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Jody Freeman is still trying to find gender-affirming care for her 17-year-old son, Finn. She hasn’t been able to get a refill for his testosterone prescription since mid-September. In the past few months, they’ve been denied at various pharmacies near where they live in Grove Hill, Alabama, including Walmart, Walgreens, CVS, and a mom-and-pop store. Finn’s doctor keeps transferring the prescription, and pharmacies keep refusing.
Gender-affirming care for minors is still legal in Alabama, for now. But in a town with three stop lights and not much else — where putting a McDonald’s on the highway is big news — it might as well not be.
A legal fight over Alabama’s felony ban on gender-affirming care means it can’t be enforced right now. But that pause hasn’t changed the reality for Finn and his family: there is nowhere to go. Every state bordering Alabama has also banned gender-affirming care for trans youth. Although there are exceptions for several nearby Southern states — Louisiana’s ban does not go into effect until January, and Arkansas’ care ban has been blocked by a judge — Freeman has still been unable to find health care for her son.
She looks at a map of the South and sees a wall of gender-affirming care bans in limbo or bans that have already gone into effect. Freeman knows that eventually, the family will have to find care for Finn out of state. In addition to travel costs, they may have to pay for care without insurance, since a few clinics that she’s reached out to — one in Illinois, and another in Mississippi — informed her that they recently changed to private pay only.
Freeman isn’t alone. Across the South, families of transgender youth who want to find gender-affirming care for their children are wading through a morass of pending legal cases and being turned away at pharmacies without crucial information on what their rights are. This gauntlet comes with mounting financial costs.
Some families decide to flee their states to areas more protective for trans youth, which usually saddles them with a higher cost of living. Others try to get back-and-forth doctor’s appointments across state lines, which require hours-long car trips taken monthly or every few months, depending on how many check-ups their medication requires.
In response, a few LGBTQ+ organizations are raising money to give directly to families seeking gender-affirming care for their transgender children. The grants, ranging from a few hundred dollars to a few thousand, are primarily meant to cover travel costs, but can also be used for things like gender-affirming clothing and supplies.
Right now, Freeman has a $500 grant from the Campaign for Southern Equality stashed in a savings account. That money can help the family with travel expenses for if, or when, they find an out-of-state provider that will refill Finn’s medication. So far, the LGBTQ+ advocacy group’s emergency project has distributed roughly 350 similar grants of $500 to families of trans youth living in Southern states.
The Campaign for Southern Equality is how Freeman found out that Finn’s care is still legal in the first place. When the organization contacted her in August about grant money that it’s offering to families of trans youth seeking gender-affirming care, she was told that the legality of the care in Alabama is still in limbo — for now.
In addition to funding, the project has focused on getting accurate information to families about the legal and political status of gender-affirming care bans, and helping families find health care providers. The legal landscape is confusing: Alabama is one of 21 states in the country that has banned gender-affirming care for transgender youth, and legal challenges have affected whether those laws are enforceable.
Many trans adults and families of transgender youth are simply confused — about what their state law says, how it affects gender-affirming care for their child, what bordering states’ laws are, and whether they actually have to jump ship to another state.
Carolyn Jones, project manager for the Southern Trans Youth Emergency Project, has had direct conversations with many trans people and their families who are rattled by misinformation.
“If you don’t have a connection to an organization like this or to an attorney, it’s almost impossible to understand what’s going on,” she said. A lot of families incorrectly thought their state law on gender-affirming care would cause them to lose custody of their kids.
Another, smaller organization is also offering aid to families of trans youth. Genderbands, a trans-led nonprofit, is offering travel grants for transgender youth who are seeking gender-affirming care. The exact amounts for cash grants given by the organization vary each year, but last year they were typically $5,000 each.
Adam Polaski, communications director for the Campaign for Southern Equality, said that most families who apply for help with their organization are looking for a way to live in the state where they currently reside. But some families are using the money to move to other states to find health care.
Erica Mannery-Barker’s family in Mississippi is one of those families. She works for the ACLU of Mississippi’s legal department. Unlike other parents in the state, she had a heads-up on what was coming before the state banned gender-affirming care for trans youth in February. She and her husband have twins, who are both in middle school. Their daughter is transgender, and her twin is nonbinary.
As early as August last year, her family was having conversations about what the best course of action would be. Once the law was signed, it was clear that finding gender-affirming care for their daughter by driving to and from a neighboring state would be impractical and possibly dangerous.
It was one of her own colleagues that told her about the available emergency funds for Southern transgender youth being offered. The Mannery-Barker family received $1,000 from the Campaign for Southern Equality, which was used to offset costs on a drive from Mississippi to Alabama in an attempt to find gender-affirming care there.
She eventually deemed such trips to be too risky. Mannery-Barker believes that the Mississippi attorney general is likely to prosecute parents of transgender youth living in the state who seek gender-affirming care elsewhere, since the law says that the attorney general will enforce compliance with the state’s gender-affirming care ban. The state’s law, like several others, also mandates that adults cannot aid or abet the provision of gender-affirming care to a minor — which some advocates see as implicit no-travel clauses.
That threat of potential prosecution is what, Mannery-Barker said, ultimately drove it home for her family: “we have got to get out of here.”
In March, the family made a decision: they would have to move. Mannery-Barker’s husband has already relocated to Nevada, while she and their two children will follow in about two months.
Mannery-Barker feels “bittersweet-excited” about the move. Her kids will be in a better environment, especially at school, where she and her husband have already had refreshing conversations with knowledgeable staff about how to be respectful towards gender-expansive students. But the family doesn’t have friends or family in Nevada and the move has already cost $50,000, a price tag that she expects to keep climbing.
“I was about to say our situation is extreme, but actually it’s not. Because a lot of other families have opted to do the same,” Mannery-Barker said.
And even in states without statewide gender-affirming care bans, families are still facing restrictions.
At the Campaign for Southern Equality, Jones worked with one Texas family that found a clinic appointment in New Mexico for gender-affirming care. The clinic canceled three weeks before the appointment. That’s happened a few times, she said — where clinics have decided to stop seeing out-of-state patients traveling from states with gender-affirming care bans.
South Carolina is one of two states in the South that has not enacted a statewide ban on gender-affirming healthcare for transgender youth. But Aryn Kavanaugh’s kids still can’t access their care.
Kavanaugh lives in Myrtle Beach, South Carolina, with her husband and two teenage children — both of whom are transgender. Last December, her kids’ care was interrupted. The Medical University of South Carolina (MUSC) started canceling the family’s doctor’s appointments. Her son was receiving testosterone as part of his transition and her daughter was being prescribed puberty suppressants.
Kavanaugh would reschedule an appointment, then the office would cancel again. She was especially worried about her son, Parker, not being able to get his testosterone prescription refilled. He was about to turn 17, and had been on testosterone for several years at that point. Gender-affirming care was, and is, still legal in the state.
Eventually, Kavanaugh found out through the news that MUSC was no longer providing gender-affirming care to adolescents. It took until the end of January to get verbal confirmation of that from the hospital, she said.
“Me and the kids were just terrified about what the next steps were gonna be and, were other doctors going to be canceling their services?” she said.
Earlier in 2022, the state legislature had banned the Medical University of South Carolina from using state funds to provide gender-affirming care to minors under sixteen — through adding a measure to the state budget. Conservative state legislators were putting pressure on the hospital system.
And Kavanaugh was left to figure out how she could continue her son’s prescription. Suddenly stopping a hormone treatment can have adverse side effects. She had to figure out where to turn next. She couldn’t find an endocrinologist specializing in treating transgender youth in Myrtle Beach. So she knew they would have to travel.
The closest option she could find was three hours away — in the state capital, Columbia. Her kids go to the Prisma Health Children’s Hospital there now. Her daughter, Grey, who recently turned 16, has been able to get her estrogen prescribed for the first time.
Kavanaugh was first introduced to Prisma Health Medical Group through the Campaign for Southern Equality. Grant money from the LGBTQ+ organization helped the Kavanaughs pay for that first three-hour drive, plus insurance co-pays and some gender-affirming clothes for Parker and Grey.
The Kavanaugh family has received $1,000 in total from the advocacy group’s emergency project for Southern transgender youth. This spring, they were given $250 per child, then over the summer, another $500 total was granted in the same way.
On top of the costs of travel, insurance co-pays for medication, and buying gender-affirming clothing, both of her children see therapists weekly. It costs $40 a week for both of them. They are required to see a therapist in order to get gender-affirming care — so that’s another mandatory expense. They will have to make the drive to Columbia every six months for the kids to get routine blood tests done and to get refills on their prescriptions.
“Those bills really add up. So having a little bit of a crutch to land on and just feel like there are people out there that care is huge,” she said. The Kavanaughs are a dual-income home, but part of why they moved to South Carolina in the first place was for a lower cost of living. Aryn teaches 10th grade English, and her husband works in real estate.
It feels like a desperate and hopeless time for many families, Polaski said. But families of trans youth have options to seek financial aid.
“There is a way to continue to receive the care that you need,” he said. “I want people to know that help is available. It’s going to be more expensive. It’s going to be harder. It is a confusing and chaotic time, but it’s possible.”
The changing landscape has also affected Genderbands’ approach. This is the first time that the volunteer-run organization, which has existed since 2015, has expanded its gender-affirming care grants to trans youth in addition to trans adults. Ian Giles, founder and executive director of Genderbands, said that the nonprofit’s mission has become more critical than ever.
“With every anti-trans bill that comes out, I feel like it’s more and more important that we are there and we are visible,” he said. “I feel like I need to get out as many grants as possible as soon as possible before there’s so many laws that we’re not able to do what we do,” he said.
Trans youth are under attack right now, Giles said — and he’s determined to keep going, even if the constantly changing legal landscape affects whether they can get grants out the door. They will just have to change their approach, he said.
In Alabama, Finn won’t legally be an adult until he’s 19. So accessing gender-affirming care in the state isn’t as simple as waiting until his next birthday. By October, he had two vials of testosterone left. He’s been rationing injections, skipping a week or so at a time, in order to make the medication last. He only has a few shots left. His mother has applied for a Genderbands travel grant ahead of the organization’s November 30th deadline and is still trying to find a clinic in New Orleans that will take new patients.
“We’re getting to that point of desperation,” Freeman said.
