Families with transgender kids are increasingly forced to travel out of state for the care they need

On an early morning in June, Flower Nichols and her mother set off on an expedition to Chicago from their home in Indianapolis.

The family was determined to make it feel like an adventure in the city, though that wasn’t the primary purpose of the trip.

The following afternoon, Flower and Jennilyn Nichols would see a doctor at the University of Chicago to learn whether they could keep Flower, 11, on puberty blockers. They began to search for medical providers outside of Indiana after April 5, when Republican Gov. Eric Holcomb signed a law banning transgender minors from accessing puberty blockers and other hormone therapies, even after the approval of parents and the advice of doctors.

At least 20 states have enacted laws restricting or banning gender-affirming care for trans minors, though most are embroiled in legal challenges. For more than a decade prior, such treatments were available to children and teens across the U.S. and have been endorsed by major medical associations.

Opponents of gender-affirming care say there’s no solid proof of purported benefits, cite widely discredited research and say children shouldn’t make life-altering decisions they might regret. Advocates and families impacted by the recent laws say such care is vital for trans kids.

On June 16, a federal judge blocked parts of Indiana's law from going into effect on July 1. But many patients still scrambled to continue receiving treatment.

Jennilyn Nichols wanted their trip to Chicago to be defined by happy memories. They would explore the Museum of Science and Industry and, on the way home, stop at a beloved candy store.

Preserving a sense of normalcy, she decided — well, that’s just what families do.

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Families in Indiana, Mississippi and other states are navigating new laws that imply or sometimes directly accuse parents of child abuse for supporting their kids in getting health care.

Some trans children and teens say the bans send the message that they cannot be themselves. That leaves parents looking for out-of-state medical care that can help their children to thrive.

“What transgender expansive young people need is what all young people need: They need love and support, and they need unconditional respect,” said Robert Marx, an assistant professor of child and adolescent development at San José State University. Marx studies support systems for LGBTQ+ and trans people aged 13 to 25. “They need to feel included and part of a family.”

Some families in Indiana have turned to the support group GEKCO, founded by Krisztina Inskeep, whose adult son is transgender.

“I think most parents want to do best by their kids,” Inskeep said. “It’s rather new to people, this idea that gender is not just a binary and that your kid is not just who they thought at birth.”

The perceptions of most parents, Marx said, do not align neatly with the extremes of full support or rejection of their kids’ identities.

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On June 13, Flower and Jennilyn left Indianapolis with a care plan from Indiana University’s Riley Children’s Hospital, the state’s only gender clinic. The decision to start puberty blockers two years ago wasn’t one the family took lightly.

Jennilyn recalled asking early on whether her daughter’s gender expression was permanent. Ultimately, she listened to her daughter and learned that it was never in doubt.

Conversations between Flower and her mother are often marked by uncommon candor.

“Before I knew you and before I walked this journey with you,” Jennilyn told her, “I would not have thought that a kid would know they were trans or that a kid would just come out wired that way.”

Now, Jennilyn said her worries have shifted to Flower’s spelling skills or how she’ll navigate crushes, seeing her early anxieties as irrational.

Flower said she and her parents make medical decisions together because, “of course, they can’t decide on a medicine for me to take.”

“At the same time, you can’t pick a medicine that we can’t afford to pay for or that, you know, might harm you,” Jennilyn responded.

—— In Mississippi, a ban on gender-affirming care became law in the state on Feb. 28 — prompting a father and his trans son to leave the state at the end of July so the teenager can find health care in Virginia.

Ray Walker, a 17-year-old honor student, lives with his mother, Katie Rives, in a suburb of Jackson. His parents are divorced, but his father also lived in the area.

When Mississippi Republican Gov. Tate Reeves signed the bill banning hormone therapy for anyone younger than 18, he accused “radical activists” of pushing a “sick and twisted ideology that seeks to convince our kids they’re in the wrong body.”

As the provision of gender-affirming care became scarce and was later outlawed, Walker's father, who declined to be interviewed, accepted a job in Virginia. Rives, however, is staying in Mississippi with her two younger children.

Walker's memories of the anguished period when he started puberty at 12 still haunt him. “My body couldn’t handle what was happening to it,” he said.

After a yearslong process of evaluations, then puberty blockers and hormone injections, Walker said his self-image improved. Then came the ban.

“Mississippi is my home, but there are a lot of conflicting feelings when your home is actively telling you that it doesn’t want you in it,” Walker said.

The family sees no alternative. As Walker’s moving date approaches, Rives savors the moments they share. She says she still feels lucky, as not all families are able to afford to travel out of state.

“We know that’s an incredibly privileged position to be in,” Rives said.

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Flower's favorite activities are often less inflected with politics than with her status as a soon-to-be teenager. She's a Girl Scout who enjoys catching Pokemon with her 7-year-old brother Parker. Over a milk shake and vegan grilled cheese at a Chicago diner, she offered a joyful take on their itinerary.

“First of all, we’re going be able to chill at the hotel in the morning,” Flower explained. “Second of all, there’s a park nearby that we can have a lot of fun in. Third of all, we might have a backup plan, which is really exciting. And fourth of all: Candy store!”

The appointment the next day gave them another reason to celebrate: If care was not available in Indiana, they could get it in Illinois.

“Indiana could do whatever the hell they’re going to do,” Jennilyn said, “and we can just come here.”

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Arleigh Rodgers reported from Chicago and Indianapolis. Michael Goldberg reported from Jackson. Rodgers and Goldberg are corps members for the Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that places journalists in local newsrooms to report on undercovered issues.