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Oklahoma trans youth, providers face uncertainty in gender-affirming care access

Protestors at the Oklahoma State Capitol. They were protesting House Bill 2177, a bill that would have banned gender-affirming care for minors and limits it for adults.
Beth Wallis
StateImpact Oklahoma
Protestors at the Oklahoma State Capitol. They were protesting House Bill 2177, a bill that would have banned gender-affirming care for minors and limits it for adults.

Alex is your average 16-year-old high school theater kid. He is obsessed with listening to his favorite musicals, “The Book of Mormon” and “Falsettos,” and already has a long list of credits from his budding theater career.

He’s grown up in Oklahoma City alongside his mom, Chelsea, who was his age when she had him. She’s most proud of his confidence, intelligence and willingness to always be there for his friends.

Alex — who requested StateImpact use his first name due to safety concerns — is a trans boy who has been out to his family since he was 12. It’s always been easy for him to be proud of his identity because of the support he received.

“He's my only,” Chelsea said. “It was never going to be an issue.”

What’s been harder is accessing gender-affirming care, which was targeted by 15 bills in Oklahoma this year. One bill, SB 613, was signed by the governor in May, banning gender-affirming care for people under 18.

That bill was paused by Oklahoma Attorney General Gentner Drummond amid litigation from the ACLU of Oklahoma, meaning youth like Alex can still access that care for now. But as that lawsuit develops, trans youth and providers are coping with uncertainty on whether access will continue in Oklahoma, and some aren’t sticking around to find out.

Waning access to gender-affirming care

Alex started seeing pediatric medicine specialist Shauna Lawlis at OU’s adolescent clinic when he was 13 and began testosterone two years later in August 2022.

Chelsea said this care has meant a lot to Alex. He’s got a mustache coming in, and his voice dropped into the tenor range, which is great for his theater endeavors.

But, most importantly, she said he’s coming into his own.

“I've started passing a lot more, and instead of people instantly being able to figure out I'm trans, I've had people actually be surprised about it,” Alex said. “I've been able to blend in better.”

Alex had to move to Oklahoma City’s Diversity Family Health clinic in October after Gov Stitt threatened to block nearly $40 million in funding if OU continued providing that care. And, in May, Stitt signed SB 613, banning gender-affirming care for people under 18 — although it isn’t in effect yet.

Alex is still at Diversity Family Health, and Dr. Lawlis has left the state. His mom, Chelsea, said she's thinking about doing the same.

“I'll make my phone calls. I'll contact my reps. I'll do all of those things that I should do. And I vote, of course. But I know that if I spend hours yelling at them, it's not going to change anything,” Chelsea said. “And so, my time is better spent finding alternatives if we have to leave. I mean, we've really considered if we need to get out of the country.”

The American Academy of Pediatrics recently reaffirmed its gender-affirming care recommendation, saying youth should have access to it. Across the country, 142 bills have been introduced in 2023 targeting this care, and around 40% of LGBTQ youth report they’ve considered suicide in the past year.

House District 88 Rep. Mauree Turner sits in their office, decorated by art they've received from their constituents.
Jillian Taylor
StateImpact Oklahoma
House District 88 Rep. Mauree Turner sits in their office, decorated by art they've received from their constituents.

Rep. Mauree Turner (D-Oklahoma City) was on the house floor fighting bills like this. They helped advocate against HB 2177, which would have banned gender-affirming care for minors and insurance providers from covering care for minors and adults. The bill died in session.

When Gov. Kevin Stitt signed SB 613, he said this in a press release:

“We cannot turn a blind eye to what’s happening across our nation, and as governor I am proud to stand up for what’s right and ban life-altering transition surgeries on children in the state of Oklahoma."

Youth rarely receive gender transition surgeries before 18. Turner said they were upset the legislature didn’t hold an interim study to determine whether a bill like SB 613 was right for Oklahoma youth.

The fight against these bills is very personal for Turner, who is advocating for their community as a non-binary legislator. They've had youth call them to lead a difficult conversation on what it means to detransition because of recent legislation.

"Which is essentially talking to somebody about what going back into the closet looks like in some cases," Turner said. "And, how do you do that? I think it's just jarring, and it's heartbreaking."

Navigating new policies

Places like Diversity Family Health and Trust Women — which mainly provided abortions until Oklahoma’s near-total ban — are expanding their gender-affirming services and taking on additional patients after OU had to close its doors.

Kiernan Cobb, Trust Women’s director of nursing, said the clinic is trying to network with more insurance providers to make puberty blockers more accessible. Those are shots given every three to six months to delay the changes of puberty.

Cobb said they believe the goal of bills like SB 613 is to create confusion so care is interrupted.

“I really keep bringing it back to abortion, but it is so similar. I've worked in repro for about 10 years, and working with Trust Women this past year is my first real experience doing gender-affirming care,” Cobb said. “But there's such similarities in the legal attacks, the hoops patients have to jump through to get here. All of it looks really similar. So all of that's really horrific and tragic for patients.”

But, despite this care still being legal amid a temporary stay on SB 613, Freedom Oklahoma’s Nicole Mcafee said they’re still hearing from people who are confused about whether care is legal or not.

Nicole McAfee is the executive director of Freedom Oklahoma, a local advocacy and organizing group for the 2SLGBTQ+ community.
Nicole McAfee is the executive director of Freedom Oklahoma, a local advocacy and organizing group for the 2SLGBTQ+ community.

“We are working with a lot of people with different levels of information … and dealing with also, sort of the implications of concerns for folks who are seeking that care about, if records around access, especially in this interim period, while it's in this gray space of the attorney general saying it won't be enforced, if any of that could be used against them at any point later,” Mcafee said.

In Texas, Gov. Greg Abbott directed the Department of Family and Protective Services to investigate parents who provide gender-affirming care to their trans children. Chelsea said policies like that make her fearful to take risks.

“I've asked, and I've not gotten any answers. Are they going to go after parents who take their children out of state for care? And is that a risk that we should take or not?” Chelsea said. “I mean, do I want to take the chance of losing my kid to the state? I mean no.”

Alex said growing up trans is already hard without politics.

“Sometimes, I'm slightly jealous of cis people," Alex said. "They don't have to worry about getting killed, or all the things that can happen because you're trans.”

Taking action despite an uncertain future

Alex’s experience isn’t singular in Oklahoma. The ACLU’s lawsuit against SB 613 includes five families with trans youth from across the state. Megan Lambert, the ACLU of Oklahoma’s legal director, said they’re fighting it on an equal protection claim.

“When a law relies on sex to determine who can and cannot receive medical care, that sex-based classification is subject to heightened scrutiny. And here, the state is utterly unable to meet that very high standard,” Lambert said. “While they have said that these restrictions are to protect the health and the best interests of minors, all evidence points to the contrary.”

The ACLU of Oklahoma is still waiting on a motion for a preliminary injunction, which requests SB 613 not go into effect through the remainder of the suit’s proceedings.

Alex has plans to attend Oklahoma City University or OU to get a theater-related degree. But as the legal battle continues, and his access to care is in question, he said his visions for the future are changing slightly.

But, for now, Alex is just trying to focus on being a kid. He’ll keep auditioning for shows, he’ll continue adding to the stories he writes in his free time, and he’ll rely on his family and friends despite the uncertainty of the future.

“Mainly, I've done my best to stay in the loop but not know too much about it to just keep at least some sanity,” Alex said.

If the bill were to go into effect, trans youth would have a six-month tapering-off period, meaning they could access puberty blockers or hormone therapy during those months.