With hard-won rights, such as access to hormone replacement therapy or permission to use one's chosen pronouns in school, breaking down in states across the country, trans residents of all ages are left with a choice: Flee or, in many cases, risk imprisonment or detransition. Many who do choose to flee are then faced with another hurdle in finding out where they will receive gender-affirming care in states with already overwhelmed healthcare systems.
According to a recent analysis by journalist and trans activist Erin Reed, five states are considered to have the worst anti-trans laws for adults, while 12 more fall under "High Risk Within 2 Years" and another two in "Moderate Risk Within 2 Years." For youth, 20 states are listed as having the worst anti-trans laws. Florida is listed under its own special category on both maps, "Do Not Travel."
In states close to Illinois, the current situation may not be as dire as Florida's—where Gov. Ron DeSantis signed laws limiting gender-affirming care, pronoun use in schools, drag shows and more—but it doesn't make the reality any less grim. Four out of five border states—with Wisconsin as the exception—passed anti-trans laws restricting healthcare or other freedoms in 2023. These other freedoms include areas such as playing on sports teams aligned with a student's gender, using the bathroom aligned with one's gender in schools and allowing teachers to answer questions from students of all ages about LGBTQ+ identities.
Through this nearby turmoil, Illinois has become like the eye of the hurricane for the Midwest. At the start of 2023, Gov. J.B. Pritzker signed HB 4664, thus protecting the right to both gender-affirming care and reproductive healthcare.
The bill also protects providers in the state from being prosecuted by other states who have banned such care. These "shield" laws—Illinois is one of 11 states plus Washington D.C. with such laws—protect trans healthcare opportunities and require health insurance providers to include coverage for gender-affirming care. They also offer many other protections in social life for trans and other LGBTQ identities of all ages.
However, even in a state as protected as Illinois, resources and programs are limited and some face internal issues of their own. In Chicago, for example, Howard Brown Health, which provides services to a number of transgender clients, has faced many labor issues. Not only are trans people fighting for accessible care, but they are potentially losing resources from formerly well-oiled programs.
Medical Director of Trans CARE at UChicago Medicine Andrew Fisher said that his practice has started to see more requests for care.
"Where that's led to challenges is, for example, patients who are located in Texas or Florida, where certain aspects of their care may be banned," he said. "Even if we were to be licensed in those states, we couldn't provide care in those states. But if that patient is able to travel to Illinois to seek that care, then we can legally provide [it]."
In order to help folks who may be coming from out of state, Fisher said, some locations' practitioners will try to schedule surgery and hormone consultations on the same day to save them travel-time. He noted that, although there are similarities with the way abortion's criminalization in some states has pushed people to seek care elsewhere, gender-affirming care creates different challenges, considering it is a lifelong process and requires regular surveillance.
This regular surveillance is one of the most complex issues to work around when patients come from anti-trans states. With medical processes requiring regular blood work and prescriptions filled, it can be complicated to align all the moving parts.
"We try to put in advanced planning with our team, ahead of [patients'] visits, to figure out what kind of needs they're going to have, so when they show up, we have a plan for them," Fisher said.
Another major issue facing trans patients in Illinois is that the demand for services greatly outnumbers the supply. Ricky Hill, a research assistant professor for Northwestern's Institute for Sexual and Gender Minority Health and Wellbeing, said getting a consultation for gender-affirming surgery can take up to a year's wait, and the appointments only open up to schedule once a month due to the level of traffic.
Northwestern also takes Medicaid insurance, which means even more people are coming to them for help as they may not be able to access other treatment options.
Aside from the care Northwestern's program is able to provide, Hill said they've also seen issues on the side of drug manufacturing. Hormone shortages, for example, are a significant problem.
Farther outside Chicago in more conservative eras, locations to access care are not as widespread. Mallory Klocke, gender affirming hormone therapy program director of Planned Parenthood Illinois, said it's an intentional choice for her organization to offer gender-affirming care at all of their locations—Planned Parenthood has centers in areas such as Bloomington, Decatur, Springfield and the recently-opened Carbondale location.
She said these locations have helped expand access for people seeking services both in Illinois and those coming from border states.
"The percentage of care [provided at these locations] that is gender-affirming care tends to be a little bit higher at some of our central Illinois locations," Klocke said. "Our Carbondale location just opened up, and we have been anticipating that abortion care [and] gender-affirming care will make up a large portion of people that are coming for care at that location."
In right-wing circles, civilians and politicians alike are often trying to make the case for a wave of detransitioners regretting their treatments. However, Hill said detransition is often forced, with people losing access to their gender-affirming treatments and being forced to lose their progress.
"And anytime anyone is made to do something against their will, we know that there are negative mental-health outcomes," Hill said. "I don't necessarily subscribe to a medicalist approach to transgender identities, but I also acknowledge that for many people, medical care is integral to their ability to live a comfortable life as a transgender person. When folks do lose access to their care, it is stressful."
Hill said they feel hopeful that both widespread prejudices against trans people and anti-trans legislation will lessen due to a general shift in public opinion. With the Republican party often using anti-trans fear mongering as a discussion topic, Hill said they think more people across all parties are realizing there are much more important things to focus on.
"[It] feels to me very different than four years ago," they said. "I'm hopeful that things have just gotten so bad in other areas that we can really start to view [the anti-trans wave] as the distraction it is."
