L pulled out a plastic case with small plastic parts of syringes
“So this is my kid's stuff,” she said, standing in the bathroom of her family’s house in Alaska.
L is a mom who doesn’t want to give her full name because she’s worried about the safety and privacy of her family. She's raising a 16-year-old nonbinary transmasculine kid, who uses both “he” and “they” pronouns.
In her bathroom, L looked into a cabinet and pulled out another plastic bag, this one filled with about 15 small, white boxes with prescription labels.
“And this we got like the day after the election,” she said. “That’s not as much as it probably looks like, but it should last close to a year.”
Inside the boxes were glass bottles of testosterone, supplies for her kid’s gender-affirming health care. She said she was worried about whether they would be able to fill his prescriptions once Donald Trump took office.
“We were in a panic,” she said.
It has taken her and her family years to navigate her kid’s gender journey, and land on care that works for them. When he hit puberty, she said, her kid became a shell of a person. They were anxious, depressed and self-harming, and she and her husband didn’t know what was going on.
“We spent a lot of time at night trying to problem solve, like, ‘What can we do? Where can we go?’ And honestly worrying that we were going to find them dead in the morning,” L said. “And it wasn’t until we accessed gender-affirming care, which can mean a host of things, but until we accessed hormones, that it was almost like a magic bullet for them.”
President Trump has issued at least five executive orders aimed at trans people during his first few weeks in office, and one order is already making it difficult for some trans and nonbinary people to access care.
Medicaid, for low-income and disabled Americans, and Tricare, for military and their families, no longer cover gender-affirming care for people age 19 and under. Gender-affirming care can include medical, social and psychological interventions to support someone’s gender identity. Medical practices and hospitals risk losing federal funding if they provide gender-affirming care for those 19 years old and younger. And more executive orders are likely to impact trans and queer rights and care moving forward. One may allow denial of health coverage for religious reasons. Others order federal organizations to enforce a strict sex binary. One bars trans people from enlisting in the military or transitioning if they’re already in the military. It’s hard to know how all these executive orders will unfold, and which will get blocked or reversed through legal battles. There are already lawsuits challenging some of the orders, through the ACLU, the Human Rights Campaign Foundation and different states. But experts worry that many trans patients and those needing HIV treatment and prevention, like PrEP, won’t be able to access or afford care.
The tone of Trump’s executive orders isn’t a surprise to L. Everyone in her tight-knit queer and trans community has been preparing for a Trump presidency. She said losing gender-affirming care for her kid is just not an option.
“I just know where we were and we can’t go back there,” L said. “I can’t do that to my kid. So we will do whatever we have to do. We’ll go into debt. We will go to other countries.”
This stress, fear and confusion is something that Identity Health Clinic in Anchorage sees a lot of lately in their patients. The clinic is the largest provider of gender-affirming care in the state and many of their patients rely on Medicaid.
Tom Pittman, Identity’s executive director, said the clinic has seen Medicaid denials of coverage for minors already. But despite changes in coverage, he said, it’s still legal to seek and provide health care.
“It is a right, and we get to have the respect of the society that we live in to do that,” Pittman said. “It's under attack, but we still get to, right now.”
Identity has a legal and insurance team to help patients understand their rights and navigate claims, and Pittman said they’re planning to launch a fund to financially support patients whose care isn’t covered.
He said the clinic pulled out of its federal funding late last year, to make it less vulnerable to what Pittman calls “personal vendettas” against queer communities.
But he said even if patients can still access health care, the executive orders ostracize trans people and patients.
“When you take someone that has already interacted with society, knowing that there are people out there that disrespect them, that want to push them down, and then you do this to them, [and] it becomes something that's an official act of their government, that's even worse,” Pittman said. “That's even more destabilizing.”
That destabilization is something H, a trans woman in Alaska, has been wrestling with. We’re identifying her by her first initial to protect her privacy.
“I haven't questioned my safety this much, even when I was working in the fishing industry, even in places [where] I've been assaulted for being trans,” H said. “Now there is just a general anxiety of existing in the world.”
H is also seeing the impacts of executive orders ripple through her community. Some trans women she knows are leaving the country because they’re scared for their health and safety. Several of the executive orders specifically target trans women.
“I'm so afraid of losing people,” H said, a tear rolling down her cheek. “I've had friends that have submitted themselves to residential treatments already, like, this is f-ing real. I was thinking to myself, riding these ups and downs, ‘Man if I don't take care of myself, I'm afraid for myself.’ I don't want to have a mental breakdown.”
H is an artist and she said through all of this stress and sorrow, her art has been a lifeline. Making art about all of this is something she now calls a “purpose in this world.”
“As much as they try and separate us, we have the tools to build those connections and to create strong community,” H said. “And that is, honestly, the greatest form of resistance that you can have.”
She said throughout history, trans women have always found each other and supported each other, and she said she and her trans “sisters” in Alaska are doing that now.
