After ban, trans children and their families going out of state for care

By Drew Costley, originally published on Verite News on February 8, 2024

Nicholas Lavender, 15, said everything changed for the better after he started receiving healthcare to affirm his identity as a transgender man through CrescentCare in 2022.

“I’ve gotten so much more confident, I’m so much more happy with myself, I have a lot more friends, I’m more outgoing,” he told Verite News. “It’s so good to have access to it.”

But all of that was threatened last year, when the Louisiana legislature passed a bill banning transgender youth from accessing gender-affirming healthcare in the state, going so far as to override a veto by John Bel Edwards in order to codify the ban into state law.  

The law, Act 466, prohibits doctors from performing surgery on minors — though those procedures are rare, according to a recent study — or prescribing hormones to them, which is more common.

The ban went into effect at the beginning of this year. It contained a carve out for youth who are already receiving hormone replacement therapy, though not indefinitely. The law only allows doctors to gradually wean them off medication, a form of detransitioning, with a cutoff at the end of the year.

Lavender was disappointed but not surprised when he heard that the conservative legislature managed to override Edwards’ veto. His mother, on the other hand, was infuriated.

“It’s really, really sad to me that my child and his friends have just come to accept that that’s what the political and social culture is in Louisiana, because, you know, that’s not who we are,” Beth Rosch said. “That’s not what most people think. So I’m really angry just at the political aspect of it.”

Now that the ban has gone into effect, parents across Louisiana have begun planning to seek gender-affirming care from out of state providers. Those who can afford it now face the prospect of paying thousands of dollars for travel and extended stays, on top of the cost of the care itself, in states without similar bans. And it’s costing transgender youth and their parents time away from school, work and their communities.

Lavender and Rosch, who live in New Orleans, are among those families who can afford it, and but it means they’ll miss some of the more popular Mardi Gras parades to travel out of town for care.

“We’re lucky enough to be able to have the resources to seek care elsewhere,” Rosch said. “And it’s not easy or cheap, but we’re able to do it and certainly it’s a priority.”

The cost of routine medical care

Marcela Singleton panicked when she first found out the gender-affirming care ban was going to become law. She didn’t know in the moment what that would mean for her child, who was assigned female at birth and was just about to start taking testosterone to help affirm their genderfluid identity. Singleton’s child asked not to be identified by name in this story.

She started considering whether to look for medication on the gray market — on e-commerce websites like Indiamart, or get hormones from friends who have prescriptions.

“I just knew that we were gonna do whatever we needed to do to get [them] what they need,” she said. “We were prepared to do things in a less than legal way.”

Then a friend connected her with the Transgender Education Network of Texas, a group based in Austin that advocates for trans rights and educates people on gender diversity. They were a step ahead of organizations in Louisiana, Singleton said, because of a similar ban that went into effect in Texas in September 2023. The group connected Singleton with Southern Equality, a group that fights for LGBTQIA+ rights throughout the South.

Southern Equality offered to help Singleton pay for her and her child to travel out of state in order to keep receiving hormones and told her about Elevated Access, an Illinois-based group that offers free flights around the country to people seeking gender-affirming care out of state.

“I felt really encouraged that we weren’t going to have to be getting like gray market hormones and figuring out elaborate schemes to continue [their] care,” Singleton said.

Once she realized there were resources available to help her continue care for her child, Singleton started planning a trip to New York to meet with doctors there, though she hadn’t confirmed travel arrangements at the time of publication.

“That was really heartening,”  she said. “Overall, my experience has just been one of overwhelming gratitude and amazing love for the community coming together to support one another.”

Rosch and Lavender are also going to the Northeast to continue gender-affirming care. They are leaving New Orleans on Thursday (Feb. 8) to travel to Rhode Island to meet with doctors. Rosch is missing two days of work, Lavender is missing one day of school and both of them are missing most of Mardi Gras weekend and Fat Tuesday because of the trip. After the initial visit to Rhode Island, friends will ship prescriptions to Rosch in New Orleans for Lavender to take.

They are also paying a lot more for this trip to the doctor than she would if it were a local trip. It’s going to cost her family approximately $1,000 for the trip total and it would have cost more if they weren’t staying with friends. Accessing the same care would cost less than $100 if she were able to get the medication in New Orleans.

“It’s making an enormous, inordinate inordinate amount of work out of something that should be just daily health care,” Rosch said. “It impacts the rest of the family, too. My husband and my other child are impacted by this. They either would have had to drop everything and come with us or stay back and have their time with us disrupted …. It’s extremely expensive and inconvenient.”

A legal fight and a broken heart

Of course, not everyone can afford to take the required time off work to travel for treatment, even if they receive grants from trans rights groups, leaving many scrambling to figure out how to get healthcare for their children.    

Five families, some of whom live in Terrebonne, Orleans and Livingston, are suing the Louisiana State Board of Medical Examiners over the lack of access caused by Act 466. They filed the lawsuit in Orleans Parish Civil District Court last month, claiming that the ban violates the state’s constitution and strips parents of their right to make healthcare decisions for their children.

“By selectively banning such treatments for trans youth, this law deprives Louisiana adolescents of equal access to medically necessary, and often life-saving care that is effective in treating gender dysphoria and addressing other serious health conditions such as depression, anxiety, and even suicidal ideation that can occur when gender dysphoria is left untreated,” Suzanne Davies, one of the attorneys representing the families, said in a press release about the lawsuit.

The state Attorney General’s Office did not respond to a request for comment on the suit by publication time.

It may be a while before that suit reaches a resolution. It’s still in the early phases, and the state has yet to file an answer to the Jan. 8 complaint. And even if a judge were to rule in the plaintiffs’ favor, it’s likely the state would appeal. So some families will still have to reconcile with the lack of access in Louisiana.

“I’m really heartbroken for all the families that are in a jam who can’t easily go somewhere else and spend that money traveling and seeking care elsewhere,” Rosch said.