High school senior Kyle has visited Chicago three times over the last two years. The 17-year-old has grown to love the Windy City, the birthplace of one of his favorite indie rock bands, Fall Out Boy. He plans to apply to a prestigious arts college there this fall.
But the New Orleans teen and his family didn’t make these journeys for fun. Chicago was one of the only places where Kyle could continue to access testosterone, part of the gender-affirming care he needed to alleviate his intense feelings of gender dysphoria, after his home state of Louisiana’s ban on care went into effect in January 2024.
“I describe it as getting caught up with other boys my age,” Kyle told HuffPost about taking testosterone. He’s enjoyed hearing his voice deepen and watching his face become more square.
Kyle considers himself lucky as one of the few trans kids in his community that is able to continue accessing care by traveling out of state. He was able to get a $500 grant from the Campaign for Southern Equality, an LGBTQ+ advocacy group, to make the trips more manageable. Without financial resources or family support, the vast majority of his trans friends are instead forced to wait until they’re adults to start the process of medically transitioning.
HuffPost spoke with three families of transgender youth — all of whom requested to use pseudonyms or to use first names to protect their privacy — who shared stories underscoring the lengths to which they’ve gone and the distances they’ve traveled in order to access gender-affirming care for their children in the aftermath of a tidal wave of state-level bans on this care.
They may have to continue traveling farther and farther to continue care. Future access to gender-affirming care for transgender youth is now in the hands of the Supreme Court, which is set to issue a ruling this month to decide whether state-level bans on minors are a form of sex discrimination and violate the Constitution.
Currently, more than a third of transgender youth age 13 to 17 live across the 26 states that have passed some form of a ban on gender-affirming care, according to a 2024 report from the Williams Institute.
The case before the highest court, United States v. Skrmetti, involves Tennessee law SB 1, which bars the use of puberty blockers and hormone treatments for the purpose of gender transition and instead encourages minors to “appreciate their sex” assigned at birth.
The outcome in Skrmetti rests largely on what level of judicial scrutiny, or official skepticism, the justices require Tennessee’s law to be examined under. If the court rules that Tennessee has to apply heightened scrutiny — a more rigorous review given to laws around gender discrimination — the state is more likely to lose. In that case, the courts either could flat-out rule the law is unconstitutional, or more possibly, send the case back down to a lower court for reconsideration.
If, however, the Court sides with Tennessee and allows for rational basis — a review typically reserved for economic regulations and not classifications of race, gender or national origin — this means that state’s ban would remain in effect. Experts worry that could make it more difficult for trans legal advocates to challenge other state bans on gender-affirming care for minors and adults. If the court sides with Tennessee, they say this could open up broader implications for other arenas of legal rights to privacy.
Anthony Michael Kreis, a constitutional law professor at Georgia State University, said that Skrmetti is one of several cases on the subject of rights to privacy and bodily autonomy, which have been under attack in recent decades. He thinks about the fight to uphold transgender rights as having separate but overlapping interests with rights to abortion, marriage equality, family formation and parental rights.
“When you start taking that bundle of sticks, that bundle of rights and you remove one and then maybe chop off another, suddenly that entire bundle is a little less stable,” Kreis said.
During oral arguments on Tennessee’s ban in December, the conservative justices seemed skeptical of trans legal advocates’ arguments that SB 1 violates the Constitution.
Justice Brett Kavanaugh, who was appointed by President Donald Trump, asked at one point if it was best to leave bans on care up to the “democratic process,” seemingly suggesting that the issue should be determined by state law — as is now the case with reproductive health care.
Many legal experts have begun to imagine what the landscape could look like in the event that the court upholds Tennessee’s ban.
“A loss in Skrmetti would give some wind in the sails of conservatives who are trying to chip away at Bostock,” Kreis said, referring to the landmark Supreme Court case which protected employees from discrimination based on sexual orientation or gender identity.
In Project 2025, conservative advocates signaled their desire to restrict the application of the 2020 Supreme Court ruling in Bostock to advance transgender rights — and so far at least one conservative Texas judge, Matthew Kacsmaryk, has worked to minimize its impact.
The possibility of the Supreme Court upholding Tennessee’s ban especially worries families of trans youth within the state.
In Nashville, Diane has worked hard to create an affirming childhood for her soon-to-be-14-year-old trans daughter, Lily. She enrolled her in a trans support group, let her pick out her favorite skirts, and has given her space and encouragement as she figures out the kind of girl she wants to be. After Lily told her parents she was trans at age 11, by cc’ing her parents on an email declaring she used she/her pronouns, Diane quickly saw her daughter shed an “invisible weight.”
But in 2022, the state passed its ban on care for trans youth. Many providers in Nashville abruptly stopped seeing patients before the law even went into effect — and later halted care for cisgender youth that could be seen as “pathways to gender affirmation,” one doctor told HuffPost. Diane’s family began to consider out-of-state options within a few hours’ driving distance of their home, and landed on a children’s hospital in Cincinnati, Ohio. They visited the hospital three times over the course of nine months, speaking with therapists, social workers and doctors.
On the last trip, Lily received a hormone blocker insert into her arm to delay the effects of her natal puberty until she turned 14. That same day, Ohio’s Republican legislature overturned a veto from Gov. Mike DeWine, banning gender-affirming care for youth in the state.
Now the family travels to a clinic in Washington, D.C., where they’ve been twice already to establish care — and in their next visit this summer, their doctors will work with the family to determine if Lily is ready to start estrogen therapy. Their insurance doesn’t cover gender-affirming care and they’ve exhausted their airline miles. The trips are difficult for Lily, who has to miss school for these appointments, as well as for Diane, who deals with chronic fatigue from long Covid.
“The idea that I’m letting my daughter follow some whim is insulting,” Diane said. “This is not a whim, this is not a phase — this is who she is.”
Other families in the South have even had to consider traveling internationally in order to get gender-affirming care for their children.
Ana, a language professor in Birmingham, Alabama, said that she ultimately decided to travel with her son back to her home country of Spain to see a doctor that specializes in gender-affirming care after she tried, and failed, to meet with out-of-state providers that had monthslong waitlists.
“It’s like swimming against the current,” Ana said, noting that she hasn’t seen her 17-year old-son smile since January. After he first came out as transgender at 13, he was heavily bullied and ostracized by his friends.
In Spain, Ana’s son (who has dual citizenship) restarted the process of establishing his gender dysphoria diagnosis and a treatment plan from the beginning, even though he had already taken testosterone for three months prior to Alabama’s ban.
Spain allows trans teens to receive hormone therapy and puberty blockers with support of their parents, and allows anyone over 16 to legally register their gender on documents. Ana said her son plans to move to Europe after graduating high school due to the level of anti-trans legislation and rhetoric in the U.S.
“It feels like he’s going to into exile,” she said.
Over the last three years, the rising anti-trans legislation in state legislatures coupled with Trump’s slate of anti-trans executive orders has dramatically shifted the life decisions of trans youth, their families and even trans adults.
Trump has wielded executive orders to threaten to pull federal funding from hospitals that serve LGBTQ+ youth, or schools that allow trans girls to play on female sports teams. Last month, House Republicans passed a massive domestic policy package that would include provisions to bar Medicaid and Affordable Care Act plans from covering gender-affirming care for trans youth and adults alike.
The vast uncertainty of the state of transgender rights — as many legal challenges to state and federal actions make their way through the courts — has many families of LGBTQ+ people holding their breath for the Skrmetti decision. But the uncertainty could swing in multiple ways.
“[Skmretti] isn’t an end-all, be-all. If trans people lose Skrmetti, it’s not supposed to be that forever and ever more states can restrict health care for trans youth,” Ezra Young, a New York lawyer and scholar, said. “The case is very fact-specific. The Supreme Court could say there might be a subset of trans youth for which the state of Tennessee has a special interest in protecting.”
Young said the outcome of Skrmetti and the scope of the ruling entirely rests on how the justices write the decision. He likens the significance of a possible victory in Skrmetti to something like Windsor v. U.S., a 2013 case before the Supreme Court that struck down parts of the Defense of Marriage Act, barring gay and lesbian couples from obtaining certain federal tax benefits.
The Windsor victory was one case in a chorus of early victories for same-sex marriage — but it wasn’t until the court’s 2015 Obergefell decision that protected the fundamental right nationwide to same-sex marriage under the Constitution.
Similarly, the landscape of trans legal rights and representation has shifted dramatically in the last five years, and often delivered a mixed bag of results.
“It feels like we’re left on an island,” said Mariah Moore, the co-director of policy and programs at Transgender Law Center.
“Ever since the Dobbs decision, we’re seeing what happens when lifesaving care is no longer available,” she said, referring to the slate of women dying or suffering pregnancy complications after being denied access to abortion-related care in the wake of the Supreme Court’s ruling ending the federal right to abortion.
When Moore came out as trans in 2006, she remembers how difficult it was to access gender-affirming care, especially without health insurance.
“Black trans women opened their homes for us Black trans kids to eat, be housed, find the right doctor. That’s the type of things communities did,” she said. “I’m a beneficiary of that care and that’s what was instilled in generations of queer and trans people.”
No matter the outcome this month, Moore said, she knows this isn’t the end in the fight for trans liberation.
“Our collective liberation will not come from the courts, the DOJ, DHS, or the Oval Office,” she said. “That liberation will come when we come together as a people and demand that every single person deserves access to health care.”