Who cares for trans youth?

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Editor’s note: This is the first part in a two-part series following young transgender people and their families dealing with new restrictions in access to healthcare in and near western Mass. Part one tells the stories of some of these families, and part two will focus on organizing efforts to fight rollbacks in care access. Throughout the series, The Shoestring has allowed some sources to use pseudonyms for fear of targeting due to their identities.

“I’m a boy. Deal with it.”

That was the text message that Blaze Hartley sent to his mom at age 11 to come out as male. Before, Blaze had identified as non-binary, then gender-fluid, but found that he was uncomfortable with she/her pronouns.

The name Blaze also came from trying things out and seeing what felt good. Stacey, his mother, said that one day, she received a call from her son’s guidance counselor at school, asking her whether or not it was okay for students and staff to use a new name that Blaze had chosen at the time: Dirt. 

Stacey said that when her son came home, she called him over for a conversation. Blaze’s reasoning was that he wanted something different, like an object. Dirt was the first thing that came to mind. 

“‘Do research, look up names in other languages. Look up other objects that don’t make it seem like you hate yourself,’” she said she told him. “‘Come back in seven days.’ He came back three hours later with ‘Stick.’ I went: ‘Wonderful. You obviously didn’t learn how to tell time.’” 

After a week, he had it: Blaze — which everybody loved. Two years later, he had kept the name, and they were able to change his name legally. Blaze got the day off of school to celebrate after his court hearing for the name change.

“Those are the happy things that I’m doing instead of the frantic calling places to see where I can get my sixteen-year-old top surgery,” Stacey said.

***

Blaze learned that Connecticut Children’s Medical Center would discontinue gender-affirming care for minors through the news last year. The hospital attributed that decision to pressures from the Trump administration, including threats of withholding federal funding, according to the Connecticut Mirror.

It’s a trend seen nationwide in states that haven’t already outright banned gender-affirming care for minors, a broad spectrum of services that can range from puberty blockers and hormone therapy to visits with a psychologist. According to the Williams Institute of the University of California Los Angeles, over half of U.S states have some form of legislation that restricts healthcare to trans minors. While several states, including Massachusetts, have shield laws to protect people seeking care that can pose legal risks — it doesn’t mean that access to that care is guaranteed. With new federal directives and subsequent legal challenges cropping up regularly, blue-state hospital systems have been left to determine access to care on their own.

In Southern New England, it’s meant that families like the Hartleys now cross state lines to access care, and within Massachusetts, some patients have scrambled in recent months to find new providers as Fenway Health in Boston, Outer Cape Health Services on Cape Cod, and Baystate Health in western Massachusetts have all stopped providing gender-affirming care to patients under age 19.

“We are approaching each situation on a case-by-case basis to ensure that every child’s needs are considered with compassion, clinical judgment, and care,” President and CEO of Connecticut Children’s Medical Center, Jim Sherling, told the Connecticut Mirror at the time of their rollback of care. “We remain fully committed to providing inclusive, respectful care to all children and to ensuring that every family continues to feel safe, supported, and heard at Connecticut Children’s.”

But the Hartley family didn’t get any calls. They didn’t even get an email, which was sent to other patients.

When Stacey tried to contact the hospital, she said she got little response or explanation, and other hospitals in Connecticut, like Yale, were also shutting down youth gender-affirming care services.

“We felt like we were being treated like shit, like second class citizens,” Stacey said. “And it’s like, we gave you money to do this. The least you could do was maybe individually call each person.”

It wasn’t the first time Blaze’s healthcare had been abruptly stopped, either. Blaze had been receiving progesterone to stop menstruation, when one day the family got a call that the provider would no longer be offering that care, Stacey said.

And so began the scramble for a new provider. 

“I was very, very stressed out because I had finally gotten my child to a good place in his mental health,” Stacey said. “And now I’m looking at all of that tumbling back. We had two suicide watches where I’m locking up medicines and knives and things like that because I don’t want to lose him.”

She said that whether or not her son received gender affirming care should’ve been a family decision, made by Blaze and his parents. Despite being able to continue to get care at Transhealth, a not-for-profit clinic in Northampton, Massachusetts, Blaze has not been able to get top surgery — a common shorthand for breast reduction or mastectomy — though he said some of his friends have had successful surgeries. Last year, the Trump administration enacted a series of regulations to restrict access to puberty blockers, hormone therapy, and surgery. 

Even before the regulations, Stacey said that providers wanted Blaze to be on testosterone for a year before starting the process for top surgery. In most cases, for a minor to get gender-affirming surgery, they needed thorough documentation of their gender dysphoria, parental consent, letters from both physical and mental health providers, and long-term gender-affirming care.  

Stacey said that she hasn’t been able to make any appointments for top surgery to the hospitals she’s been in contact with. 

She wished she hadn’t waited to get her son top surgery.

“Now I’m kicking myself that I waited because it’s all the: ‘Well, if I hadn’t waited, he would have gotten the top surgery,’” she said. “I take so much of that blame on myself and I feel terrible.”

“I don’t hold that against you,” Blaze told his mom. 

Blaze doesn’t go swimming. He used to wear a binding tape to flatten his chest, which can tear skin, as well as cause chafing and rashes. But the alternative — dysphoria — is more harmful, said Stacey.

“Testosterone changed my life. It made me so much happier. I used to never pass in public and now I do one hundred percent of the time,” Blaze said. “The way people interact with me, the way I’m able to connect with people in the world now that they don’t see me as a woman, or like weird or different. It makes life so much easier.”

But escalating systemic violence against trans people, restrictions to care and the political climate are causing some people Blaze knows to flee the country, he said, including his friends and even his therapist, all people who identify as LGBTQ+. 

And for the first time in their lives, the Hartleys have gotten passports. They’ve never been out of the country, and they don’t want to leave the states, but they wanted to be ready in case they needed to.

“I am Jewish, I was raised Jewish,” Stacey said.”Being raised Jewish and having gone to, like, fifteen years of Hebrew school, you know, every year we had to relearn the Holocaust. Every year we had to do a remembrance ceremony. It’s always in the forefront of my mind.”

At school, after one student learned he was trans, Blaze said that his classmate kept calling him homophobic slurs instead of his name, despite having been friendly before. His therapist reported the behavior and Blaze filled out an incident report, and the behavior stopped, but he still has to interact with the student. He’s also been told by parents of his friends that he’s “living in sin,” and been asked invasive questions about his gender identity, including one that Blaze said was tied to misinformation that’s been spread on the news about trans people. 

“The path is similar,” Stacey said. “We see it happening.”

But the Hartleys still find space for joy. Between their several pets — Blaze wants to be an exotic pet veterinarian — and their involvement in their local music scene, the family keeps busy. 

“We understand that we are living in very hostile times right now. So we always have to have a little bit of our guard up, but there’s only so much we can do,” Blaze said. “And life would suck if we just spent the whole thing being miserable because some people don’t like us. It’s better to just enjoy what you can instead of being miserable about what you can’t.”

***

After a busy morning with her two children, Nicole is settled into her couch — softened with constant shared use. It’s the birthday of her daughter, Victoria, who came out as trans to her about two years ago. (“Nicole” and “Victoria” are pseudonyms).

Springfield’s Baystate Medical Center had been Victoria’s healthcare provider, in part because other local providers didn’t offer the kind of care she needed. But in February, Baystate suddenly announced that it would cut off gender-affirming medical care for children like her.

The drive to Springfield from the Berkshires to see a psychologist and endocrinologists — a requirement for minors to receive gender-affirming care — is 110 miles round trip. And following Baystate’s decision, Nicole said that she has to start from the beginning: get a new provider, get a consultation with them, and all within the timeframe for her daughter’s next puberty blocker shot. But Nicole said that she’s shielded her daughter from all the uncertainties.

“As far as she can tell, nothing significant has changed. She had to go to an extra doctor appointment and talk to a new person, which is always really uncomfortable for her,” Nicole said. “She is neurodivergent and shy, and does not love talking to new people. But as far as she knows, her care’s going to continue. And that’s all she cares about, is knowing that it will continue.”

Nicole and others called Baystate’s restriction on gender-affirming care premature and harmful. They say that Baystate and other medical providers are responding in advance to threats from the Trump administration to cut Medicaid and Medicare funding for hospitals that offer gender-affirming care to transgender minors.

In letters that the clinics sent out explaining their decisions, they named the Trump administration’s executive orders and public declarations threatening cuts as central reasons for shuttering these services. Despite a federal judge blocking Trump’s executive order withholding federal funding from those healthcare providers, none of those providers have reversed their decisions. 

Many physicians consider gender-affirming care to be life-saving treatment. Studies have shown that trans people who want and have access to puberty blockers and hormones have decreased adverse mental health outcomes, including lowered depression and suicidality. The American Academy of Pediatrics has slammed the Trump administration’s efforts as a “baseless intrusion into the patient-physician relationship.”

Baystate declined an interview with The Shoestring, as did TransHealth — the private clinic where Baystate is referring its patients. 

Baystate’s decision comes at a time when anti-trans legislation and rhetoric has uprooted and threatened the lives of people nationwide. From the revoking of driver’s licenses from trans people in Kansas to the outright ban to gender-affirming care to minors in New Hampshire, Republicans have turned transgender people into a scapegoat, stripping away their rights in the process.

“If we start saying that one group can be sacrificed for everyone else, where does it stop?” Nicole said. “If we give in to this for one group, where does it end?”

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