The grim reality of relocating to get access to gender-affirming care

In my work as a pediatric psychologist, I’ve been seeing a surge in the number of families with transgender or nonbinary children who are moving to Connecticut, where I live and work. In the past month, a real estate agent colleague has worked with 30 families with transgender children who were trying to find homes in central Connecticut, where they could get access to gender-affirming care.

This influx is indicative of a grim reality: nearly half of respondents to the U.S. Trans Survey reported having thought about moving to another state because theirs considered, or passed, laws that target transgender people for unequal treatment, and 5% of respondents had actually moved out of state because of such state action.

These families come from states where lawmakers have restricted the ability for health care workers to provide evidence-based care to their children, especially Texas, Missouri, and Florida. I won’t be surprised to see families moving from Idaho soon, given this week’s Supreme Court decision to allow Idaho to enforce a ban on gender-affirming care for transgender young people and criminalize doctors who provide appropriate care for these young people.

As someone who works with children and teens, I can say that being a teenager — which has never been easy — has gotten exponentially worse for those who are transgender or nonbinary, and who are more likely to need mental health care.

I first came to work with transgender and nonbinary youths because I specialize in topics like obesity, eating disorders, diabetes, and pain. I am fortunate to work with a diverse group of families and, despite their many differences, one thing remains constant: kids’ health suffers in environments that don’t support them.

Most people understand that there’s a deep connection between emotional and physical health. My experience working with kids with chronic pain (pain that lasts longer than three months), bears this out.

Imagine you’re a teen with a history of lower back pain. You wake up one morning, and your back isn’t feeling so good. You’ve got a full day at school, where you’ll see your friends, and then your mom is going to take you to a quick doctor’s appointment. After that, you are going to the mall with your best friend to look for new dresses for the homecoming dance. It is an exciting day ahead. Does the pain in your back seem manageable? Probably, because you have such a great day ahead.

Now imagine the same situation for a transgender female. At school, you are bullied, called the wrong name, and disrespected. Your doctor uses the wrong name and pronouns. And you know you’ll be laughed at trying on dresses at the mall. It’s unlikely your back pain will feel manageable.

As one of my patients said to me recently, “The less stressed I am, the less pain I have. When people are using correct pronouns and stuff, I’m less stressed, which means less tension and less pain.”

Society needs to create environments that are positive, safe, and affirming, as detailed in the Surgeon General’s Advisory on Protecting Youth Mental Health. When kids are in environments that allow them to cope well with the things that are going on for them, their ability to manage pain improves. But they don’t get that chance when creating supportive environments is politicized.

For transgender and nonbinary kids, bans on gender-affirming care are hurting them, physically and emotionally. That’s why more than half of transgender and gender nonbinary youths seriously considered suicide last year, and one in five attempted it.

The research is clear: the catastrophic decision to attempt suicide is caused by the regular hostility these kids face, not something about these kids themselves. This is a result of the messages they’re getting from those who reject them or deny their rights. Imagine the distressing feeling of hearing political and other leaders debate the merits of who you are. Rates of depression and anxiety are high for this group of adolescents because they’re not accepted and are being used as political pawns.

The impacts quickly go from emotional to physical.

Research offers ways to help. Young people who live in homes where their pronouns are honored are half as likely to attempt suicide. Allowing kids to use a name, pronoun or choice of clothing that best fits who they know themselves to be tells them they are supported. And making sure they have access to developmentally appropriate gender-affirming care improves mental and physical health.

At this crucial point, an opportunity exists to completely support the health of transgender and nonbinary kids. As a collective society, we do that by putting into place policies that support — not hurt — kids and create environments that allow them to be their true selves. Everyone has a part in this: Politicians should stop trying to score political points and put kids’ health first. Deciding who health care providers treat and the kind of care they provide should be governed by the patient and the provider, not politicians or faith leaders. School and community leaders need to allow young people the ability to be who they know themselves to be at school and on sports teams. And the rest of us should believe kids when they tell us who they are.

No one should be forced to choose between the community they call home and being able to access the care their children need. It takes little effort to create these environments to support kids. And for transgender kids, it’s a matter of life or death. That’s true whether you live in Connecticut, Texas, Florida or Idaho.

Melissa Santos, Ph.D., is a pediatric psychologist and researcher in Connecticut.

If you are thinking about suicide, or concerned about a loved one, contact the 988 Suicide and Crisis Lifeline by calling or texting 9-8-8 or visiting www.988lifeline.org.