Aryn Kavanaugh was sitting in her living room in  when her 17-year-old daughter came into the room and said: “I’m really scared. I think people are gonna die.” Katherine, who is using her middle name for her protection, told Kavanaugh that she thought transgender youth may be the target of violence due to the hate generated by ’s recent action.

On 28 January, Trump issued an  to gender-affirming care for youth under 19 years old. It directed federal agencies to deny funding to institutions that offer gender-affirming medical care including hormones and puberty blockers.

“ immediately  and turned away new patients to adhere to the directive. In early February, Katherine was dropped as a patient at , where she received gender-affirming care after South Carolina banned hormone therapy, surgery and puberty blockers for trans youth last year. Some parents say that their children’s mental health severely declined in the weeks following the executive order. And as a result, families have gone to great lengths to ensure that their trans kids continue to receive care, including considering moving abroad or stocking up on puberty suppressants.

“We have seen dozens of families affected across the United States, in many, many states that have been left and abandoned without care that they need,” said Omar Gonzalez-Pagan, senior counsel and healthcare strategist at the LGBTQ+ civil rights organization Lambda Legal. “This is an unlawful executive order because it seeks to override the congressional mandate to condition federal financial assistance on non-discrimination, and this order seeks to require discrimination as a condition of federal funding.”

The pause follows a  filed on 4 February by civil rights organizations including Lambda Legal and the American Civil Liberties Union (ACLU) on behalf of transgender youth. ACLU staff told the Guardian that they anticipated that the preliminary injunction would remain through the court proceedings.

Some hospitals that stopped providing care to trans youth after the January directive, such as  and ,  or  in late February. Kavanaugh said she was “relieved and hopeful” about the preliminary injunction, though it does not roll back  on trans youth healthcare, which was signed into law last year.

Her 18-year-old trans son Parker and Katherine received treatment at Medical University of South Carolina and then a private clinic in the state for several years until Henry McMaster, the governor of South Carolina,  a ban on gender-affirming care for trans minors in May 2024. Parker is now old enough to receive his care in South Carolina, but the state ban means that the family has had to drive more than five hours each way to Virginia Commonwealth University for Katherine’s doctors’ appointments and medicine every few months.

Being dropped as a patient due to the federal ban “puts us in a really tough spot because we’re already having to find care outside of South Carolina. And so that just limits our options,” Kavanaugh said. Katherine’s doctors connected her to a private medical practice in Fairfax, Virginia, that does not receive federal funding, so they were able to avoid a lapse in her care. While the change in providers did not cost more money, it stretched their commute to more than seven hours.

In late February, Katherine’s puberty-blocker treatment at Virginia Commonwealth University resumed. In a , the hospital said that patients would continue medications, but that surgeries would remain suspended. Trans kids’ treatment remains in limbo as federal challenges wind through the court.

### A psychological toll

 have  that gender-affirming medical care greatly improves trans people’s mental health and quality of life. A 2022  published in the journal JAMA Network Open analyzed data from a study of 104 transgender and non-binary youth from ages 13 to 20 who received hormonal therapy or puberty blockers at the Seattle Children’s Gender Clinic for a year. Researchers found that 60% of participants reported lower rates of depression and 73% had less odds of suicidal ideation and self harm after receiving gender-affirming hormones and puberty blockers.

, who experience the intersecting stigma of being gender diverse and racial minorities, are at even greater risk of poor mental health. A  of 33,993 LGBTQ+ young people by the Trevor Project, a non-profit, found that one in four Black transgender and nonbinary youth attempted suicide in the past year, more than double the rate of their cisgender counterparts.

“It’s already difficult to access healthcare and treatment. It’s additionally difficult for folks who belong to other marginalized communities, especially families and children of color, as well as folks who are on various forms of state-funded insurance and may have difficulty selecting their providers to begin with,” Harper Seldin, a senior staff attorney at the ACLU, told the Guardian.

“There is already a subset of gender clinics in this country who provide this care. When you lay over on top of that insurance and access based on family means, it’s particularly devastating for families who can’t just pick up and go somewhere else – to another city, state or other country – to get care.”

While her trans daughter’s care hasn’t been directly affected by the executive order, Sarah, a Texas mother who asked that her last name not be used to protect her daughter’s privacy, said that her daughter Raven was devastated by the president’s directive. Raven, a 16-year-old Black trans girl in Texas who is using a pseudonym, dropped out of school last month due to her declining mental health, exacerbated by the federal ban. Sarah said that Raven had rarely got out of bed, and when she did, she would show her mom news reports of murdered Black trans girls and women.

“She has told me that she’s afraid of being killed if she leaves the house,” Sarah said. “She really only will leave the house with me. But that’s very few and far between, because she’s just incredibly depressed.”

Since dropping out of school, Sarah said that Raven’s depression and anxiety significantly decreased, and she plans to start GED test preparation classes over the summer.

In November 2024, the LGBTQ+ non-profit Human Rights Campaign Foundation released a  that showed that half of the 36 transgender people killed in the last 12 months were Black trans women. That reality has made it terrifying for Raven to live as a Black trans girl, Sarah said.

Raven’s medical providers have increased her antidepressants dosage, and she now checks in with her psychiatrist every three weeks. Since last year, Raven has had to fly to Colorado every six months to receive gender-affirming care due to a  on treatment for minors. She has received grants from the non-profit Campaign on Southern Equality to fund the travel for medical treatment, which has helped defer some of the exorbitant costs of seeking out-of-state care.

Sarah said that she has researched living in other nations and would be willing to order medicine from Canada if Raven could no longer get medical treatment in Colorado. Gender-affirming care has drastically improved Raven’s life. “She feels more herself,” Sarah said. “If she didn’t have it, I don’t think she would choose to stay alive.”

Navigating medical care restrictions has caused anxiety for parents who are shouldering the burden of the policies’ twists and turns for their children. A Georgia-based parent, Peter Isbister, said that he had chosen not to share the news of the executive order with his 11-year-old trans son Lev, who is using a pseudonym out of fear of harassment: “It’s taken a psychological toll on his parents, not on him.”

An endocrinologist is currently monitoring Lev’s hormone levels to determine when he will be put on puberty blockers. Isbister, an attorney and founder of the peer support network Metro Atlanta TransParent, has to contend with the federal executive order and a  on puberty blockers for minors in Georgia.

“If the bill passes in Georgia, then we as a family are going to really have to study up more seriously on how it works to be an out-of-state person to get care in California, New Mexico, Massachusetts or wherever,” Isbister said. “And the more states that restrict access to care, the harder that’s going to be.”

As a result of the federal and state policies, Isbister said that he has talked with an immigration attorney about acquiring Canadian citizenship for his son. But at least for now, Lev’s clinic continues to provide him care.

While Isbister was “heartened” by the judge’s injunction on the executive order, he said that it is “wrenching and in my view unjust that my ability to provide my kid healthcare should be an issue for our federal courts.”
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