The distance that U.S. families must travel to access gender-affirming care for their transgender children has increased dramatically in recent years, along with associated travel costs, thanks to state laws banning such care for minors, according to a new report from the Campaign for Southern Equality (CSE) and the Southern Equality Research & Policy Center.
The report, titled How Far? The Extreme Travel Burden of Bans on Medically Necessary Care for Transgender Youth, used geographic information system mapping software to estimate the distances families in states with anti-trans healthcare bans would need to drive to reach clinics. It also draws on conversations with over 500 parents of trans children through CSE’s Southern Trans Youth Emergency Project (STYEP), which helps families living in states with gender-affirming care bans access care.
Related:
Prior to the recent wave of anti-trans laws severely restricting or banning outright gender-affirming healthcare for young people in states across the country, families in most parts of the contiguous U.S. were within a one- to four-hour drive from a clinic where their kids could receive care, according to the report.
But in the deep south and rural areas, it now takes upwards of eight hours of driving time for families of trans youth to reach clinics that provide gender-affirming care. Such care has been endorsed by every major American medical association as safe, evidence-based, and often necessary for the treatment of gender dysphoria in young people.
In one of the report’s many examples, prior to Republican Gov. Greg Abbott signing a state ban into law last June, families in Houston, Texas, could access gender affirming care for their kids within the city limits. Now, they must drive over 18 hours roundtrip to reach a clinic.
Even in states like Arkansas, where bans have not gone into effect, some providers have stopped seeing patients, forcing families to travel to get the care their children need. In others, like North Carolina and Georgia, trans kids who were receiving gender-affirming care prior to the passage of those states’ bans can still receive care in-state, while new patients must travel elsewhere. It’s even more complicated in Georgia, where minors can receive puberty blockers, but must travel to access hormone therapy.
The report also looks at the costs and other burdens associated with travel to access care, including gas and vehicle costs, airfare, overnight expenses, meal costs, and time off from work and school.
Anecdotally, CSE reports that about 90% of families in states with bans that are also surrounded by other states with bans choose to fly rather than drive to states where they can access care. While that can lower travel time, it also drives up the cost for families, with average cost of a single roundtrip domestic flight costing around $276. Other factors — like the cost of childcare for other children, ground transportation, and hotel accommodations — further increase the costs families of transgender youth face. And these are usually not one-time trips. Families that don’t choose or are unable to permanently relocate are forced to travel regularly, sometimes every three to four months, for appointments, according to the report.
One parent in Texas told CSE that the state’s anti-trans healthcare ban and another in Louisiana, which borders Texas, had thrown their family into “logistical chaos.” After providers in both states could no longer provide gender-affirming care, they were forced to travel to see a provider in Albuquerque, New Mexico. While a STYEP grant covered their flight, their additional expenses included hotel accommodations, car rental, and out-of-pocket costs for their daughter’s medication.
Another parent in Oklahoma described the toll traveling to another state had taken on their daughter.
“She said on the drive that having to go to another state — one that is even more conservative than our own — was humiliating and scary,” the parent said of their child. “It was incredibly stressful to have to stop at gas stations and rest stops not knowing if anyone would comment on what bathrooms we were using.”
