By Mariam Sunny
May 21 (Reuters) - Confronted with Trump Administration threats to gender-affirming care for young transgender people, American families are weighing moves out of their states to gain access to needed healthcare, according to doctors, patients, policy experts and advocacy groups.
Upon taking office for the second time, President Donald Trump issued an executive order aimed at limiting access to gender-affirming care for patients under age 19, building on legislation or rules in 27 mostly
Republican-led states that restrict such care. The order has been temporarily blocked by a judge but the administration continues to push new bans.
By the time the Justice Department began subpoenaing healthcare providers for patient records related to gender-affirming care last July - another action temporarily blocked by courts - Harleigh Walker, a 19-year-old transgender girl from Alabama, was considering a move.
"My family and I were discussing, after high school where I might go to college, and I'm from Auburn, Alabama, next to one of the best schools in that state," Walker said. "But I could not stay in the state of Alabama because my parents, my doctors, and I were being criminalized."
She now attends college in Maryland, a state that protects access to gender-affirming care. "There's a level of safety here. This is a very accepting, pretty progressive state," Walker said.
The family still talks daily about a move either to a friendly state or out of the country, her father, Jeff Walker, said.
Newly released data from a survey conducted from March 4 to October 15, 2025, by the non-profit Trevor Project, which provides free, specialized support to LGBTQ+ youth, found that Harleigh's story is a common one. Nearly one-third of 16,000 LGBTQ respondents aged 13 to 24 said they or their families were considering moving to a different state for care.
Nearly 1.5 million people aged 13 to 24 identify as transgender in the U.S., a UCLA study based on health records found.
POLICY VS SCIENCE
The Trump Administration's effort to end gender-affirming care includes threatening hospitals with cutting off access to lucrative Medicare payments. The program for people aged 65 and older or with disabilities serves 70 million people.
The U.S. Department of Health and Human Services declined to comment.
Gender-transition care can range from advice on adopting a preferred name or pronoun to puberty-blocking drugs and hormones or surgery. Medical care is often given to people diagnosed with gender dysphoria, or distress when a person's gender identity doesn't align with their sex assigned at birth.
Most medical groups, including the American Medical Association, the Endocrine Society, and the American Academy of Pediatrics, say such care can be life-saving.
In February, the American Society of Plastic Surgeons recommended delays in gender-related surgeries for young people.
Decisions by hospitals to reduce or pause these services are driven by legal and financial risk assessments, not changes in clinical evidence or patient need, said Alex Sheldon, executive director at LGBTQ health advocacy group GLMA.
The Trevor Project survey found about 75% of young people had experienced difficulties in accessing gender-affirming care.
FEWER OPTIONS
Since January 2025, more than 40 hospitals have restricted such care for young people, STAT News reported in February based on its own analysis.
But some hospitals, such as Children's Minnesota, have begun offering care again following a federal court ruling that vacated the U.S. health agency's restrictions. It had paused care on February 27.
University of Michigan Health stopped providing hormone therapies and puberty blockers as gender-care treatments for people under 18 last August, citing the July federal subpoena and "unprecedented legal and regulatory threats to our clinicians and our institution."
Claire Cabrera, 43, is the mother of a teenager who traveled from a rural part of the state where they live to receive care there. The adolescent spent six years navigating their gender journey, from new pronouns and clothes in fourth grade to puberty blockers and testosterone.
After running out of a three-month supply of testosterone, they now rely on a telehealth service to prevent missing an injection, which can lead to hormonal shifts, menstrual cramps and anxiety.
"We will do whatever it takes to support our child, including looking at other options outside of the state and outside of the country," Cabrera said.
SCRAMBLING FOR ALTERNATIVES
Canada and European countries have become more attractive options as U.S. care access dwindles, said Kellan Baker, a health-policy adviser at Movement Advancement Project, a transgender rights advocacy think tank.
In California, prominent healthcare provider Children's Hospital Los Angeles shut its gender clinic in 2025 after 30 years, describing external pressure and "no viable path forward."
Maria Do, an organizer with the Los Angeles LGBT Center, said families were scrambling for alternatives since the closure, stockpiling medicines and seeking treatment abroad.
Dr. Beth Cronin, an obstetrician-gynecologist from Rhode Island, said she has patients coming from Texas and Florida, looking for 'blue state' stability for treatment.
Opposing court rulings on whether a Rhode Island hospital must comply with handing over medical records of trans youth are currently being appealed.
One patient with family in Canada was considering a move there, while another young father said such a move was too expensive, Cronin said.
"I don't think it's a realistic option for most patients in general," Cronin said.
(Reporting by Mariam Sunny in Bengaluru; Editing by Caroline Humer, Mrinalika Roy and Bill Berkrot)
