Trans care restrictions force some families to travel hours, spend hundreds for treatment

Misty Stamm was working tirelessly to figure out the details: waking up early, the hourslong drives, booking hotels and finding doctors who could legally administer gender-affirming hormone therapy to her 16-year-old transgender daughter.

Stamm is living in one of the 24 states where legislation is restricting gender-affirming health care for transgender youth, so she and parents like her must make long, expensive trips out of their home states to find the care their children need, according to a new report from the Campaign for Southern Equality Research and Policy Center.

“If we didn't have the care, I don't think she'd be alive,” said Stamm.

Stamm, who lives in Tennessee, drove five hours to get her daughter to a gender clinic in Ohio when her family first started considering care options. She wanted her daughter to be seen by a physician in person.

With new gender-affirming care restrictions set to go into effect soon in Ohio, Stamm and her daughter have since turned to a telehealth provider in Virginia.

However, they still have to drive two hours to Virginia for the online appointment, as to not break Tennessee law, which also bans telehealth providers from providing care and treatments like puberty blockers and hormone therapies to a minor located in the state.

Stamm told ABC News that the time, effort and money they’re spending to access care is worth it.

When she came out as transgender at 13, “the mental health issues stopped completely,” said Stamm. “That affirmed to us that this was the right thing.”

Stamm's daughter had been in counseling and therapy since she was in fifth grade, struggling with her mental health and experiencing depression, anxiety and suicidal ideations.

At age 14, Stamm's daughter received puberty blockers to temporarily pause the development of physical sex characteristics. As her daughter grew older, the family and physicians together decided to move forward with hormone therapy. Throughout this process, they said, psychologists and therapists were consulted and were required for approvals.

“There's no talk of surgery or anything like that,” said Stamm. “That's a decision that she can make when she is an adult.”

Meanwhile, her mental health has progressed exponentially – Stamm said her daughter has since been released by her therapist and is only seen occasionally, as needed.

"She's just doing so well, and if we didn't have access -- we have to have it. She has to have it."

Gas, airfare, lodging and other expenses to cross state lines and access gender-affirming care could cost hundreds to thousands of dollars, the Southern Equality report states.

Stamm says she and her husband have spent likely thousands of dollars in travel costs to get care and are anxiously awaiting the day their daughter turns 18 so she can access care more freely.

The report from Southern Equality Research and Policy Center found that it could take almost 20 hours of driving roundtrip for some families across the South and Midwest to reach a state where trans youth care is legally accessible.

Families with transgender children across southern Florida, Louisiana, Missouri and Texas are the hardest hit, according to the report -- they would need to take a more than eight-hour car ride one way to get to a clinic that serves trans youth.

For Jennifer, an Austin, Texas, resident who asked to go by a pseudonym for safety concerns, said the health care bans in her state threw her family into logistical and financial chaos.

Her 15-year-old daughter’s appointments to begin hormone therapy were canceled before the law in Texas even went into effect. When they sought out care in Louisiana, providers also were canceling appointments.

She sought out the help of local advocacy groups to help her family find a provider in Texas' neighbor to the west, New Mexico.

However, the costs continue to mount: “We are in a position that we could afford to buy plane tickets and stay in a hotel for a couple of nights and pay all of the out-of-pocket expenses for the medical care,” said Jennifer. “For a lot of people, that's probably not an option.”

Though telehealth has expanded opportunities for access to care, policies like those in Tennessee restrict these appointments for prescriptions from happening in the state and force some families like the Stamms to cross borders for online appointments.

Tennessee Gov. Bill Lee, who signed the gender-affirming care ban, has defended the bill against legal challenges.

"Tennessee is committed to protecting children from permanent, life-altering decisions," said Lee in a post on social platform X after the Justice Department argued the law violates the Fourteenth Amendment's Equal Protection Clause.

Supporters of gender-affirming medical care bans argue that children should wait until they’re older to make these medical decisions, and that there needs to be more research on the impact of these procedures on patients.

In the state’s court filings in opposition to a lawsuit against the ban, the state invokes Dobbs v. Jackson Women’s Health Organization – the decision which overturned Roe v. Wade and ended federal protections for abortion rights.

The state argues that Dobbs allows states “to regulate medical treatments” and that it does not discriminate against transgender people because “not all transgender individuals use puberty blockers, hormones, or surgery.”

“This Court should acknowledge divergent views and hold that the responsibility to choose between them rests with the people acting through their elected representatives,” read the state’s filing.

The Tennessee Legislature is now considering a bill that could make it a felony to help a minor access gender-affirming care out-of-state without parental consent.

Transgender care for people under 18 has been a source of contention for state politicians in recent years, impacting a group estimated to make up less than 1.5% of the population ages 13-17, according to an estimate from researchers at the University of California, Los Angeles.

Often due to discrimination, stigma, and gender-related stress, trans youth are at increased risk for poor mental health and suicide, substance use, experiencing violence, and other health risks, according to the Centers for Disease Control and Prevention.

Major national medical associations, including the American Academy of Pediatrics, the American Medical Association, the American Academy of Child and Adolescent Psychiatry, and more than 20 others have argued that gender-affirming care is safe, effective and medically necessary.

“Allowing them to live in their identity is what saves their mental health,” Jennifer said in response to criticism over transgender medical care.

As families continue to seek out avenues for care, Jennifer and Stamm want lawmakers to know that they're just a "normal, regular family."

“I want them to see us as people,” Jennifer said. “We are their neighbors, we are people who teach their kids in school. We are people they work with.”

Stamm adds, "She's just a regular kid, just trying to be a regular kid. … This has just presented so many challenges for her and we feel isolated. Our circle is tight and small ... Hopefully, people will be a little bit more empathetic to what we're going through. And how ridiculous all of this is."