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    • Families with transgender kids are increasingly forced to travel out of state for the care they need

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    On an early morning in June, Flower Nichols and her mother set off on an expedition to Chicago from their home in Indianapolis.

    The family was determined to make it feel like an adventure in the city, though that wasn't the primary purpose of the trip.

    The following afternoon, Flower and Jennilyn Nichols would see a doctor at the University of Chicago to learn whether they could keep Flower, 11, on puberty blockers. They began to search for medical providers outside of Indiana after April 5, when Republican Gov. Eric Holcomb signed a law banning transgender minors from accessing puberty blockers and other hormone therapies, even after the approval of parents and the advice of doctors.

    At least 20 states have enacted laws restricting or banning gender-affirming care for trans minors, though several are embroiled in legal challenges. For more than a decade prior, such treatments were available to children and teens across the U.S. and have been endorsed by major medical associations.

    Opponents of gender-affirming care say there's no solid proof of purported benefits, cite widely discredited research and say children shouldn't make life-altering decisions they might regret. Advocates and families impacted by the recent laws say such care is vital for trans kids.

    On June 16, a federal judge blocked parts of Indiana's law from going into effect on July 1. But many patients still scrambled to continue receiving treatment.

    Jennilyn Nichols wanted their trip to Chicago to be defined by happy memories rather than a response to a law she called intrusive. They would explore the Museum of Science and Industry and, on the way home, stop at a beloved candy store.

    Preserving a sense of normalcy and acceptance, she decided -- well, that's just what families do.

    Families in Indiana, Mississippi and other states are navigating new laws that imply or sometimes directly accuse them of child abuse for supporting their kids in getting health care. Some trans children and teens say the recent bans on gender-affirming care in Republican-led states send the message that they are unwelcome and cannot be themselves in their home states.

    For parents, guiding their children through the usual difficulties of growing up can be challenging enough. But now they are dealing with the added pressure of finding out-of-state medical care they say allows their children to thrive.

    In the Nichols family alone, support took many forms as they traveled to Chicago: a grandmother who pitched in to babysit Flower's 7-year-old brother, Parker, while their father Kris worked; a community of other parents of trans kids who donated money to make the trip more comfortable.

    "What transgender expansive young people need is what all young people need: They need love and support, and they need unconditional respect," said Robert Marx, an assistant professor of child and adolescent development at San Jose State University. Marx studies support systems for LGBTQ+ and trans people aged 13 to 25. "They need to feel included and part of a family."

    In Indiana, rancorous legislative debates, agitated family relationships and exhaustive efforts to find care have drawn families to the support group GEKCO, founded by Krisztina Inskeep, whose adult son is transgender. Attendance at monthly meetings spiked after the state legislature advanced bills targeting trans youth, she said.

    "I think most parents want to do best by their kids," Inskeep said. "It's rather new to people, this idea that gender is not just a binary and that your kid is not just who they thought at birth."

    The perceptions of most parents, Marx said, don't align neatly with the extremes of full support or rejection of their kids' identities.

    "Most parents exist in a kind of gray area," Marx said. "Most parents are going through some kind of developmental process themselves as they come to understand their child's gender."

     On June 13, Flower and Jennilyn set off on their trip, unsteady but hopeful. They brought a care plan from Indiana University's Riley Children's Hospital, the Hoosier State's only gender clinic.

    At the time, the pair worried whether Chicago providers could meet their request for full-time support or as a backup if Indiana's ban went on hold. They considered whether they could make the drive every three months, the necessary interval between Flower's puberty blockers.

    The decision for Flower to start puberty blockers two years ago wasn't one the family took lightly.

    Jennilyn recalled asking early on whether her daughter's gender expression was permanent. She wondered if she had failed as a mom, especially while pregnant -- was it an incorrect food? A missed vitamin?

    Ultimately she and Kris dismissed those theories, ungrounded in science, and listened to their daughter, who recalled the euphoria of wearing princess dresses at an early age. Flower cherished a Little Red Riding Hood cape and felt certain of her identity from the start.

    "I remember that I really disliked my name," Flower said of her birth name. "This is just like who I am. It's all that I have a memory of."

    Conversations between Flower and her mother are often marked by uncommon candor, as when discussing early memories together at an Indianapolis park.

    "Before I knew you and before I walked this journey with you," Jennilyn told her, "I would not have thought that a kid would know they were trans or that a kid would just come out wired that way. I always thought that that was something adults figured out, and so there were times that it was really scary because I didn't know how the world would accept you. I didn't know how to keep you safe."

    Now, Jennilyn said, her worries have shifted to Flower's spelling skills and how she'll navigate crushes.

    Flower, for her part, appreciates being heard. She said she and her parents make medical decisions together because, "of course, they can't decide on a medicine for me to take."

    "At the same time, you can't pick a medicine that we can't afford to pay for or that, you know, might harm you," Jennilyn responded.

    "That's what I really like about her," Flower said, of her mother. "She leaves a lot of my life up to me."

    In Mississippi, a ban on gender-affirming care became law in the state on Feb. 28 -- prompting a father and his trans son to leave the state at the end of July for Virginia. There, he can keep his health care and continue to see doctors.

    "We are essentially escaping up north," said Ray Walker, 17.

    Walker lives with his mother, Katie Rives, in a suburb of Jackson, the state capital. His parents are divorced, but his father also lived in the area. Halfway through high school, Walker is an honors student with an interest in theater and cooking. He has a supportive group of friends.

    When Mississippi Republican Gov. Tate Reeves signed the bill banning hormone therapy for anyone younger than 18, he accused "radical activists" of pushing a "sick and twisted ideology that seeks to convince our kids they're in the wrong body."

    The state's largest hospital halted hormone treatments for trans minors months before Reeves signed the ban. That hospital later closed its LGBTQ+ clinic.

    After that clinic stopped offering its services, Walker and other teenagers received treatment at a smaller facility in another city, but those services ended once the ban took effect.

    As access to gender-affirming dwindled and was later outlawed, Walker's father, who declined to be interviewed, accepted a job in Virginia, where his son could keep his health care. Walker plans to move in with his father this month. Rives, however, is staying in Mississippi with her two younger children.

    Walker's memories of the anguished period when he started puberty at 12 still haunt him. "My body couldn't handle what was happening to it," he said.

    After a yearslong process of evaluations, then puberty blockers and hormone injections, Walker said his self-image improved.

    Then the broad effort in conservative states to restrict gender-affirming care set its sights on Mississippi. The path toward stability that Walker and his family forged had narrowed. It soon became impassable.

    "I was born this way. It's who I am. I can't not exist this way," Walker said. "We were under the impression that I still had two years left to live here. The law just ripped all of that up. They're ripping our lives apart."

    The family sees no alternative.

    "Mississippi is my home, but there are a lot of conflicting feelings when your home is actively telling you that it doesn't want you in it," Walker said.

    As Walker's moving date approaches, Rives savors the moments the family shares together. She braces for the physical distance that will soon be between them. Her two younger sons will lose Ray's brotherly presence in their daily lives.

    She still feels lucky.

    "We know that's an incredibly privileged position to be in," Rives said of her son moving to Virginia. "Most people in Mississippi cannot afford to just move to another state or even go to another state for care."

    Flower, initially dispirited by the debates at the Indiana Statehouse, brightened after her parents took her to her first Pride march on June 10 in Indianapolis.

    She tied a transgender pride flag around her shoulders and covered her pink shirt in every rainbow heart-shaped sticker she could find. She gripped a sign that read: "She belongs."

    Her favorite activities are often less inflected with politics than her status as a soon-to-be teenager. She's a Girl Scout who enjoys catching Pokemon with her brother. Before the trip, she zipped around an Indianapolis park on a pink scooter, her hair tangled by the wind.

    Prior to entering Chicago's Museum of Science and Industry, Flower used a women's bathroom. At a diner in the city, she ordered a mint chocolate chip milkshake and a vegan grilled cheese. Jennilyn created an itinerary to make their experience as joyful and uncomplicated as possible.

    "First of all, we're going be able to chill at the hotel in the morning," Flower said. "Second of all, there's a park nearby that we can have a lot of fun in. Third of all, we might have a backup plan, which is really exciting. And fourth of all: Candy store!"

    The doctor's appointment the following day, initially intimidating, soon gave them another reason to celebrate: If care was not available in Indiana, they could get it in Chicago.

    "Indiana could do whatever the hell they're going to do," Jennilyn said, "and we can just come here."

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