"E" still remembers the day when her daughter said she was transgender.
“Very benign, sitting and brushing teeth early in the morning. They were four years old and said, ‘Oh, I’m not who you thought I was. I’m actually a girl.’”
We’re using E’s middle initial because she worries about harassment and violence against her family. E’s child has consistently presented as female.
“She’s happy and doing well, and looking forward to continuing that journey," E says.
E’s daughter is about a year away from puberty. The plan was to go on puberty blockers and eventually hormone replacement therapy at Community Medical Center in Missoula.
Major medical associations say that’s appropriate care for youth gender dysphoria. But in June, the hospital closed its gender clinic to minors. It was a big blow for E’s daughter.
“To her, it just wasn’t even a thought that it wouldn’t happen," E says. "So she was like, ‘no, I’m a girl, so when I go through puberty, I’m going through girl puberty.’”
The Trump administration calls gender affirming care harmful, and says it needs to protect children from irreversible harm. Surgery on minors for gender dysphoria is very rare.
This year, Montana’s Supreme Court permanently protected gender care for minors.
Community Medical said in a statement that the regulatory and legislative environment is changing too fast for them to continue offering gender care. Hospital officials declined an interview request.
E says that she was told the nearest option for her daughter is a seven hour drive to Seattle Children's Hospital. She doesn't know if she can afford that trip.
“And it’s just heartbreaking,” she says.
At least two clinics in Montana say they offer the type of care her daughter wants, but E hadn’t heard about that.
Community is one of several hospitals around the country to stop offering treatments like puberty blockers or hormone therapy to kids.
The Trump administration has sent letters and has subpoenaed hospitals for data on gender affirming care. The administration has threatened to prosecute providers under laws against genital mutilation. The FBI is also soliciting tips for doctors providing gender affirming care.
Lindsey Dawson with the nonpartisan health policy research group KFF says hospitals across the country are dropping gender care for minors because of that pressure campaign.
“This includes in both red and blue states and purple states as well," Dawson says. "There have been reports in California, Colorado, Pennsylvania, Montana now.”
Kathryn Brogan is an adolescent psychiatrist that works with trans youth in Montana. She says there will be ramifications for families who struggle to find care.
“Realistically, an increased risk of suicide, an increased risk of every kind of mental health comorbidity,” Brogan says.
Transgender youth are four times more likely to attempt suicide.
The Montana Chapter of the American Academy of Pediatrics says parents should talk to their provider about finding care in the state.
But Brogan is also hearing from parents worried about their legal risk.
“They wonder, is my kid going to end up on a list that’s going to be used against them in the future; Or will I be, as a parent, held responsible for some sort of abuse allegation in the future,” Brogan says.
Montana families feel betrayed by hospital administrators who end gender affirming care for minors, despite it still being legal.
Liz, is 18 and transgender in Missoula. Community Medical Center ended gender care for those under 19.
“I feel it’s their job as health care providers, is to stand up to this and to say, 'this is care that saves lives,' which they didn’t do,” she says.
Liz fears for her safety so we’re only using her first name and having someone else read her quotes.
Liz also hadn’t heard about local clinics that could continue her hormone treatment. She plans to drive to Seattle Children’s for now because she has an established relationship with a provider.
Still she worries about access.
“They’re going to see even more of an influx of patients. And can they take that many people? How far out does their wait list become,” she wonders.
Seattle Children’s didn’t respond to an interview request about its plans to continue serving transgender kids.
Liz worries it could be the next hospital to stop offering this care.
