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California Becomes First Sanctuary State for Transgender Youth Seeking Medical Care

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a young man and his mom smile for a portrait wearing purple shirts that read 'I support LGBTQ youth'
Kathie Moehlig (right) and her 19-year-old son, Sam, pose for a selfie at Spirit Day 2020 in San Diego. Kathie helped Sam access puberty blockers so he could transition at around age 11, and says the family only regrets not doing it sooner. (Courtesy of Kathie Moehlig)

California is the first state in the nation to create a sanctuary for transgender youth seeking gender-affirming medical care. Gov. Gavin Newsom signed a new law in September that ensures transgender kids from elsewhere can safely access hormones or puberty blockers here. The legislation also shields families from child abuse investigations or from being criminally prosecuted for seeking gender-affirming care.

“In California we believe in equality and acceptance. We believe that no one should be prosecuted or persecuted for getting the care they need — including gender-affirming care,” Newsom said in a signing message. “Parents know what’s best for their kids, and they should be able to make decisions around the health of their children without fear. We must take a stand for parental choice.”

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This year a wave of bills in states ranging from New Hampshire to Arizona have attempted to limit, ban or criminalize access to medical care for transgender and nonbinary youth. An Alabama law passed in February not only banned medication for transgender youth, but ruled that doctors who break it could face up to 10 years in prison.

“You don’t disfigure 10-, 12-, 13-year-old kids based on gender dysphoria,” Florida Gov. Ron DeSantis said at an August press conference. “I think these doctors need to get sued for what’s happening.”

Most of these laws are in legal limbo as they are challenged in court. Meanwhile, families are panicking.

Scared out of Texas

After decades of building a life in Texas, a mother of a 12-year-old suddenly worried she might be investigated for child abuse, after Gov. Greg Abbott ordered the Texas Department of Family Protective Services to investigate parents who are providing gender-affirming care to their kids last February.

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“We were stunned that it was no longer safe for us to be there,” said the mother, who asked that KQED not use her name to protect her identity and that of her child.

Even after a Texas judge temporarily stayed such investigations, Texas Attorney General Ken Paxton insisted that they were legal and would continue.

Media reports soon detailed experiences where state investigators pulled trans youth out of classrooms for interrogations.

“With their parents not being there,” said the Texas mother, adding that she heard similar stories from family friends. “And these are children that have only socially transitioned. All they asked for was to be called a different pronoun. That's terrifying.”

Three years ago, her own 12-year-old daughter asked her friends and family to use feminine pronouns.

“And so we sat down and talked to our kid,” she said. “We gave her a little card to go to school with that listed her rights and told her what to do if somebody came to investigate us.”

But the family could not relax. They said they had no choice but to sell their home. This fall they packed up all of their belongings and moved to Southern California.

“It feels very good to not feel like you're in danger — in that really critical place of our family being ripped apart,” said the mother.

Providing refuge

They feel safe under a new law authored by state Senator Scott Wiener (D-San Francisco), which declares that any potential out-of-state arrest warrant for violating laws related to such care will be given “the lowest law enforcement priority.”

“We are going to provide them with refuge and we're not going to send them back and we're not going to honor subpoenas,” said Sen. Wiener. “And our law enforcement is not going to enforce the laws of Texas and Alabama criminalizing these families.”

A family at a rally at the Capitol in St. Paul, Minnesota, to support trans kids. A recent wave of bills has sought to ban or criminalize gender-affirming care for trans minors in several states. (Michael Siluk/UCG/Universal Images Group via Getty Images)

High stakes

Mental health therapists say puberty blockers and hormone therapy can save lives. A recent survey found that nearly 1 in 5 transgender 13- to 24-year-olds have attempted suicide in the past year.

The World Health Organization defines gender-affirming care as a variety of “social, psychological, behavioral and medical interventions designed to support and affirm an individual’s gender identity.”

These interventions can be nonmedical — called social transitioning — like when a child adopts a chosen name and/or new pronouns or dresses in alignment with their gender identity. Research suggests changing one's name may reduce depression and suicide ideation.

Also, beginning in early adolescence, doctors may prescribe medical interventions. The World Professional Association for Transgender Health recommends waiting until youth are 15 years old for surgical procedures, according to their new guidance released over the summer.

Constitutional questions

The new California law faces fierce opposition. Forty-five organizations, including the Alliance Defending Freedom and The Heritage Foundation, penned a letter to Newsom urging him to veto Wiener’s bill.

“We want these treatments to not be happening on minors because they're permanent,” said Greg Burt, director of capitol engagement for the California Family Council, a Christian faith-based organization. “We do not assume that your body is the problem. We think it's much more logical to encourage young people to try and get their minds to match their bodies.”

a person wears a shirt that reads 'protect trans kids'
A person takes part in a rally during a Transgender Day of Visibility event outside the State House in Boston on March 31, 2022. (Jessica Rinaldi/The Boston Globe via Getty Images)

Yet the standard of care for kids who are really distressed and diagnosed with gender dysphoria does include medical interventions.

California is also acting as a sanctuary for those individuals seeking abortions from other states after the U.S. Supreme Court overturned Roe v. Wade, the historic 1973 ruling that granted a legal right to the procedure. But conservatives, including Burt, argue that California’s “sanctuary” laws on abortion and gender-affirming care violate the Constitution.

“There's going to be a constitutional crisis if states don't honor each other's civil judgments,” Burt said.

Jessica Levinson, professor at Loyola Law School in Los Angeles, said there “could be litigation both with respect to abortion and with respect to gender-affirming care.”

But she and other legal experts are not convinced by conservative critiques that the new California laws violate the Constitution’s full faith and credit clause.

“I think the weight of the law indicates that states are separate sovereigns. If and until there is a national standard that indicates nobody can obtain gender-affirming care or nobody can obtain an abortion, the law allows for a patchwork,” Levinson said.

That patchwork is crucial to the families seeking help at Trans Family Support Services in San Diego.

“The politicians should not be making medical decisions for anybody, nor should they be making parental decisions for anybody,” said Kathie Moehlig, the organization’s executive director.

About a decade ago, Moehlig helped her 11-year-old access puberty blockers.

“My son would not still be alive if we waited until 18,” she said. “He already was in so much distress and so completely miserable that his body was becoming something that he knew he was not.”

Today she says her son is thriving in college, studying theology. He has never regretted transitioning.

There is no solid data on how many kids remain satisfied with medical interventions, or feel remorse about gender-affirming transitions. A recent report from Reuters highlights the lack of solid evidence on the long-term effects of gender-affirming care. For example, there is very little known about how transitioning affects fertility or cognitive development. Puberty blockers and sex hormones do not have FDA approval for children’s gender care, and the National Institutes of Health has said that clinical trials have not yet determined whether there are any short- or long-term health risks for teens.

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For the Moehlig family, their only regret is that they waited as long as they did to transition their son.

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