The first time Misty and her 15-year-old daughter traveled to Ohio to see a doctor, they stayed in a hotel near the Cincinnati hospital. On the second trip, two months later, they left their Knoxville home at 4:30 a.m. and drove more than four hours, watching the sun rise from the interstate, before meeting with an endocrinologist at 10 a.m. Because Tennessee pharmacies would not fill a prescription for her daughter’s estrogen, they waited in a Cincinnati CVS parking lot for two hours and arrived home that night after Misty’s husband, Chris, made dinner for their two younger children. On a Wednesday night in December, Misty drove two hours to Waynesville, N.C., and back to pick up a prescription refill.
Before Tennessee lawmakers and Gov. Bill Lee approved a new law banning gender-affirming care for transgender youth in March, the drive to their Knoxville endocrinology clinic had been 15 minutes. Their regular pharmacy is a mile away.
“It’s really saving her life,” Misty said, explaining why she is willing to make the recurring road trips. “That’s what it boils down to. It’s lifesaving treatment.”
With the new ban on gender-affirming care for minors now in effect in Tennessee, parents across the state are making difficult decisions for their families on where to live and how to find medical care. For some, it’s a debate on whether to leave the state entirely and where and when to move. For others, it’s how to navigate out-of-state healthcare and best support their child when moving isn’t an option.
“There are also a lot of folks who maybe would, ideally, want to leave but can’t for various reasons. Financial reasons is a big one,” said Emma Chinn, a Nashville policy manager for Campaign for Southern Equality, an Asheville, N.C.-based nonprofit supporting LGBTQ individuals. “It’s a really big deal to have to find a new job, and (there’s) the cost of moving and leaving your family and other support systems. That’s just not something everyone can do.”
The new Tennessee law blocks puberty blocking medication, hormone treatments and rare surgical procedures for transgender youth. Those already receiving that care in Tennessee must end it by April. Some Tennessee doctors have already stopped providing these treatments, forcing families like Misty and Chris’s to find gender-affirming care in other states.
People are really moving mountains to do whatever they can to get care for their kid and just stay afloat.
– Emma Chinn, Campaign for Southern Equality
With the exception of Virginia, Tennessee is surrounded by states with new bans on gender-affirming care, although some states’ restrictions have been held up in court. Beyond Ohio, some Tennessee families are seeking care in South Carolina and Illinois, driving as many as eight hours for doctor visits, according to the Campaign for Southern Equality. In North Carolina, Tennessee patients must have begun seeing providers prior to August, and South Carolina lawmakers are expected to consider a ban again in 2024.
Southern Trans Youth Emergency Project, a regional program that is part of Campaign for Southern Equality, partners with two Tennessee nonprofits and has provided financial grants, patient referrals and community education in states where care has been banned or impacted. Families have spent the $500 grants on out-of-state travel for care, telehealth appointments, moving costs or gender-affirming clothing. As of December, the organization had issued 55 grants to Tennessee families.
For many families, keeping their child alive and healthy is a real concern. The risk of suicide attempt was nearly 8 times greater for transgender youth compared to cisgender peers in a 2022 study published by the Canadian Medical Association Journal. A separate 2021 study in Journal of Adolescent Health found that gender-affirming hormone therapy lowered rates of depression and suicidality among transgender and non-binary teens.
“People are really moving mountains to do whatever they can to get care for their kid and just stay afloat,” Chinn said.
‘A kick to the gut’
Misty, a nurse, and Chris, a software developer, mostly work from home and have more flexible schedules, an arrangement that has made traveling out of state possible for their family. They have accessed two grants from Campaign for Southern Equality that have helped with medical expenses as insurance has grown more complicated. They are going by their first names to protect their child’s privacy.
The couple has thought about moving to the Northeast where transgender rights are more protected, but they have decided to stay in Tennessee. There are smaller, even “crazy” reasons, Misty said, like the weather and the pool they just built, but there are bigger considerations, too. Tennessee is their home. Chris and Misty are both from the Knoxville area and their families live there. A move to the Northeast could mean a significant increase in living expenses. Their two oldest children no longer live at home, but uprooting the younger siblings would be disruptive for them.
“All our families are here. Tennessee affords us a good lifestyle,” Chris said.
And, the trips to Cincinnati are temporary. Their daughter will be 18 in less than three years. If she were younger, if they were unable to work from home or if she were not mentally stable, they would be more likely to leave, Misty said.
We have got to support our child. If we are not able to do that in the state of Tennessee through gender-affirming health care, then we are going to have to go somewhere else.
– Jason, parent of a transgender child
Similar conversations are taking place in homes across the state. Jason, who has spent most of his two decade law enforcement career in Middle Tennessee, and his wife are also assessing their location as they consider their 10-year-old’s pending adolescence. She has not begun gender-affirming treatment, but she may want to in a few years. Jason will be eligible for retirement benefits in nine years, but because of the state’s new law, he’s wondering if he will need to freeze his pension and restart elsewhere.
“We have got to support our child,” said Jason, who also asked to go by his first name. “If we are not able to do that in the state of Tennessee through gender-affirming health care, then we are going to have to go somewhere else.” He added, “It stinks.”
They are considering the Washington, D.C., area. Moving would reduce the pension earnings they had planned on, but it would mean his child could access the care she might need.
Jason’s child was six when she told her mother on a trip to Fall Creek Falls that she felt more like a girl and wanted her help and they have been supportive of her journey. Seeing statistics on suicide rates and the lowered risk that came from acceptance and support was “all we needed to hear,” Jason said.
Jason and his wife check in with their daughter regularly to see how she is navigating school with the enforcement of a 2021 bathroom law for transgender students. While she has teachers and administrators who support her, that hasn’t always been the case.
“All she has to do is tell us, ‘It’s just too much,’ and we’ll go,” Jason said.
Tennessee legislators supporting the gender-affirming care ban said their motivation was protecting kids. Republican Rep. William Lamberth, representing Portland, Tenn., cautioned against “cutting off body parts” and irreversible treatment and urged counseling instead. He did not respond to requests for comment for this story.
“What these children need is love and support, mental health treatment and time,” House Majority Leader William Lamberth said in February of hormone therapy. (Photo: John Partipilo)
“What these children need is love and support, mental health treatment and time,” Lamberth said to fellow lawmakers in February. “They need time to determine how they feel about that change.”
Jason spent days at the state’s Capitol and talked to more than a dozen Republican lawmakers about the issue. He is not opposed to age limits on surgery, but he does not support bans on puberty blockers, which pause puberty development and allow for more time to make bigger decisions, and hormone therapy. Some lawmakers have agreed with him in private, but ultimately voted with their party, he said.
“It’s a kick to the gut,” Jason said. “A lot of these laws do seem to be extreme and go against what professionals are saying. They don’t care.”
Chris described himself as fiscally conservative and he voted for both Republican Gov. Bill Lee and former President Donald Trump in their first terms. To see both the governor and lawmakers approve laws impacting transgender youth has frustrated and angered both him and Misty.
“We are just trying to keep our child alive until she is mature enough to make her own decisions,” Chris said. “A lot of the people who are supporting these kinds of laws don’t even really even understand what the law is doing.”
Navigating health care, school, driver licenses
For Misty and Chris, the conversation around transgender care began about five years ago. At a young age, their child was more feminine, and in fifth grade, she came out as gay. She struggled with mental health, and suicide attempts, overdoses and several in-patient stays followed. In seventh grade, she told her mother she was a girl. After dozens of sessions with medical doctors and therapists, they eventually made the decision to begin puberty blockers and estrogen. Surgery is not something they are considering for her, but she can make that choice at 18.
“Really, not much has changed,” Chris said. “It’s the same person. It’s always been the same person.”
Chris and Misty both grew up in conservative, evangelical Christian homes. Most of their longtime friends have similar backgrounds. For Chris, reconciling his faith with homosexuality and gender dysphoria was a process.
“Fundamentalist dads, we feel like it’s our task to teach the word of God to our kids,” Chris said. “Because of that, it leaves you not sure what to do.” He added, “It was hard.”
Rejecting their child or withholding support was never an option, Chris said, and he sought to educate himself on gender dysphoria. Both parents emphasized the care and thought that has gone into each medical decision and that this is an issue that neither of them, including their daughter, have sought out.
Misty and Chris’s daughter homeschools, a decision driven by the Tennessee law regulating school bathrooms. Using a special bathroom means bringing more attention to her transition. It can also mean using a restroom on the other side of school. Eventually, she unenrolled and began studying at home. Since their daughter left school and as her gender-affirming care has progressed, her mental health struggles have eased, Misty said.
Beyond the new travel logistics for gender-affirming care and bathroom challenges, living in Tennessee as the political winds have targeted transgender individuals has been difficult for them. The state also passed a law in 2023 on driver license gender identification, complicating their daughter’s timeline for learning to drive and posing potential safety issues for her, Misty said. Relationships with family members and friends have been affected and classmates, even teachers, have made hurtful comments. Their daughter loves volleyball, but there is not a place for her to play, and Misty calls ahead to make sure businesses and various organizations are welcoming.
“I keep her in a little bubble, but I’m like, ‘how long am I going to be able to do that?’” Misty said.
Moving from Tennessee to Virginia
Tennessee families who have moved face other challenges. Kristen Chapman and her two daughters left Nashville for Richmond, Va., in July so that her youngest could continue gender-affirming care. Their father has remained in Nashville for his job. The move felt necessary, but it has proved far more difficult than she anticipated.
“It’s been a rough landing,” Chapman said. “The kids are still very raw from having their family busted up, leaving all their friends, leaving everything they have ever been familiar with, trying to start in a new place.”
“A rough landing,” said Kristen Chapman of her family’s move to Virginia. (Photo: John Partipilo)
Chapman had hoped that once they found an apartment “everything would fall in place,” she said. But the expense of moving, finding a job that works for her, changing schools for both teens, age 17 and 15, has all been harder than she had expected. Willow’s teachers at her new school called her by her former name daily, based on new guidance in Virginia, one of several factors that led her to homeschool until they find a better fit. They are also working through the emotional trauma that they have experienced in the past year as lawmakers debated their options. Chapman had long prioritized her kids’ education, strategizing for years for top Nashville magnet schools, but now their mental health is her main focus.
“For all families with a trans kid in Tennessee , whether they moved or didn’t move, they are experiencing a whole nother level of mental health challenges that come from being targeted and deemed unworthy,” Chapman said. “The impact of the last year has a long tail that I did not foresee.”
Making regular six to eight hour drives for Willow’s medical care did not seem manageable. But even beyond the logistics, she didn’t feel like her family was safe or welcome anymore in Tennessee, a state where she was born and lived in for about 35 years.
“It was no longer home,” she said. “I felt like, long term, my kids had a better shot of becoming who they want to become if we are in a place we are wanted.”
