According KFF Health News data, states colored red have restricted gender-affirming care for minors. Kansas could soon follow. (Naomi O’Donnell/The Beacon)

If Kansas bans gender-affirming care for minors, Kansas City families with transgender children will be hundreds of miles from a doctor who could help them.

Kansas lawmakers stand poised to follow a conservative playbook that 24 states, including Missouri, already have used to outlaw treatments like puberty blockers and hormone therapy.

The Kansas Legislature passed a bill last week that would ban gender care for people younger than 18 and bar transgender youth already receiving treatment from continuing  it in the state. Gov. Laura Kelly is expected to veto the legislation, but an override is plausible.

Families with trans kids on both sides of the state line  watch with trepidation. If care options in Kansas go away, families in Missouri will also lose their nearest outlet for care. Parents in both states will be forced to choose between discontinuing their child’s treatment or searching for it in a city elsewhere in the country.

“We’re already seeing families from Missouri traveling all the way to Seattle,” said Katy Erker-Lynch, executive director of PROMO, a St. Louis-based LGBTQ advocacy group.

One Kansas City parent, who asked not to be identified to protect his child, said his family would look for care in Colorado or Minnesota, which would become some of the closest options if Kansas shuts down.

But traveling is only an option for families that can afford to take time off work and pay for travel and hotels.

“If you are not financially privileged, your kid will suffer,” said a Lee’s Summit woman whose 18-year-old daughter is transgender.

Networks have sprung up across the country to get women to states, like Kansas, where abortion remains available after the U.S. Supreme Court struck down Roe v. Wade. Likewise, a network is taking shape to get children and adults to states that still allow gender-affirming care.

Proponents of laws to ban gender-affirming care for minors worry the treatment will harm children and cause physical changes they might later regret.

Gender-affirming care, which the Kansas bill would make illegal in the state, is widely endorsed in the medical community. Medical professionals consider it lifesaving for some people suffering from gender dysphoria, a condition that can develop when a person’s gender identity doesn’t match their biological gender.

It includes a range of treatments, from mental health care to medical treatments, like hormone therapy and surgery. Most major health care organizations, including the American Academy of Pediatrics, agree that the care is medically necessary for most transgender people.

Care for children starts with social changes — letting a child live as the gender that matches their gender identity. That could continue.

But other types of gender-affirming care such as puberty blockers, which pause physical changes associated with puberty, and, later on, hormone therapy would be inaccessible in Kansas and Missouri. Surgery in people younger than 18 is exceedingly rare.

The Overland Park mother of a 14-year-old transgender son said the child hasn’t started taking testosterone, the male hormone, but he will when his parents and doctors believe that level of care is appropriate.

The mother, who asked not to be identified to protect her son’s privacy, doesn’t know what she will do if that care is no longer available in Kansas. But to protect her son, who was suicidal before he began living as a boy, she said she will do whatever she has to to find it.

“We’ll continue to find ways to make sure he stays safe,” she said. “Even living in a different country would not be out of the plan.”

A 2023 survey by the Trevor Project, an organization focused on the mental health of LGBTQ youth, found that half of transgender young people have seriously considered suicide in the past year and nearly one in five has attempted suicide.

When someone takes steps to transition to the gender that matches their identity, the risk of suicide goes down, health experts said. Suicide risk also drops when a person’s gender identity and pronouns are acknowledged and supported at home and school.

But the opposite is true when political rhetoric seems to constantly take aim at transgender health care, said Katie Heiden-Rootes, an associate professor at St. Louis University who works with the university’s Transgender Health Collaborative.

“It introduces seemingly culturally acceptable rhetoric about LGBTQ people,” she said, “and can really embolden discrimination and bullying in a more open way, because it seems to be OK right now to say these things and talk about trans people this way.”

The frequent attempts in state legislatures to pass laws that would remove options for transgender care are even damaging to trans people living in states where laws support them, said Roz Gould Keith, whose support group organization, Stand With Trans, is based in Michigan but offers online support groups to people throughout the country.

“The anti-trans rhetoric that is prevalent across the country affects everyone and erodes self-esteem,” she said. “People feel that in general the country wants to erase their existence.”

A survey from SLU’s Transgender Health Collaborative found that the anti-trans laws and legislation in Missouri are pushing families with trans kids out of the state. The survey found that health care providers also want to leave.

The group said 40% of survey respondents who were parents of LGBTQ youth had considered leaving Missouri, where state legislators introduced 48 bills last year affecting LGBTQ rights — and passed two that were signed into law. This year, they introduced another 34.

Parents surveyed cited increased stress, mental health, safety fears and the political climate as the top reasons for wanting to leave the state.

One in three health care providers surveyed said they had considered leaving the state because of the LGBTQ climate. Losing health care providers who are already in short supply harms everyone, said Heiden-Rootes, an author of the survey.

“We already are a state with really high amounts of medically underserved areas,” she said.

Estimates by the Williams Institute at the University of California Los Angeles School of Law suggest 1.6 million people in the United States identify as transgender. About 300,000 of those are 13 to 17 years old — including 2,100 in Kansas and 2,900 in Missouri.

The Human Rights Campaign estimated at the end of last year that three in 10 transgender youth lived in states that had banned care.

When Missouri Gov. Mike Parson signed legislation banning gender-affirming care last year, many Kansas City families found providers just across the state line in Kansas. A Kansas ban would force them to states farther away, where waiting lists can stretch beyond a year.

The Kansas bill was amended to give children until Dec. 31 to stop current treatment, including puberty blockers, testosterone, estrogen or other medications related to gender transition.

Opponents decry the effort to make patients already getting treatment to stop.

“They want to force de-transition all of these kids,” said Susan Halla, board president of TransParent, a national support and advocacy organization based in St. Louis. “They really don’t understand what de-transitioning is going to do to these kids.”

Although Missouri’s law banning minor care included a grandfather clause, which was supposed to allow children already getting care to continue it, that didn’t prevent many children in the state from losing care. In September, the Washington University Transgender Center at St. Louis Children’s Hospital said it would no longer prescribe puberty blockers or hormones to minors.

The center said the Missouri law created “unsustainable liability for health care professionals and makes it untenable for us to continue to provide comprehensive transgender care for minor patients without subjecting the university and our providers to an unacceptable level of liability.”

The University of Missouri soon followed suit, leaving patients across the eastern and central parts of Missouri with few options. Halla said many families have chosen to travel out of state rather than stop treatment.

Since 2023, the Campaign for Southern Equality in North Carolina has been working to support families in states where gender care has been outlawed. The organization’s Southern Trans Youth Emergency Project works with a network of gender clinics around the country and has helped more than 600 families find care since the program started in response to Tennessee and Mississippi passing bans.

The group has distributed $416,000 in direct emergency grants to families of trans youth or trans individuals, covering the cost of traveling to reach a doctor and other expenses associated with traveling. It also connects people to an organization that works with volunteer pilots who will fly them to appointments that are farther away.

Sometimes, the group sets up a telehealth connection, so a family only needs to cross a state line and dial into an appointment rather than having to drive farther to an in-person appointment.

“It’s certainly not just Tennessee and Mississippi, as we thought it would be at the beginning of last year,” said Carolyn Jones, who oversees the program.

And as more bills, including legislation in Kansas and Missouri, were introduced this year, the tide of people seeking transgender care in the dwindling number of states where it is still legal will likely continue to rise.

New legislation that prohibits doctors from offering care or threatens parents who help their children get gender-affirming care is regularly being introduced.

Legal challenges to the laws are ongoing across the country, including in Missouri. Some have been successful.

Last summer, a federal judge struck down an Arkansas law — the first in the country to ban transgender care. But lawmakers in that state have since passed legislation that could create a de facto ban on the care by making it more difficult for providers to get malpractice insurance.

Groups fighting the laws banning gender-affirming care hope more legal challenges will be successful.

“We’re clinging on to hope, because that’s all we have right now,” Halla said. “And that (hope) is that these will be proven illegal. … It’s an overreach of government (to say) that parents and doctors who have trained medically for this can’t provide this to children.”

There could be reason to believe the wave of anti-trans legislation could be subsiding, Erin Reed, a journalist who tracks anti-LGBTQ legislation, reported in her blog last week. Georgia, for instance, ended its legislative session without passing any of the proposed bills.

“Often when asked by other journalists about ‘where this is all going,’ I would state that, ‘We have yet to see a bottom,’” Reed wrote. “That is no longer the case — it appears that we have actually found that bottom in several states across the United States.”

But Erker-Lynch said that, at least in Missouri, restrictions could still grow.

“This is a decades-long struggle,” she said.