In recent years, states across the Mountain West have passed laws that limit doctors from providing transgender children with certain kinds of gender-affirming care, from prohibitions on surgery to bans on puberty blockers and hormones. Colorado families say their state was a haven for those health services for a long time, but following executive orders from the Trump administration, even hospitals in Colorado limited the care they offer for trans patients under age 19. KFF Health News Colorado correspondent Rae Ellen Bichell spoke with youth and their families.<\/p>\n
GRAND JUNCTION, Colo. \u2014 On a Friday after school, 6-year-old Esa Rodrigues had unraveled a ball of yarn, spooked the pet cat, polled family members about their favorite colors, and tattled on a sibling for calling her a \u201cbutt-face mole rat.\u201d<\/p>\n
Next, she was laser-focused on prying open cherry-crisp-flavored lip gloss with her teeth.<\/p>\n
\u201cYes!\u201d she cried, twisting open the cap. Esa applied the gloopy, shimmery stuff in her bedroom, where a large transgender pride flag hung on the wall.<\/p>\n
Esa said the flag makes her feel \u201cimportant\u201d and \u201chappy.\u201d She\u2019d like to take it down from the wall and wear it as a cape.<\/p>\n
Her parents questioned her identity at first, but not anymore. Before, their anxious child dreaded going to school, bawled at the barbershop when she got a boy\u2019s haircut, and curled into a fetal position on the bathroom floor when she learned she would never get a period.<\/p>\n
Now, that child is happily bounding up a hill, humming to herself, wondering aloud if fairies live in the little ceramic house she found perched on a stone.<\/p>\n
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Her mom, Brittni Packard Rodrigues, wants this joy and acceptance to stay. Depending on a combination of Esa\u2019s desire, her doctors\u2019 recommendations, and when puberty sets in, that might require puberty blockers, followed by estrogen, so that Esa can grow into the body that matches her being.<\/p>\n
\u201cIn the long run, blockers help prevent all of those surgeries and procedures that could potentially become her reality if we don\u2019t get that care,\u201d Packard Rodrigues said.<\/p>\n
The medications known as puberty blockers are widely used<\/a> for conditions that include prostate cancer, endometriosis, infertility, and puberty that sets in too early. Now, the Trump administration is seeking to limit their use specifically for transgender youth.<\/p>\n Esa\u2019s home state of Colorado has long been known as a haven for gender-affirming care, which the state considers legally protected and an essential health insurance benefit. Medical exiles have moved to Colorado<\/a> for such treatment in the past few years. As early as the 1970s, the town of Trinidad became known as \u201cthe sex-change capital of the world\u201d when a cowboy-hat-wearing former Army surgeon, Stanley Biber<\/a>, made his mark performing gender-affirming surgeries for adults.<\/p>\n On his first day in office, President Donald Trump signed an executive order<\/a> refuting the existence of transgender people by saying it is a \u201cfalse claim that males can identify as and thus become women and vice versa.\u201d The following week, he issued another order<\/a> calling puberty blockers and hormones for anyone under age 19 a form of chemical \u201cmutilation\u201d and \u201ca stain on our Nation\u2019s history.\u201d It directed agencies<\/a> to take steps to ensure that recipients of federal research or education grants stop providing it.<\/p>\n Subsequently, health care organizations in Colorado; California; Washington, D.C.; and elsewhere announced they would preemptively comply. In Colorado, that included three major health care organizations: Children\u2019s Hospital Colorado, Denver Health, and UCHealth. At the end of January and in early February, the three systems announced changes to the gender-affirming care they provide to patients under 19, effective immediately: no new hormone or puberty blocker prescriptions for patients who hadn\u2019t had them before, limited or no prescription renewals for those who had, and no surgeries, though Children\u2019s Hospital had never offered it, and such surgery is rare among teens<\/a>: For every 100,000 trans minors, fewer than three undergo surgery.<\/p>\n Children\u2019s Hospital and Denver Health resumed offering puberty blockers and hormones on Feb. 24 and Feb. 19, respectively, after Colorado joined a U.S. District Court lawsuit in Washington<\/a> state. The court concluded that Trump\u2019s orders relating to gender \u201cdiscriminate on the basis of transgender status and sex.\u201d It granted a preliminary injunction blocking them from taking effect in the four states involved in the lawsuit.<\/p>\n Surgeries, however, have not resumed. Denver Health said it will \u201ccontinue its pause on gender-affirming surgeries for patients under 19 due to patient safety and given the uncertainty of the legal and regulatory landscape.\u201d<\/p>\n UCHealth has resumed neither medication nor surgery for those under 19. \u201cOur providers are awaiting a more permanent decision from federal courts that may resolve the uncertainty around providing this care,\u201d spokesperson Kelli Christensen wrote.<\/p>\n Trans youth and their families said the court ruling and the two Colorado health systems\u2019 decisions to resume treatments haven\u2019t resolved matters. It has bought them time to stockpile prescriptions, to try to find private practice physicians with the right training to monitor blood work and adjust prescriptions accordingly, and, for some, to work out the logistics of moving to another state or country.<\/p>\n The Trump administration has continued to press health providers beyond the initial executive orders by threatening to withhold or cancel federal money awarded to them. In early March, the Health Resources and Services Administration said it would review<\/a> funding for graduate medical education at children\u2019s hospitals.<\/p>\n KFF Health News requested comment from White House deputy press secretary Kush Desai but did not receive a response. HHS deputy press secretary Emily Hilliard responded with links to two prior press<\/a> releases<\/a>.<\/p>\n Medical interventions are just one type of gender-affirming care<\/a>, and the process to get treatment is long and thorough<\/a>. Researchers have found that, even among those with private insurance, transgender youth aren\u2019t likely<\/a> to receive puberty blockers and hormones. Interestingly, most gender-affirming breast reduction surgeries performed on men and boys are done on cisgender \u2014 not transgender \u2014 patients.<\/p>\n Kai, 14, wishes he could have gone on puberty blockers. He lives in Centennial, a Denver suburb. KFF Health News is not using his full name because his family is worried about him being harassed or targeted.<\/p>\n Kai got his period when he was 8 years old. By the time he realized he was transgender, in middle school, it was too late to start puberty blockers.<\/p>\n His doctors prescribed birth control to suppress his periods<\/a>, so he wouldn\u2019t be reminded each month of his gender dysphoria. Then, once he turned 14, he started taking testosterone.<\/p>\n Kai said if he didn\u2019t have hormone therapy now, he would be a danger to himself.<\/p>\n \u201cBeing able to say that I\u2019m happy in my body, and I get to be happy out in public without thinking everyone\u2019s staring at me, looking at me weird, is such a huge difference,\u201d he said.<\/p>\n His mom, Sherry, said she is happy to see Kai relax into the person he is.<\/p>\n Sherry, who asked to use her middle name to prevent her family from being identified, said she started stockpiling testosterone the moment Trump got elected but hadn\u2019t thought about what impact there would be on the availability of birth control. Yet after the executive orders, that prescription, too, became tenuous. Sherry said Kai\u2019s doctor at UCHealth had to set up a special meeting to confirm the doctor could keep prescribing it.<\/p>\n So, for now, Kai has what he needs. But to Sherry, that is cold comfort.<\/p>\n \u201cI don\u2019t think that we are very safe,\u201d she said. \u201cThese are just extensions.\u201d<\/p>\n The family is coming up with a plan to leave the country. If Sherry and her husband can get jobs in New Zealand, they\u2019ll move there. Sherry said such mobility is a privilege that many others don\u2019t have.<\/p>\n For example, David, an 18-year-old student at Western Colorado University in the Rocky Mountain town of Gunnison. He asked to be identified only by his middle name because he worries he could be targeted in this conservative, rural town.<\/p>\n \t\t\t\t\t<\/p>\n \t\t\t\t\t<\/p>\n David doesn\u2019t have a passport, but even if he did, he doesn\u2019t want to leave Gunnison, he said. He is studying geology, is learning to play the bass, and has a good group of friends. He has plans to become a paleontologist.<\/p>\n His dorm room shelves are scattered with his essentials: fossils, Old Spice deodorant, microwave macaroni and cheese. But there are no mirrors. David said he got in the habit of avoiding them.<\/p>\n \u201cFor the longest time, I just had so much body dysphoria and dysmorphia that it can be kind of hard to look in the mirror,\u201d David said. \u201cBut when I do, most of the time, I see something that I really like.\u201d<\/p>\n He\u2019s been taking testosterone for three years, and the hormone helped him grow a beard. In January, his doctor at Denver Health was told to stop prescribing it. His mom drove hours from her home to Gunnison to deliver the news in person.<\/p>\n That prescription is back on track now, but the mastectomy he\u2019d planned for this summer isn\u2019t. He\u2019d hoped to have adequate recovery time before sophomore year. But he doesn\u2019t know anyone in Colorado who would perform it until he is 19. He could easily get surgery to enhance his breasts, but he must seek surgical options in other states to reduce or remove them.<\/p>\n \u201cColorado as a state was supposed to be a safe haven,\u201d said his mother, Louise, who asked to be identified by her middle name. \u201cWe have a law that makes it a right for trans people to have health care, and yet our health care systems are taking that away.\u201d<\/p>\n It has taken eight years and about 10 medical providers and therapists to get David this close to the finish line. That\u2019s a big deal after living through so many years of dysphoria and dysmorphia.<\/p>\n \u201cI\u2019m still going, and I\u2019m going to keep going, and there\u2019s almost nothing they can do to stop me \u2014 because this is who I am,\u201d David said. \u201cThere have always been trans people, and there always will be trans people.\u201d<\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\nUSE OUR CONTENT<\/h3>\n