‘Trans Migration’: Amid Attacks on Gender-Affirming Care, Trans People are Traveling Long Distances to Access Services

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The U.S. Supreme Court on Wednesday upheld Tennesee’s ban on gender affirming medical care for transgender minors. The vote was 6-3, along ideological lines. Another 26 states have laws similar to Tennessee’s.

Access to gender-affirming care for the LGBTQ+ community is growing increasingly unstable under the Trump administration. In January 2025, Trump signed an executive order directing federal agencies to ensure that institutions receiving federal research or education funds stop what it called “chemical and surgical mutilation” of minors—defining minors as anyone under 19, despite 18 being the legal age of adulthood.

Though the order has yet to take effect and is being challenged in court, healthcare providers in New York and Pennsylvania have already begun limiting gender-affirming services in anticipation.

As a result, many trans people are now forced to travel long distances—or even relocate—to access essential care. Corinne Goodwin, Executive Director of the Eastern PA Trans Equity Project, says she’s seen two trends emerge: people moving to the Northeast from states like Florida and Tennessee that have enacted bans, and Pennsylvanians driving hours in or out of state to find providers. This comes as major health networks in Pennsylvania—including UPMC, Penn State Health, and Penn Medicine—have scaled back or stopped offering gender-affirming care for patients under 19, whether pharmacological such as puberty blockers, or surgical, like top surgery.

“We’ve already had an issue of — if you live in a very rural part of the state, [such as] Wayne or Pike County near the Catskills, you may already have had to drive an hour and a half or two hours, sometimes three hours, to access gender affirming healthcare in a face-to-face environment.” Goodwin said. “This has just made that even worse because now people who maybe lived in Harrisburg, right in the middle of the state and right where both UMPC and Penn State Health have large hospitals and had practitioners providing this type of care, they now have to travel to Philadelphia or to Baltimore to Johns Hopkins. If you live in the northern part of the state, you might have to drive into New York City.”

Charlie Solidum, the Director of Programs and Services at the Hudson Valley LGBTQ+ Center, explained that in addition to the complete withdrawal of gender-affirming care, clinics in the Hudson Valley who want to continue providing these services are also having to neutralize their language, scrubbing their websites of any information related to this care to maintain federal funding. Solidum is a trans man himself who had seen the increase in access to gender-affirming care with the passing of the Affordable Care Act in 2010, which prohibits healthcare providers and insurers from discriminating on the basis of gender identity and opened the door for gender-affirming care to be reimbursed by insurance.

“The gender-affirming care page of one of the local clinics here, in the days following that executive order, [was taken down], and it was just an error for many days after that,” Solidum said. “I’ve also seen that, because of this heightened scrutiny on the transgender community, providers have become more neutral about their coding of certain procedures. For example, if a patient previously were to be receiving hormone care under the diagnosis of gender identity disorder or gender dysphoria, we are seeing providers sort of shift that language and instead codify the diagnosis as an unspecified endocrine disorder.”

Solidum said that because providers are no longer openly promoting their gender-affirming healthcare services, access remains an issue as these resources are now harder to find.

“We’re seeing that there’s an underground whisper network of referrals of people trying to find out who is providing this care because it’s going to be less outwardly visible,” Solidum said.

But for the trans community in the United States, who, based on a 2024 survey conducted by the National Center for Transgender Equality , faces unemployment at four times the national rate, this migration is far from easy. An “amazing inconvenience and expense,” Goodwin described that, in addition to transportation costs, people cannot even be sure that their insurance plan covers care in a different state.

“Another way to look at it is to use what’s called the ALICE line, which stands for Asset Limited, Income Restrained, Employed,” Goodwin said. “In the 42 counties in the state of Pennsylvania [we serve], 46%, almost half of transgender people live at or below the ALICE line. So if you are a member of the ALICE community, where you are working paycheck to paycheck, do you have the extra money to allow you to drive two or three or four or more hours for treatment and pay for a hotel room to get that treatment? The answer is probably not. So we know that we have people who are skipping their care, rationing their care to try to overcome this.”

In addition, Solidum said that the compounded marginalizations that trans people, especially trans people of color, face in terms of not only unemployment but also housing instability and food insecurity further exacerbates this issue. Although non-profits like Rainbow Railroad, which is based in Canada and the United States, has done organizing focused on helping queer people facing persecution “ get to safety ,” the impact of Trump’s executive order is reverberating through whole communities.

With that being said, migration is not a new issue for trans people who have historically had to navigate a lack of options for gender-affirming care, especially in New York and Pennsylvania’s more rural areas that are underresourced. For the Hudson Valley, Solidum explained that many people travel to New York City because there’s limited providers who are not only friendly but also competent in gender-affirming care.

“Speaking personally, up until last year, I was traveling to the city myself to get my testosterone because I am on a certain delivery method known as TESTOPEL,” Solidum said. “It’s a hormonal implant, and that’s something that’s been very difficult to access up here. So every three months I would have to go down to the city, have my entire day be about going to this one medical appointment. Luckily, I’ve been able to find a provider that can do that for me up here in the Hudson Valley region, but according to my primary care provider, the people who are accessing that specific method of hormone delivery, you can count on one hand.”

In addition to emphasizing the life-saving nature of gender-affirming care for trans youth in terms of reducing depression and suicide ideation by 60% and 73% respectively , Goodwin said she wants to push back against the sensationalized misconception that trans youth have always had unrestrained access to services like hormones or puberty blockers.

“The truth is that there is a tremendous amount of gatekeeping, and there’s a lot of hurdles you have to overcome,” Goodwin said. “In most cases, you have to see at least one, often two therapists who will provide a letter stating that you have a diagnosis of gender dysphoria…Then you have to find a healthcare provider who will provide that care. In many cases, you have to wait months and months for an appointment. Then you have to get approval from your insurance company to provide the care.”

For the healthcare providers who openly maintain their gender-affirming care, Solidum noted that they are feeling the strain of an influx of patients as more people pivot to these institutions.

“The thing about migration is that the higher volume of patients that these providers are seeing, you’re gonna see longer wait times. It’s going to be harder to get appointments in general because trans-affirming providers are very much in demand, and they are also human beings with limited capacity.”

Trans people and their loved ones are actively searching for resources, with Goodwin describing a jump from about six calls to the project on any given day to 20+ calls after Trump’s inauguration in search of resources — especially parents, “moms calling us in tears,” who are worried about their kids. In addition to the “whisper network,” Solidum, who has a background as a peer outreach worker in New York City, said that mutual aid networks by and for the trans community in Hudson Valley have been strong in filling that gap.

“In periods of heightened tyranny…we need to turn to each other,” Solidum said. “Building community and building those structures to sustain us outside of the support from the state, I think is where most of the movement is going.”

Image: Two volunteers for the Kingston Pride March hold up a “Trans Lives Matter” sign as part of a sign-making workshop led by local art activist Lauren Hollick in front of the Hudson Valley LGBTQ+ Center on June 7 (Photo credit: @lgbtqcenter on Instagram)

Note: This story was updated on June 19 to include the Supreme Court decision and updated June 22 to clarify that decision.