HRT stands for Hormone Therapy Treatment.
If you remember from one of my previous posts, the transitioning journey for trans may include three major phases, (1) social transition (non-medical such as pronouns, clothing, hairstyle, or voice), (2) hormone therapy (which will be a life-long commitment), and (3) the optional (bottom) surgery (it is not only expensive but also dangerous, sometimes, life-threatening). (Note: bottom surgery can be done on 21+, so, for the moment, it is very much on the back burner and we do not even think much about it, other than struggling with finding the good panties - I may need to start a line of product one day!).
The legal requirements for adolescents to receive HRT vary from state to state since the federal government does not specify anything about hormone therapy or puberty blocker for adolescents, although the Biden administration has done a few things to promote access to health care and to prohibit discrimination in providing health care to the LGBTQA+ community.
(Note: hormone therapy is done at later stage when teens already underwent their puberty years, most significantly, trans girls have already developed deep voices that could not be reverse with HRT; and puberty blocker is done at early stage, typically for pre-teens, so that trans girls do not have to deal with deep voice, among other things such as body hair and odor, wet dreams or erections, and trans boys do not have to deal with enlarged breasts).
Four states, including Arkansas, Texas, Arizona, and Alabama (in that chronological order), have recently in 2021/2022 enacted restrictions on limiting LGBTQA+ youths' access to HRT (gender-affirming health care). Fifteen other states are considering pieces of similar legislation. Some examples are: criminalizing or imposing professional disciplinary action, penalizing parents aiding, permitting individuals to file for damages against providers, and limiting insurance coverage or payment, among many other little things such as "the bathroom bills" or "don't say gay" bill.
Meanwhile, some states have adopted broad non-discrimination health protections based on gender identity and sexual orientation, including:
- Prohibitions on health insurance insurance discrimination based on sexual orientation, or
- Requirements that state Medical programs explicitly cover health services related to gender transition
The implication is that youth access to gender-affirming care boils down to state policies. In our particular case, we are stuck in a conundrum. I just quit a state-employed job in New York, where not only the access is great but the facilities are familiar with tons of youth transitions; I am now working a state-employed job in Texas, where I decided NOT to add my children to a family plan to avoid any legal issue towards me aiding my child (potentially considered child abuse); we are still living in New York where our base home is and we do not have a New York-sponsored medical plan; I decided to have my children added to their father's family plan which is based on a state-employed job in California, and while California is even more open and progressive than New York, my child has to either fly in to get in-state health care, or receive out-of-state health care, which is subject to a different set of rules.
Long story short, we have been very patient (while being somewhat frustrated) with months and months of waiting - waiting to figure out the process, for the next appointment with a doctor (or even a nurse practitioner from Gender Health Services under Adolescent Medicine), for the sorting out of insurance benefits and the upgrading to a better plan that would cover out-of-state health care, and finally, the jigsaw puzzle pieces fall a bit together. We now have three different options (note that there is a fourth):
(1) Kid could fly out to California, especially for the first appointment in-person (COVID allowed for many virtual setups but we are post-COVID now), and hopefully, depending on the physician, they may or may not allow subsequent visits to be done virtually (since the refills should not be a problem).
(2) Kid could receive the treatment from a local prestigious hospital, but the law in New York State would require months of consulting with a therapist (pediatric psychologist, basically) to talk about the emotional struggles, to make sure this is the right decision before getting a letter of support.
(3) Kid could alternatively opt in for a newer approach called the "informed consent model" where we could cut off the months of therapy (where no DNA or blood test is done, just self-reported symptoms) and sign a consent form to acknowledge the potential risks that might come with receiving HRT.
(4) This scares me as a mom. My kid threatens to buy cheap hormone treatments off some dark website if she could not get HRT that she has been craving for. While I don't think HRT is the magic potion that will take her depression away overnight, my heart dropped she might actually do it.
Do some research, consider the so many plans you could possibly have, including flying/ driving to a different state, including alternative health care providers. It is a tough battle and I can't wait to finally have our very first HRT appointment tomorrow (under the "informed consent model").
2023 will be a better year for sure!
Ref: https://journals.sagepub.com/doi/abs/10.1177/0022167817745217?journalCode=jhpa