Heather wants to escape Alabama. Urgently. 

The 48-year-old music teacher first moved with her two children to rural Marion County, located in the northwestern part of the state right on the Mississippi border, from Lancaster, Pa., last August. She was in the midst of a divorce, and her parents said she could live in the home where she was raised because they were getting a new place about 10 minutes down the road.

Heather planned to send her kids, one of whom is transgender, to a just-opened charter school in the Birmingham area that marketed itself as an “LGBTQ-affirming learning environment.” It seemed like a fresh start.

But by April, Republican Gov. Kay Ivey signed into law a bill that outlawed providing gender-affirming medical care for transgender children like Heather’s 15-year-old son, Robert, who takes testosterone. 

The state also banned students from using bathrooms that aligned with their gender identities, as well as discussions surrounding sexual orientation or gender identity in elementary-school classrooms. The school at which Heather had hoped to enroll her kids, the Magic City Acceptance Academy, wound up increasing security that month after it was targeted in an attack ad by an Alabama Republican gubernatorial candidate.

Heather’s best friend told her it was time to leave Alabama entirely. Yet that would be far easier said than done: Similar rhetoric against transgender children was cropping up in deeply conservative states across the country, and developmentally appropriate gender-affirming care — which can include puberty blockers and hormone therapy — was likened to child abuse in Texas. Even lawmakers in states with more moderate Republican governors, like Ohio, mulled legislation that could require pelvic exams on child student-athletes to make sure transgender girls can’t play on female sports teams. 

If this was a domino effect, Heather had to keep her son from getting crushed.

“I want to get us somewhere where we are safe forever,” said Heather, who asked that she and her son be identified only by their first names for safety reasons. “I don’t have the money to move us all across the country and bounce from state to state until I get to one that is going to be the right one for us.”

Places like Illinois, where Heather is considering relocating her family, seem safe. But that kind of security still comes with a price tag. 

‘There are so many families who want to move, I know, that are going to be stuck here and living in fear.’

— Heather, the mother of a transgender child

To get out of Alabama, Heather will have to navigate an expensive cross-country move under concerns of a looming recession, a tight housing market, and the worst inflation in four decades. She’ll have to exhaust her savings and tap into a GoFundMe she felt guilty creating in the first place, joining the legion of trans adults and parents of trans children who have similarly asked for money to move out of conservative states. She’ll likely have to purchase a modest home, since her budget for property in the Chicago area is about $200,000, even though the median home price there in April was $325,000. And she’ll have to leave the family members she had hoped to be closer to — all for the kind of safety that “everyone deserves,” Robert told MarketWatch.

“It’s unfair that people are just picking on people who just want to go to the doctor and get what they need,” Robert said.

That treatment is part of what makes the move out of Alabama so worthwhile. The kind of care Robert receives is supported by the American Academy of Pediatrics and the American Medical Association. Researchers have said it may be linked to improved mental health among transgender and non-binary youth. 

Still, a March report from the Williams Institute at UCLA School of Law found that more than a third of transgender youth in the U.S. lived in states that had restricted access to gender-affirming care or considered laws to do so. 

In Alabama, a sergeant with the Gadsden Police Department told legislators during a February hearing that the state’s ban, if enacted, would force him to “someday put handcuffs on these people that are heroes in my life” — the medical providers who supported his transgender child. 

“We are refugees,” Heather said. “There are so many families who want to move, I know, that are going to be stuck here and living in fear. I don’t think anybody should be forced to do that.”

‘Naked politicization’

Ellen Kahn, the Human Rights Campaign’s senior director of programs and partnerships, is quick to acknowledge that things are looking grim for LGBTQ people across the U.S right now: From mid-January through May, when most state legislatures were active, her organization tracked and opposed 340 bills that would be harmful to that community. Of those proposals, 143 were explicitly anti-trans bills, and more than 40 intended to limit or entirely ban gender-affirming care. Other bills included language that barred transgender kids from playing on sports teams that aligned with their gender identity. 

So far, 24 of those bills have passed and been signed into law, Kahn said. “Starting last year, the sports bills and the medical-care bans really got legs with conservatives [and] really became a galvanizing force for the Republican Party,” Kahn said. 

Arkansas became the first state to ban gender-affirming treatments for transgender youth when the state legislators voted to override Republican Gov. Asa Hutchinson’s veto of a controversial bill restricting care last spring. Months later, in July, that bill was temporarily blocked by a federal judge following a lawsuit from the American Civil Liberties Union. 

Outside of legislative efforts, Texas Republican Gov. Greg Abbott also directed his state’s child welfare agency to investigate parents whose kids received gender-affirming care in February of this year, setting off a political firestorm. (Abbott couldn’t legally compel the agency to do that, a May ruling from the Texas Supreme Court determined, though some investigations resumed after the same ruling lifted a statewide injunction blocking them. On June 10, another judge temporarily put those probes on hold again.)  

Then, at the beginning of Pride Month, Florida Gov. Ron DeSantis’ administration also asked the Florida Board of Medicine to ban or restrict gender-affirming care for transgender kids, according to a letter obtained by NBC News. The state has similarly moved to block Medicaid coverage for gender-affirming care for all transgender people.

But statehouses aren’t the only places where LGBTQ people and their allies are being threatened. A California elementary school was hit with graffiti in May that said, “Pervs Work Here,” apparently after criticism over a third-grade teacher affirming a transgender child’s pronouns, according to CBS Los Angeles. This month, 31 alleged members of a white nationalist group were arrested near a Pride event in Coeur d’Alene, Idaho, over accusations that they were conspiring to riot. A parent allegedly threatened to “show up and kill” somebody at Canaan Schools in Canaan, Vt. — triggering a two-day closure — if a transgender person or drag queen ever came near their child, according to a police affidavit seen by VTDigger. (Vermont Gov. Phil Scott, a moderate Republican, has backed legislation protecting trans rights.)

On the other end are the policymakers and business leaders who are trying to defend transgender people’s civil rights. The chief executive officer of Certain Affinity, an Austin-based video game developer that has worked on Halo and Call of Duty games, said in May that due to the “naked politicization of private-health matters” including care for transgender youth and abortion, the company would cover certain relocation costs for its employees so they could be in “another, safer state or province that we operate in.”

Democratic lawmakers in states like New York and California have also proposed legislation that would create legal safe havens for transgender kids and their parents. And this month, President Joe Biden issued an executive order directing the U.S. Department of Health and Human Services to protect kids and families “from attacks on their access to health care,” and “release new sample policies for states on how to expand access to comprehensive health care for LGBTQI+ patients,” according to a White House fact sheet.

The whiplash between calls for inclusivity and heightened attacks has backed some families up against a wall: The places most familiar to them may feel hostile, if not dangerous. But the less-familiar places that are theoretically safer are sometimes more expensive, and could still be targeted by transphobic attacks.

“People have deep roots where they are,” Kahn said. “They have connections with neighbors, friends.”

Yet her organization has come across several parents and kids who may soon be forced to leave that behind — if they haven’t already. 

Kahn, who works with about 20 families as part of the Human Rights Campaign’s Parents for Transgender Equality National Council, recalled a Miami-based mother of a gender-nonconforming boy who, after advocating for her child at his elementary school, found allies in staff and the school principal, enabling a “great experience” for him. Now that he’s about to go to middle school in a more hostile political environment — Florida teachers will be banned from classroom instruction about sexual orientation and gender identity among young kids due to a new state law, dubbed “Don’t Say Gay” by LGBTQ advocates, that takes effect in July — the mother is worried about continuing to raise a family in a community she otherwise loves. She’s considering a move to Washington, D.C., Kahn said.

One Human Rights Campaign staffer even encountered a mother who had already left a conservative state to build a better life for her transgender son in the nation’s capital, Kahn said. The staffer was the passenger in a Lyft LYFT, +3.31% the mother was driving to make ends meet after moving from Arkansas.

The Human Rights Campaign connected MarketWatch with that mother, who asked to be identified only by her first name, Zandra, for safety reasons. She told MarketWatch that she’s currently living in an Airbnb after moving out of Little Rock in March with her two kids, a 14-year-old son who identifies as transgender and a 7-year-old daughter. 

‘What right do they have, as a government, to dictate how we parent?’

— Zandra, the parent of a transgender child

Even though Arkansas’ first-in-the-nation law against gender-affirming care for trans youth is not currently in effect due to ongoing litigation, the 31-year-old full-time student and single mom had planned to move out of the state for law school anyway. She made the jump a few months early out of fear that her son would eventually lose access to his testosterone medication, which he only began taking in February. His health provider didn’t know how long she’d be able to keep prescribing it.

“Whatever money I had left over in savings, which was essentially the leftover tax money, I took that and I left,” Zandra said, referring to child-tax credit payments. “I used every dime to get here.”

Zandra said her son attempted to take his life last year. She worried he’d plunge back into a depressive episode if they stayed. A survey from the Trevor Project released in May similarly showed more than half of transgender and nonbinary youth had seriously considered suicide in the past year, though rates of suicide attempts were significantly lower for LGBTQ kids who said they were in an accepting community.

“If you had a child with suicidal ideations and a child who is unhappy with who they are, I, as a parent, would do anything to help them succeed; help them be happy, healthy,” Zandra said. “What right do they have, as a government, to dictate how we parent?”

The trade-off of moving was dropping about $11,000 on travel to D.C. and a short-term rental. The first time she got gas in Virginia after relocating, Zandra said, she cried. And looking for a new place to live hasn’t been easy, either. Her credit score, which she said has been negatively impacted by her not using credit, is below 600. And one promising rental has a security deposit that will be hard to afford.

Running out of time

After Alabama banned gender-affirming care for kids this year, Robert’s doctor immediately wrote him a prescription for six months of testosterone, buying Heather a bit of time, she said. The law had made it a felony for medical providers to offer children that kind of care after a certain date, punishable by up to a decade in prison, though that provision was temporarily blocked by a federal judge last month following a lawsuit.

Heather still sees a ticking clock in the pills. Though she has an appointment with Robert’s doctor scheduled for September, she feels she needs to get her family far away from the state before there’s even a chance that Robert loses his medication. The last time he went without it due to a brief difficulty switching his prescription over state lines, his health rapidly fell apart, she said. He started his period, which led to gender dysphoria, according to the family’s GoFundMe. 

“I was really anxious and depressed and kind of had insomnia and spaced out,” Robert said, adding he was also “a bit paranoid and dehydrated.” 

Robert doesn’t quite know how much it will cost his family to move, just that it’s expensive. He said he has enough pills to give his mother time to save for a down payment on a home. 

That parents are struggling to afford the sort of environment that could help their child’s mental health is part of what’s so concerning, said Logan Casey, a senior policy researcher and adviser at the Movement Advancement Project, a think tank that tracks LGBTQ policies.

“I’m a transgender person, I’m 35, I live in Missouri — a red state where this kind of legislation has been introduced — and I as an adult have more economic security and mental-health support and practices to take care of myself amidst this environment,” Casey said. “Kids don’t have that same kind of support built in. They’re children. They’re inherently more vulnerable.” 

And in some respects, parents and advocates fear those decisions aren’t being taken seriously enough by people in power. 

Congress has so far failed to pass the Equality Act, which would protect people nationwide from discrimination on the basis of sexual orientation and gender identity in housing, employment and other areas, even though Biden has called upon the evenly divided Senate to approve it.

‘If they can bail out all these major corporations, then how about helping us out and helping us get our kids to safety?’

In the past, some Republican senators have argued the proposal’s protections for transgender people would provide a means to discriminate against cisgender women; Sen. Marsha Blackburn of Tennessee said in a March 2021 press release that the Equality Act “insists female athletes compete against biological males, mandates religious schools and hospitals go against their moral principles to conform to an individual’s ‘gender identity,’ and lets men into domestic violence shelters, putting battered women everywhere at risk.”

Heather feels that aside from celebrating Pride Month, Democrats haven’t put enough effort into ensuring that transgender families are safe from the discriminatory laws pushed by their rival party. After all, the states that parents want to move to are Democrat-led, Heather said. So why isn’t there more financial assistance to help families that may want to relocate, either through the expanded child-tax credit that expired in December or other government programs?

“If they can bail out all these major corporations, then how about helping us out and helping us get our kids to safety?” Heather said. 

In Fort Worth, Texas, Gary Barnard is also gravely concerned for his 12-year-old son, who is transgender. The 35-year-old father wants to move himself, his wife and their three kids to Washington state as soon as possible. 

But Barnard’s family wasn’t exactly looking to uproot their lives before Texas began to pursue anti-trans policies. After years of financial struggles, Barnard and his wife are finally stable. They have good-paying jobs at Target TGT, -2.11%, Barnard said. They also live in an income-restricted apartment complex, which helps keep the rent low. Giving that up will be difficult, so they’re raising money on GoFundMe.

If they can’t get the money to move by the end of June, they’ll simply leave their stuff, drive out of Texas, and come back for their furniture once they get their tax refund next year, Barnard said. 

Right now, Barnard’s son isn’t receiving gender-affirming care. It would potentially be safer for him to pursue that in Washington state, should he want to. The pressure is on for Barnard to make that option available. His son recently had a breakdown after seeing his body in the shower, he said, because the gender dysphoria was overwhelming. And that scared Gary. 

“I’ll do anything to keep my family together,” Barnard said. “Whether that means keeping us together and we have custody of our kids and our family is intact, or whether that means I don’t have to bury a kid — I don’t really care what it is.”

The Human Cost is a MarketWatch column looking at the toll economic, political and cultural events have taken on people’s lives.