When Bug got home from school one winter afternoon in late 2024, his mother was on the couch, watching 30 Rock re-runs. Bug sat down next to her; he had an announcement to make.
Bug, who was assigned female at birth, told his mother he was a boy — and would be using he/him pronouns.
"OK, cool," his mother, J, remembers saying. Bug, who was in sixth grade at the time, had previously come out as non-binary, but this felt like an even bigger step.
"We started talking about, like, 'What are you wanting to have happen? What do you need to be supported?'" J said. "And he asked to get health care."
Bug is a nickname, and his mother asked NPR to identify Bug that way, and identify her by her first initial, J, because the family fears harassment.
This was the kind of moment J had been anticipating for a while. She felt immensely grateful that the family had left Texas in 2024, and resettled in western Massachusetts, a state with laws that she felt were more supportive of bodily autonomy, and a culture more welcoming of diverse lifestyles.
She felt confident she would be able to steer Bug to the right medical experts who could provide the appropriate care.
But it didn't turn out to be that easy. What Bug's family didn't anticipate – and what many similar families in blue states have discovered – is that access to gender-affirming treatment can disappear even when their state's laws and leaders are supportive. That's because individual hospitals all over the U.S., in both red and blue states, have responded to President Trump's attacks on transgender health care by deciding to withdraw care on their own.
'I needed to get the kids out of Texas'
Bug and his younger sister were born in Austin. As their children grew, J and her husband were becoming increasingly worried as they watched Texas politicians shift further and further to the right — outlawing abortion, dismantling DEI programs, and limiting medical rights for transgender people.
"I had a fear of being like the frog in the boiling water and not realizing what was happening until it was too late," J said.
"It was kind of just a gut sense that I needed to get the kids out of Texas," J said. "I could see the way things were going."
After the school shooting in Uvalde, Texas, the idea took on even more urgency. They got permission from their employers to work remotely. They called a Massachusetts realtor and bought an old farmhouse in the Berkshires, sight unseen. By fall of 2024, the kids were enrolled at a nearby private school.
So when Bug came out as trans, J was relieved that they had landed in a state willing to stand up to the administration's hostility to gender-affirming care. 27 states have passed laws banning such care for minors.
In Massachusetts, the attorney general had already announced support for gender-affirming care. In 2022, Massachusetts passed what's known as a "shield" law to protect doctors and nurses who offer gender-affirming care and abortion-related care.
In 2025, state legislators strengthened that law by adding additional protections. In addition, Massachusetts law also requires commercial insurance, which Bug's family has, to cover gender-affirming care.
'I didn't think this would happen in Massachusetts'
Bug, now 14, is an artistic, opinionated teenager who wears his hair half-shaven. He loves horses and cats, makes short films with friends, and spends many hours drawing characters in his journal based on the illustrated book series, Warrior Cats.
After Bug's gender announcement, J's queries led her to Baystate Health in Springfield, Mass., the largest hospital system in the region. Baystate offered counseling for gender non-conforming youth, and the endocrinology department had experience in prescribing hormone therapy.
Bug was too old for puberty blockers, but he was excited about the prospect of starting testosterone. That would cause his voice to deepen, facial hair to grow, and muscles to get bigger. "Every part of it sounds fun," he said.
During the last months of 2025, Bug met with doctors and prepared to start hormone therapy.
The family already knew that just days after his inauguration in January, President Trump had signed an executive order against gender-affirming care for youth. Then, on Dec. 18, 2025 the administration announced a policy barring that care for youth, claiming it was damaging and vowing to investigate hospitals that provide it.
But several states — including Massachusetts — challenged the policy in court. So they figured Bug's treatment would continue.
A threat to hospitals that rely on Medicaid and Medicare
When this February rolled around, Bug was ready to take testosterone. But two weeks before the scheduled start date, Baystate announced it would no longer provide gender-affirming medications to minors, offering only counseling. A letter to patients' families did not explain why.
"All of a sudden it just felt like the floor had fallen out. Like all the support that I thought we had was gone," J said. "Maybe this is naive, but I didn't think that would happen in Massachusetts, and certainly not preemptively."
Unlike in Texas, their friends, neighbors, and even teachers seemed to fully accept Bug's gender change. Bug met other transgender kids whose families had fled conservative states where they didn't feel safe. "So I really had no idea that we were that close to just giving in," J said.
Baystate declined an interview with NPR but the hospital's media representative Heather Duggan sent a statement. It said the decision to end treatment for minors reflected the fact that "hundreds of millions of dollars in government reimbursement" that Baystate could lose as a result of the Trump administration's proposed policy.
"Nearly 70 percent of Baystate Health's patients rely on Medicaid and Medicare for coverage," the hospital statement said.
In March, in the lawsuit that Massachusetts had joined, a judge ruled against Trump's policy, although the administration could appeal.
But Baystate's decision has stuck.
Nationally, the chilling effect is clear. Dozens of hospitals have closed their youth gender programs pre-emptively, including in blue states like California, Illinois and New York.
The American Academy of Pediatrics — which has come out in favor of gender-affirming treatment for minors — declined NPR's request for an interview. The group's media representative said every pediatrician she approached was too scared of retaliation to comment publicly on the hospital closures.
'It's a scary time to be 14 and trans'
Patients' families, however, are not staying quiet. After Baystate's decision, some of the parents filed civil rights complaints with the Massachusetts Attorney General. (The Attorney General's office did not respond to NPR's request for comment.)
Bug himself took it hard.
"I felt frustrated that they would do that," he said. "I bet there's tons and tons of kids who are like, 'Okay, I'm going for trans affirming healthcare. Yay!' And then we're like, 'no, never mind.' And then like tons and tons of kids were disappointed and sad and frustrated."
For some parents, the disappointment comes with fear. One mother of a former Baystate patient said that before her child came out as a transgender girl, she had been severely depressed, battling suicidal thoughts. (NPR agreed to use the mother's first initial "L" because she also fears harassment.)
"I was hopeful that once we kind of found the right path for her, that things might start to turn around," L said, "and that's exactly what happened."
L said she's generally conservative with medical intervention. She felt her daughter, at 13, was too young for gender-related surgery, which is extremely rare among minors.
But Baystate doctors told her that hormone therapy was appropriate and safe. After they prescribed puberty blockers and estrogen, her daughter's mood and grades rose markedly, L said.
So when L got the letter announcing Baystate was suddenly ending the medical treatment, she was furious. She thought Baystate should have taken a "wait and see approach" with the Trump policy.
"There's a sense of 'how could you?'" she said. "And there's also the awareness of the impact just pulling care could have on a youth — from a physical health perspective, but also from a mental health perspective."
At the time L spoke to NPR, she still hadn't told her daughter about Baystate ending care, because she was worried that would send her back into depression.
"It's a scary time to be 14 and trans right now," L said, "so ultimately I will have to explain to her what happened, and do a lot of reassuring."
Families forced to find other options
Young trans patients in western Massachusetts do have other options, at least for now. L asked the family's primary care doctor to take over hormone prescriptions. Bug's family was referred to TransHealth, a private specialty clinic in Northampton.
"TransHealth has been staffing ourselves up for a while now in anticipation of the fact that this may be happening across the state," said CEO Jo Erwin.
The clinic expects to absorb more than 200 former Baystate patients, in addition to a few dozen that came previously from Boston's Fenway Health clinic, which also ended hormone therapy for trans youth.
Erwin said TransHealth can weather the funding threats because the clinic gets large private donations, and is not as dependent on Medicaid and Medicare as most hospitals.
"It's a horrible position to be put in by the federal government," Erwin said. "And I'm just fortunate that TransHealth has not had to face that choice."
But she said that doesn't entirely reassure the broader LGBTQ community, including transgender adults.
"When you see something like that go down," Erwin said, "people get scared that it's ultimately going to happen to everyone."
After Bug's false start at Baystate, he is excited to start taking testosterone at the new clinic. But his mother is nervous the federal government will find other ways to stop his treatment again.
"Now we're dependent on privately-funded places and that doesn't feel like very firm ground to be standing on," she said.
She sometimes second-guesses the family's move from Texas to Massachusetts, wondering if they should have kept going north, to Canada instead.
This story comes from NPR's health reporting partnership with New England Public Media and KFF Health News.
Copyright 2026 88.5 NEPM
