Sabrina Jennen’s family has deep roots in Arkansas, but she said moving to Maryland three years ago brought them a sense of safety they didn’t have in the Natural State.

The Jennens were one of  who sued Arkansas in 2021 over its law banning gender-affirming healthcare, such as hormone replacement therapy, for transgender youth like Sabrina, now 20.

Both  and , where Sabrina attends college, have shield laws protecting gender-affirming healthcare. She and her family have also found that states with more accepting LGBTQ+ policies have stronger foundations in other areas, such as education.

“When I talk about my home state of Arkansas with my peers, I really hype up the natural geography, but I make sure to disparage the politics because it truly is a limiting factor, not only for people like me, but also just normal Arkansans,” Sabrina said in an interview.

The Jennens’ choice to leave Arkansas wasn’t unique. The growing number of Republican-led states imposing restrictions on transgender youth — and sometimes adults — on matters ranging from pronouns to medical decisions have forced families to make difficult choices. Some are choosing to stay, but many have looked to other states.

State and national trends

Nearly half of transgender adults in the United States have moved or considered moving from states with laws targeting them to states with safer legal and social environments, according to a  last year from the Williams Institute, a research center on gender identity and sexual orientation at the UCLA College of Law.

“For those transgender people who do pursue relocating, service providers, businesses, and state and local governments should both consider the costs of losing members of their communities and support and welcome those who are making new homes,” the Williams Institute states.

A federal judge  Arkansas’ ban on transgender minors’ healthcare in 2023, around the same time the Jennens moved. Another family that challenged the law, the Dennises, also  where Brooke Dennis, 14, faces no legal barriers to her healthcare.

The U.S. Supreme Court  Tennessee’s similar ban last year, and an appeals court responded by allowing Arkansas’ ban . The federal government has since  from providing transgender minors’ healthcare as a condition of participating in Medicare and Medicaid programs. 

The bans on gender-affirming care have been opposed by most major medical organizations, including the . 

Healthcare for transgender adults has also become more difficult to access thanks to sweeping federal orders.

However, some transgender Arkansans prefer to stay or don’t have the means to leave the state.

Yara Sandefur and one of her four children are transgender. Leaving isn’t financially feasible for their family, but staying can be frustrating due to Arkansas’ conservative leadership and the professional obstacles that arose for Sandefur after she came out, she said.

“I just want to be able to breathe like normal folk,” she said.

‘The fight is here’

Tien Estell grew up in Arkansas and works for the state’s only transgender-owned community center, Intransitive. Estell’s work includes helping LGBTQ+ people obtain health insurance.

Estell’s work and their family, both biological and chosen, would be difficult to replicate in another state, they said.

“My heart is with my people, and the fight is here,” Estell said. “The fight is in the South.”

That fight comes forth in elected officials’ statements in addition to the legislation they approve. Gov. Sarah Huckabee Sanders declared June in Arkansas “.” Other Republican-led states such as  and  made similar declarations as a counter to LGBTQ+ Pride Month.

Additionally, President Donald Trump’s administration released  in May that calls for “the rapid identification and neutralization of violent secular political groups,” including those considered “radically pro-transgender.”

“What does it look like to move from one pocket of hatred, one pocket of erasure, to move somewhere else in this country where we still have a president who thinks I’m a terrorist?” Estell said.

‘Continuity of care’

Arkansas “has always felt like home” to Marie Mainard O’Connell, a Presbyterian pastor and mother of three, including a transgender 18-year-old who attends college in-state. When lawmakers propose bills targeting LGBTQ+ people, O’Connell routinely speaks against them.

“As I see the Legislature dog-whistling to try and distract from the real issues that are facing Arkansans, it seems all the more important to stand up for our humanity,” O’Connell said.

She is a founding member of the Central Arkansas Queer Collective, which provides support and social events for LGBTQ+ people and families. O’Connell said her own family considers Arkansas worth staying and fighting for, but it’s been “painful to lose good people to other places, simply because they need something Arkansas won’t give them.”

Shea McGinnis is among those people. His transgender 11-year-old was receiving gender-affirming healthcare in Oregon for over a year before the family moved there in May.

“We had the opportunity to keep that continuity of care for our kid and go to a place where we knew we would be protected and safe and be able to thrive,” McGinnis said.

He also said he has more peace of mind about his own healthcare, since the Trump administration  discouraging gender-affirming care for trans adults. Arkansas is  with a law allowing private insurers to refuse to cover gender-affirming care.

When Arkansas became the first Southern state to expand Medicaid under the Affordable Care Act in 2013, Estell was part of a team assisting LGBTQ+ people with enrollment. Over a decade later, Estell is among many Americans whose insurance premiums spiked this year because Congress did not extend  by the end of 2025.

“Moving to another state doesn’t solve my lack of access to healthcare,” Estell said.

‘Moving parts’

Whether to stay in Arkansas or leave is a decision with “a lot of moving parts” for O’Connell’s family, and the most important thing for them at the moment is to stay with the people they love in their home state, she said.

“Right now, staying with our friends, family, loved ones and community is outweighing the other variables, and I recognize that that’s going to be different for every family,” O’Connell said.

Dozens of Arkansans — including O’Connell, McGinnis, and Sabrina’s father, Aaron Jennen — pressured lawmakers into  a 2023 proposal that would have criminalized adults entering a restroom that doesn’t match their gender assigned at birth. The state passed a law  last year, drawing more public frustration. O’Connell told lawmakers it was “not good for our community, and it’s not good Christian values.”

What gives O’Connell hope for LGBTQ+ people’s future in Arkansas, she said, is her belief “in the resilience of human nature.”

“People, and Arkansans in particular, are fundamentally kind and want to be kind to each other,” she said.

Sandefur said she and her family lost some of their support system when she came out, but what remains of that system is in Arkansas.

“It’s my state too, and it’s my home too, and I should feel welcome here,” she said. “Part of me wants to stay and fight and part of me wants to flee, so I’m caught in the middle, but right now, it makes sense to stay and hope for the best.”

is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Arkansas Advocate maintains editorial independence. Contact Editor Andrew DeMillo for questions: info@arkansasadvocate.com.

The U.S. Supreme Court, in a potential landmark decision, upheld Tennessee’s law prohibiting gender affirming care for minors, saying children who seek the treatment don’t qualify as a protected class.

In United States v. Skrmetti, the high court overturning a lower court’s finding that the restrictions violate the constitutional rights of children seeking puberty blockers and hormones to treat gender dysphoria. The U.S. Court of Appeals overturned the district court’s decision and sent it to the high court.

The court’s three liberal justices dissented, writing that the court had abandoned transgender children and their families to “political whims.”

Tennessee lawmakers passed the legislation in 2023, leading to a lawsuit argued before the Supreme Court last December. The federal government, under the Biden administration, took up the case for the American Civil Liberties Union, Lambda Legal and three transgender teens, their families and a Memphis doctor who challenged the law, but the U.S. Department of Justice under President Donald Trump dropped its opposition.

In its ruling, the court said that the plaintiffs argued that Senate Bill 1 “warrants heightened scrutiny because it relies on sex-based classifications.” But the court found that neither of the classifications considered, those based on age and medical use, are determined on sex.

“Rather, SB1 prohibits healthcare providers from administering puberty blockers or hormones to minors for certain medical uses, regardless of a minor’s sex,” the ruling states.

The ruling says the application of the law “does not turn on sex,” either, because it doesn’t prohibit certain medical treatments for minors of one sex while allowing it for minors of the opposite sex.

The House Republican Caucus issued a statement saying, “This is a proud day for the Volunteer State and for all who believe in protecting the innocence and well-being of America’s children. Tennessee House Republicans are pleased by the court’s courage to stand firm against ideology that denies biological reality. The sterilization and disfigurement of children will no longer be normalized. As we celebrate the precedent set by this decision, we remain committed to leading the nation in safeguarding the health, safety and future of all children.”

Senate Majority Leader Jack Johnson, who sponsored the bill, said he is grateful the court ruled that states hold the authority to protect children from “irreversible medical procedures.”

“The simple message the Supreme Court has sent the world is ‘enough is enough,’” Johnson said in a statement.

The Tennessee Equality Project, an LGBTQ advocacy group, expressed dismay at the decision: “We are profoundly disappointed by the U.S. Supreme Court’s decision to side with the Tennessee legislature’s anti-transgender ideology and further erode the rights of transgender children and their families and doctors. We are grateful to the plaintiffs, families, and the ACLU for fighting on behalf of more than across the nation.”

The group said gender-affirming care saves lives and is supported by medical groups such as the American Academy of Pediatrics and the American Medical Association.

The court also rejected plaintiffs’ argument that the law enforces “a government preference that people conform to expectations about their sex.” 

The court found that laws that classify people on the basis of sex require closer scrutiny if they involve “impermissible stereotypes.” But if the law’s classifications aren’t covertly or overtly based on sex, heightened review by the court isn’t required unless the law is motivated by “invidious discriminatory purpose.”

“And regardless, the statutory findings on which SB1 is premised do not themselves evince sex-based stereotyping,” the ruling says.

is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Tennessee Lookout maintains editorial independence. Contact Editor Holly McCall for questions: info@tennesseelookout.com.

was originally reported by Orion Rummler of . .

On Thursday, the Department of Health and Human Services (HHS) published a of research on gender-affirming care for transgender youth, as directed by President Donald Trump. The agency used the release of the report to that available science does not support providing gender-affirming care to trans youth. LGBTQ+ advocacy groups worry the report will be used to further restrict gender-affirming care and to change medical guidelines in ways that harm trans youth.

The president mandated the report in an condemning the medical treatment — without evidence — as a form of mutilation, amid a broader push by the administration to from public life. Trump’s order asked the health agency to review the “best practices for promoting the health of children who assert gender dysphoria,” while to halt treatment or lose federal funding.

Now, the HHS has produced that report. The agency combed through research on the outcomes of puberty blockers, hormone replacement therapy, social transition, psychotherapy, and the rare cases of surgeries on adolescents and young adults diagnosed with gender dysphoria. 

Gender dysphoria, the reason that most trans people undergo , is a strong and persistent distress felt when one’s body is out of sync with their gender identity. Without treatment, gender dysphoria can lead to severe negative impacts in day-to-day life. 

The agency states in its of the report that the document is not meant to provide clinical practice guidelines or issue legislative or policy recommendations. However, the report does imply that health care providers should refuse to offer gender-affirming care to adolescents and young adults on the basis that such care comes with the potential for risk — despite little evidence for that risk actually being found in the report. 

“The evidence for benefit of pediatric medical transition is very uncertain, while the evidence for harm is less uncertain,” the executive summary states. “When medical interventions pose unnecessary, disproportionate risks of harm, healthcare providers should refuse to offer them even when they are preferred, requested, or demanded by patients.”

In its research review, the HHS determined that evidence measuring the effects of gender-affirming care on psychological outcomes, quality of life, regret and long-term health is of “very low” quality. This conclusion ignores decades of research, as well as a recent survey of in the United States that found an overwhelming majority report more life satisfaction after having transitioned. Access to gender-affirming care has been linked to and depression in trans youth, while gender-affirming surgeries have been found to for adults.

Even when analyzing research that the administration deemed low-bias, the HHS found “sparse” to no evidence of harm from gender-affirming care. What’s more, the report frequently found evidence demonstrating the benefits of gender-affirming care — though it ultimately downplays those findings as not significant. 

Available research on puberty blockers found high satisfaction ratings and low rates of regret. A systematic review of hormone replacement therapy described improved gender dysphoria and body satisfaction. Another found that hormone treatment leads to improved mental health. Two before-and-after studies reported reduced treatment needs or lower levels of suicidality and self-harm after hormone treatment. When measuring safety outcomes of hormone treatment, side effects did not have a major impact on treatment and complications were limited. 

Despite these findings, the Department of Health and Human Services advertised the report in a Thursday as one that “highlights a growing body of evidence pointing to significant risks” of gender-affirming care. At the White House briefing room Thursday, deputy chief of staff for policy Stephen Miller touted the new report and attributed the idea of being transgender as part of a “cancerous communist woke culture” that is “destroying this country.” 

There are side effects to many of the medications that transgender people — and cisgender people — take to receive gender-affirming care, as is the case with most medical treatments. These side effects, like the risk of decreased bone density when taking puberty blockers, are and communicated to patients.

LGBTQ+ advocacy organizations denounced the report as a political attack on transgender youth. Multiple groups said that the report’s endorsement of psychotherapy as a “noninvasive alternative” to puberty blockers and hormone treatment amounts to an endorsement of conversion therapy — a practice wherein mental health professionals try to change a youth’s sexual orientation or gender identity.

“It is already clear that this report is a willful distortion of the evidence intended to stoke fear about a field of safe and effective medicine that has existed for decades, in order to justify dangerous practices which amount to conversion therapy,” said Sinead Murano Kinney, health policy analyst at Advocates for Trans Equality. 

The Human Rights Campaign, the country’s largest LGBTQ+ rights organization, accused the HHS of producing a report that is attempting to lay the groundwork to replace medical care for trans and nonbinary people with conversion therapy. 

“Trans people are who we are. We’re born this way. And we deserve to live our best lives and have a fair shot and equal opportunity at living a good life,” said Jay Brown, chief of staff at the Human Rights Campaign. “This report … lays the groundwork to push parents and doctors aside and allow politicians to subject our kids to the debunked practice of conversion therapy.” 

No authors or contributors are named in the report or in its executive summary. The agency says these names are being initially withheld to “maintain the integrity of this process,” and states that chapters of the document were subject to peer review.