One afternoon in late 2024, a sixth-grade boy nicknamed Bug came home from school with an announcement to make. Bug, who was assigned female at birth, told his parents that he was a boy and would use he/she pronouns.
“Okay, great,” his mother, J., recalled saying (J asked to be identified only by his first initial and Bug by his nickname, because the family fears harassment).
“'What do you need to get support?'” he recalled asking next. “He asked to receive medical attention.”
This was the kind of moment J had been anticipating since the family moved earlier that year from Texas to Massachusetts, for its more liberal and inclusive politics. She was sure they could find the right medical experts. But she hadn't realized that access to gender-affirming treatment could disappear even when her state's laws and leaders supported it.
Individual hospitals across the United States, in red and blue states, have responded to President Donald Trump's attacks on transgender health care by deciding to withdraw care on their own. At least 20 hospitals did so in the early months of the Trump administration, when it threatened to withdraw federal funds or launch investigations into fraud or unsubstantiated claims, and those services have continued to decline since then.
Bug and his younger sister were born in Austin, Texas, but J and her husband became concerned after the state banned abortion; diversity, equity and inclusion programs dismantled; and limited medical and civil rights for queer and transgender people. The parents were concerned that the support services they needed for the siblings, both with autism, could also be affected.
“I was afraid of being like the frog in boiling water and not realizing what was happening until it was too late,” said J. “I needed to get the kids out of Texas.”
So when Bug came out as trans, J was relieved to have landed in a state that not only has a “shield” law to protect providers who offer gender-affirming care, but is also among 24 states that require commercial insurance, which Bug's family has, to cover it.
After Bug's gender announcement, J's consultations took her to the region's largest hospital system, Baystate Health, based in Springfield, Massachusetts, where they began the months-long process of preparing to begin hormone therapy.
Bug, an artistic 14-year-old who loves horses, cats, and making short films with friends, was too old for puberty blockers, but was excited at the prospect of starting testosterone. That would cause his voice to deepen, his facial hair to grow, and his muscles to get bigger.
“Every part sounds fun,” he said.
But last February, two weeks before Bug started taking testosterone, Baystate announced that it would no longer provide gender-affirming medications to minors and would only offer counseling. A letter to the patients' families did not explain why.
Baystate spokeswoman Heather Duggan sent a statement saying the decision to end treatment for minors reflected the fact that Baystate could lose “hundreds of millions of dollars in government reimbursements” as a result of the Trump administration's plans. “Nearly 70 percent of Baystate Health patients rely on Medicaid and Medicare for coverage,” he said.
All Bug knew was that the attention he had eagerly awaited was about to disappear.
“I was frustrated that they did that,” Bug said.
“I bet there are tons and tons of kids saying, 'Okay, I'm going to go for trans-affirming healthcare. Yes!'” she said. “And then tons and tons of kids were disappointed and sad and frustrated.”
J said it felt like the ground had fallen out from under them. “Maybe this is naive, but I didn't think that would happen in Massachusetts,” he said.
Baystate is among providers still choosing not to offer puberty blockers or hormones while the matter moves through the courts. This spring, in a lawsuit joined by Massachusetts, a federal judge found that it was illegal for the Department of Health and Human Services to threaten federal funding for providers offering gender-affirming care to minors. In June, another federal judge authorized 16 states, including Massachusetts, to move forward with another lawsuit against the administration over its push to criminalize gender-affirming care.
The American Academy of Pediatrics declined an interview request but said in an earlier statement that young patients and their families should make decisions about gender-affirming care with their doctors, “delivered compassionately and without political interference.”
A mother of a former Baystate patient said that before her daughter became a transgender child, she had been severely depressed and struggling with suicidal thoughts. (The mother asked that only her first initial, L, be used because the family also fears bullying.)
After Baystate doctors prescribed puberty blockers and estrogen, her daughter's mood and grades improved markedly, L said. So when she received the letter announcing that Baystate was ending medical treatment, she was furious. L said she and other parents filed civil rights complaints with the Massachusetts attorney general.
The attorney general's office did not respond to a request for comment.
“There's a sense of 'How could you?'” said L. “And there's also an awareness of the impact that simply receiving medical care could have on a young person, from a physical health perspective but also from a mental health perspective.”
L and J found alternatives for their children. L asked the family's primary care doctor to take over the hormone prescriptions. Bug's family was referred to Transhealth, a private specialty clinic in Northampton, Massachusetts, that said it had treated about 50 of Baystate's former patients.
“Transhealth has been hiring for some time now in anticipation of the fact that this may be happening across the state,” said CEO Jo Erwin.
Erwin said Transhealth can withstand funding threats because the clinic receives large private donations and is not as dependent on Medicaid and Medicare as most hospitals. But Erwin said that doesn't entirely reassure the broader LGBTQ+ community, including transgender adults.
“When you see something like this happen, it scares people thinking that ultimately it will happen to everyone,” Erwin said.
In May, the Colorado Supreme Court ordered a children's hospital in that state to resume medical treatments for transgender youth, while in Texas a court settlement forced a children's hospital in that state to do the opposite: start the country's first “detransition clinic.” The Trump administration has continued to pressure providers, including requesting the medical records of transgender minors.
After Bug's false start at Baystate, he was able to start taking testosterone at the new clinic in the spring.
His mother, J, said the treatment is going well and that Bug has learned to give himself the injections. But J is worried that the federal government will find other ways to stop his treatment again. He sometimes doubts the family's move from Texas to Massachusetts and wonders if they should have gone to Canada.
This article comes from a partnership that includes New England Public Media, NPR and KFF Health News.
