The Perils of Navigating the Transgender Health Care System as a Parent

Amidst an increasingly charged and transphobic political environment under the Trump administration, I took a calculated risk in 2017. I opened my laptop, typed the URL to Facebook, and wrote these words on my status: "I need help. Zara needs hormone blockers, and her insurance doesn't cover them."

That was the beginning of a strategy we used for three years to ensure that my child Zara had the care she needed to live with dignity. Every three months our community would contribute whatever they were able to give so that we could afford the cost of traveling to St. Louis Children's hospital. We'd pack our family car, drive six hours, and pay $5,000 out-of-pocket for Lupron injections, a reversible hormone blocker that provides time for young people to explore their gender identity.

As a working poor family in Fayetteville, Arkansas, we use the state-based insurance ARKids, but it did not provide coverage for treatment options of transgender children. That's an issue that's long affected trans youth across the country and recent waves of anti-trans medical care bans are only making things harder.

That wasn't the only struggle for my family: Pediatricians we'd take Zara to would cite their moral objections to addressing her symptoms of gender dysphoria—the distress she experienced as a result of being wrongly assigned male at birth. Despite years of therapy and multiple tests to prove that Zara's symptoms were not from an underlying mood or personality disorder, we continued to strike out with medical professionals refusing to treat Zara because of their transphobia.

We needed to go to St. Louis Children's Hospital, where Zara could receive the life-saving gender-affirming medical care she needed after so many roadblocks. The clinic is a celebration for our whole community, and one of the few that provide wraparound gender-affirming care for adolescents and teens free of microaggressions and judgment.

Zara was elated to be asked her pronouns, to be called by her name instead of her dead name, and told that she was trusted and believed. The doctors there helped us understand exactly the kind of care plan Zara would need to address her gender dysphoria and keep it manageable. They gave us resources on the history of transgender children and the latest peer-reviewed data on best practices on trans-affirming care.

The first day we left the clinic, Zara beamed, "they really believed me—like they know I am who I say I am."

After a year and a half of trips every three months, we transferred Zara's treatment plan upon discovering the newly launched Arkansas Children's Hospital Gender Spectrum Clinic, where there are gifted and competent medical professionals supporting gender-expansive young people in Arkansas. Zara has collaborated with the doctors there to outline a care plan that affirms who she is.

She now has a countdown to when she will start her cross-sex hormones and enter puberty. As she inches closer to her 14th birthday, Zara's excitement grows. "I'm ready for my body to reflect who I am—like I can see it in my mind," she told me the other day. We've already purchased her a Steven Universe bra in anticipation.

It is an indescribable feeling to witness your child fully living in her truth and sparkling with hope for her future, especially since the adolescent and teen years are crucially formative phases where young people are learning what they believe about themselves and the world.

What's at Stake for Transgender Youth

It's critical to share the impact discriminatory anti-trans medical care bans will have on our youth and communities. So far this year, 17 anti-LGBTQ+ bills have been signed into law. Not only will transgender youth be denied medical treatments, these health care bans will also cost them their joy, sovereignty, and euphoria. Despite the logistical and accessibility challenges, caregivers and parents of transgender youth know firsthand how affirming care produces happy and well-adjusted adolescents and teenagers.

Take, for example, Jake*. According to Jesse*, Jake's mom, cross-sex hormone therapy has transformed Jake's outlook on life and given him so much hope. "Since we started hormone replacement therapy (HRT), his euphoria is even better because his voice is dropping. It makes him so happy. He didn't even realize how deep it was until he heard it recorded. The smile on his face was the best thing I've ever seen," says Jesse, who is also a community organizer with Reconcile Arkansas, a collective of caregivers and parents in Arkansas addressing the impact of HB 1570, a bill revoking gender-affirming care set to pass into law in July.

And there's DeShanna Neal, a Black queer mother of four in Delaware. When she sought gender-affirming care for her daughter, Trinity, she discovered that puberty blockers were denied from state-based Medicaid. DeShanna waged an eight-month-long battle and, as a result of her advocacy, she transformed policy for all transgender and non-binary youth in Delaware. "Trinity is like any other child, but when she received her puberty blockers and subsequently her estrogen you could see the glow in her face," says Neal. The activist and founder of Intersections of Pride Foundation, says, "I've seen the same thing for other trans youth because of the work I did with Medicaid."

Arkansas-based mom Kris* is another outspoken advocate who has two sons: one who is transgender and one who is cisgender. She explains how the acceptance and affirmation that Aidan, her trans son, receives helps him to become more empathetic. "Being accepted and affirmed for being exactly who he is has helped him do the same for the others. We've even been able to get his name changed legally, free of charge, which thrilled him. I feel like we can finally see all of his happiness and beauty," says Kris.

As parents and caregivers, we deserve the right to secure safety, dignity, and happy childhoods for our young people. This starts with full access to care that meets the unique needs of our children. Gender-affirming health care is generative and helps young people grow into confident adults. And we are fighting for more than gender-affirming health care. We are fighting to protect the beautiful and resilient trans joy that makes all of our lives better. A world without trans joy costs too much.

*Last name has been withheld for privacy.