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. *snip* 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.

*snip*

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.