drugs is abuse & I’ll do all I can to stop it,” Paxton posted that year on social media. The offices of Republicans Paxton and Gov. Greg Abbott did not respond to several CNN requests for comment for this story.

Texas’ Supreme Court on Tuesday is set to hear oral arguments in a constitutional challenge to SB 14 by parents, doctors and advocates. Already, though, the law’s fallout for many families of transgender kids – and their doctors – has been life-altering.

‘I had to hold my tears every day’

Months before SB 14 took effect in September, some medical providers in Texas began treating the bill as law and abruptly halted care for young transgender patients – in step with their peers in more than a dozen states from Arizona to West Virginia.

The move also anguished professionals devoted to serving transgender youth, who make up a small sliver of all US kids – just 300,000 nationwide, ages 13-17, UCLA research finds – but among whom half seriously considered attempting suicide last year, according to The Trevor Project, an advocacy non-profit. Some 105,000 trans children live in states that have passed bans on gender affirming care, Human Rights Campaign reports.

“I had to hold my tears every day, patient after patient,” Dr. Ximena Lopez, a pediatric doctor who specializes in gender dysphoria, told CNN about the tense lead-up to SB 14 taking effect. “It was devastating.”

The virtual shutdown of services sent Texas households scrambling into the increasingly fractured nationwide network of care for transgender kids, where a new challenge loomed: wait times for appointments stretching months and even years, parents and health providers told CNN.

Some families also went looking for new homes outside Texas, which to Lisa Stanton had begun to feel like “a witch-hunt environment where you no longer feel safe, one where you feel like your name is probably on some list,” she said of her sense of the state government’s intrusion into her family’s and its doctors’ medical decisions for Maya.

The dread haunted her – on the roads out of Texas and up into the mountains.

In Colorado, though, Stanton began to see things could be different. It started, the mother said she realized later, at the clinic with the medical form she was filling out for her daughter’s earache. It asked for not one but two key pieces of information about Maya she now could answer with confidence: gender assigned at birth and gender identity.

Still, as Stanton soon would learn, accessing gender-affirming care isn’t necessarily easy – even in a place like Colorado – amid the coast-to-coast crunch for such services that laws like SB 14 have triggered, she said. After settling down, it only took a few phone calls to clinics to realize Maya could be on a waiting list for up to two years for a local appointment, her mother said.

So, Stanton in November took her child to a clinic in California where she’d gotten on a waitlist as SB 14 began making waves last spring, she said. Meanwhile, she calls clinics in their new home state every few months to try to get an appointment.

“There is still such a backlog,” Stanton told CNN, “that we’re having to still travel out of state for care.”

It was never a question for Stanton whether Maya needed access to gender-affirming care, as the child had repeatedly and consistently said from the time she first could speak that she would die if she had to go through male puberty.

“I needed to do what I needed to do to prevent her from confronting that extreme dysphoria that would cause suicidology for her,” her mother said.

Families split up or travel – at high costs

Another family with a 14-year-old transgender daughter and a 10-year-old nonbinary child also left Texas after their clinic in May canceled an appointment for gender-affirming care without saying why, said that mother, who to protect her family’s safety and privacy asked to be identified as Mindy Campbell and isn’t disclosing the state they moved to.

Campbell’s daughter is not publicly out as transgender, she said, noting, “The political climate with all the anti-trans rhetoric makes me very uneasy and feel unsafe of strangers who might have ill intent knew our names.”

Still, Campbell knew she had to leave Texas, where “my child was not able to receive gender-affirming care, which was not an option to us as parents,” she told CNN. “Trans kids have extremely high rates of suicide, and not having gender-affirming care increases that rate even more.”

“I was not about to stay somewhere that would put us in a situation for us to contribute to those statistics,” she said. “I’m not taking that risk.”

But Campbell’s husband could not leave his Texas-based job without stripping away their financial stability, she said. So, he stayed while Campbell and the kids moved out of Texas to a 700-square-foot temporary housing arrangement where they all share a bedroom.

The decision to start her daughter’s gender-affirming care did not come overnight, Campbell said. In the prior six years, the Campbells went to LGBTQ education conferences, classes and consultations with pediatricians, psychiatrists and gender-care doctors to learn about potential risks of treatment.

“When your child starts saying things like, ‘I would die if I had facial hair or a beard like my daddy,’ those were serious feelings that were being shared with us,” Campbell said. “To us, it was riskier to not proceed with gender-affirming care than it was to proceed with it.”

Still, her youngest child struggles to understand why they had to move just to access medical care, while her daughter feels the weight of blame for their move, Campbell said.

“The hardest part is having to separate our family and at the same time trying to reassure the kids that this is temporary, and this is not forever, and we’ll all come out of this on the right side,” Campbell told CNN. “I just don’t know when or how long it’s going to take for my husband to find a job out here that would make sense for him to leave his job there, financially. We depend on that.”

Money also is a key factor as Christina Marks, a single mother who recently lost her job, tries to maintain her 17-year-old son Ryan’s hormone replacement therapy, or HRT, following its suspension by his San Antonio clinic amid SB 14, she told CNN. The mother asked to be identified by a pseudonym to protect them from possible harm, saying she feels they would “be targeted and be the victims of hate crimes” if she used her real name.

Without HRT, she said, Ryan’s severe depression almost certainly will reemerge, threatening his mental, emotional and physical well-being, along with his prospects for a healthy and functioning life. Indeed, for three months, Marks watched her son’s mental health deteriorate and his confidence diminish as she called clinics around the country that might help him restart HRT, she said.

“It was really stressful,” Ryan told CNN. “I still had a month’s worth left of HRT and I didn’t know when I was going to be able to continue because I don’t see a future for myself where I’m not a man, a dude.”

Marks eventually found the Campaign for Southern Equality, an advocacy group that helps families with transgender youth in Southern states with bans on gender-affirming care. It offered her a grant that covers travel to a New Mexico clinic where Ryan gets treatment, though he typically has to miss school for days for it.

“Every time I worry because: The next appointment, are we going to be able to afford it?” Marks said. “Southern Equality has helped us, but I don’t know if there’s going to be a next time and if they’re going to be able to help.’

‘Denied something that makes you feel true’

Even before SB 14, medical providers and clinics treating transgender people in Texas were the target of intimidation and death threats, forcing some to close practices or relocate to other states, said Alex Sheldon, executive director of GLMA, previously known as the Gay & Lesbian Medical Association.

With the gender-affirming care ban now in place for youth, providers face an “agonizing” moral dilemma, Sheldon said: Stay in Texas and deny care to patients, knowing it will jeopardize their health while breaching professional ethics; or begin the strenuous process of moving their medical license, practice and family elsewhere.

“They want to be able to provide care for all people, particularly the most vulnerable and the most marginalized because that’s where they can see the most impact through their work,” Sheldon said. “So, even telling someone that they can’t provide care to a very small proportion of their population … means it’s just not a compromise they’re willing to make.”

Lopez, the physician who held back tears over SB 14’s treatment restrictions, has lead research on gender-affirming care, advocated for transgender patients from the clinic to the courtroom and opened Texas’ first pediatric gender clinic in 2014, she told CNN.

But as state lawmakers early last year introduced bills including SB 14 to outlaw such care for trans youth, Lopez knew she, her husband and their teenage son would have to leave Texas, she said: “I felt like it would be years for this fight to be done, and I was already drained emotionally from years of fighting like this. … I didn’t know if I had the capacity to keep up.

“I was also worried about my safety, and I didn’t know how far that could go.”

Now in California, Lopez, perhaps predictably, has welcomed an influx of families with transgender children from Texas, she said. But she still worries about the gaps some of those kids were forced to endure before resuming in other states the kind gender-affirming treatments banned by SB 14.

And Lopez agonizes over children without the means to access outside Texas the kind of treatment that could save their lives, she said.

“It’s that you are being denied something that makes you feel true, that gives you motivation to wake up every day and go to school and be yourself, that makes you more confident to have friends and go out,” the doctor said.

“They are taking that away, and I’m worried about kids getting more depressed or committing suicide. That’s just the reality.”