Families who have left Texas and other states that have banned gender-affirming care are calling themselves refugees because they have had to leave their homes for fear of persecution because of their desire to provide gender-affirming care for their children.
“We knew that with so much chaos, the culture wars would escalate the problem,” says Dr. Anna Tran, who left the state last October with her daughter. “We knew the climate would accelerate the attacks, which is why we left. It was just the beginning.”
Gender-affirming care has been a political football of late. Texas is one of 20 states that has passed laws banning puberty blockers, hormone therapy, and transgender surgery on minors, though surgery for children is rare. Many of these laws have yet to take effect and are snarled in court proceedings as conservative states battle families, the American Civil Liberties Union, and other advocacy groups to ensure their bans on gender-affirming care become a reality.
The Dallas Morning News reported on August 25 that a Texas District Judge sided with families who argued a state law banning gender-affirming care for minors would violate their parental rights and negatively impact their transgender children who are denied treatment recommended by their physicians, theoretically allowing gender-affirming care to continue despite the new law. Then, on August 31, the Texas Supreme Court allowed the legislation to take effect.
The fight over gender-affirming care in Texas began in Dallas when Children’s Health and UT Southwestern quietly unbranded the GENECIS clinic, which provided gender-affirming care to minors. The change occurred after an anti-transgender protest was planned outside the home of one of the Children’s Health board members. GENECIS founder Dr. Ximena Lopez was celebrated for her efforts to open the clinic in 2017, but as transgender healthcare became a hot-button issue, Children’s Health and UTSW decided the clinic would stop taking new patients for puberty blockers and hormone therapy (the clinic never performed surgery on minors).
Lopez took legal action against the state for denying what medical societies say is best practice treatment to patients with gender dysphoria. After the clinic was shut down, a judge ruled last year that the clinic could continue to operate while Lopez’s case against the state. But this year, legislators passed a law banning gender-affirming care, making Lopez’s legal case moot. In May this year, DMN reported that Lopez would be leaving Texas and closing her practice.
Like Lopez, many families are leaving the state for fear their transgender children will be unable to receive the treatment they say they need. The GENECIS clinic was consistently full and served patients in a large geographic area because of its unique services. Many of these families are now forced to travel or permanently move to states where this type of care is allowed. In 13 states, legislators have passed shield laws protecting gender-affirming care, endorsed by the American Medical Association, the American Pediatric Society, and others.
Tran had been a physician at Medical City Dallas before leaving for Washington to ensure her child received the care she needed. For a time, the family traveled back to Texas to receive care at GENECIS while they progressed through the waitlist in Washington, but they now receive care in their home state, where Tran’s husband eventually joined them.
In a bitter twist of fate, this is the Tran family’s second time rebuilding a life in a new place as refugees. When she was four years old, her family came to Texas from Vietnam, fleeing persecution as political refugees, and was sponsored by a Catholic church to resettle in North Texas. “It’s ironic that we came to Texas when my parents were political refugees. It gave us a chance to rebuild our lives, but this state has turned on the next generation,” she says. “Now I’m in my parents’ position where I’ve had to take my child to a safer place.”
Life is already difficult for a transgender teenager. A 2020 survey by LGBTQ youth crisis intervention organization The Trevor Project polled 40,000 LGBTQ people between 13 and 24. It found that 55 percent had major depressive disorder, and 40 percent said they had “seriously considered” attempting suicide in the past year. Governor Greg Abbott made Texas the first state to investigate families of transgender minors who receive gender-affirming care earlier this year.
According to the Journal of the American Medical Association, more than 89,000 transgender youth ages 13 to 17 live in states with limited access to gender-affirming care. The research found that the distance traveled to receive gender-affirming care for minors went from under an hour to 7.5 hours since Texas enacted its ban.
Tran’s family’s departure to a gender-affirming care haven is part of a larger movement nationwide. MPR News reports that patient requests are up 40 percent at the Children’s Hospital of Minnesota since states started enacting bans, with physicians reporting patients from all over the country, including Florida. Bangor Daily News also reports that its local children’s hospital’s gender-affirming care requests are up 40-50 percent. Both states have laws to protect gender-affirming care.
But not everyone can pick up their life and head to a state with stronger gender-affirming protections. For those who remain in Texas, Tran says that some families are forced to turn to less reputable sources for gender-affirming care online or on the black market, which can be dangerous. “It is heartbreaking to see the struggles of those who can’t leave,” Tran says. “We have survivor’s guilt because we had the resources and opportunity to leave.”
While being a self-described refugee isn’t ideal, Tran says the choice has significantly improved for her family and others she has talked to who left Texas to seek care for their children. “One thing that they always say is that they feel like they’re able to breathe,” she says. “That says it all.”
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