'It got very bad, very quickly': Families with transgender kids seek refuge in Minnesota

Heather Crawford has second-guessed herself as a mother of Cass, a transgender male.

Could she have been more supportive when her child, born female, came out at 12? Could she have prevented Cass' suicide attempt three months later? Should she hold firm now in delaying the gender-affirming hormone therapy that her 16-year-old wants?

Amid doubts, Crawford is confident in one decision: her family needed to get out of Texas.

The family moved 1,200 miles to St. Paul last summer after Texas took steps to limit pediatric access to gender-affirming care and investigate parents who sought it for transgender children.

"It got very bad, very quickly," she said.

Advocates expect more families to move to Minnesota, which has positioned itself as a refuge while other states have restricted access by transgender people to bathrooms, sports teams and medical care. Minnesota, under its new "shield law," won't support any state's prosecution of parents or doctors providing gender-affirming care for children.

Families aren't going to uproot from 18 states with bans on gender-affirming care to move to states that have yet to take a stance, said Dr. Angela Kade Goepferd, medical director of the gender health program at Children's Minnesota.

"Even if a state is closer and doesn't have a ban, they're probably going to skip to the state that has the shield law," she said.

A Florida dad limited his search to six states with shield laws and job prospects after deciding that his home state had become hostile to his 8-year-old transgender boy.

"The rhetoric started to ramp up and we could envision a time that we needed to move and decided to be proactive," said the father, Daniel, who moved to St. Paul. He spoke on condition that only his first name be published, because his wife and children are finishing the school year in Miami.

Many families have emailed Transforming Families Minnesota, and are no longer posing "what if" scenarios, said Hannah Edwards, the support organization's director: "I've seen those emails go from, 'Can we seek care in Minnesota?' to 'We're moving to Minnesota. Where is a good place to live? Which school districts are safest?'"

Gender-affirming care includes counseling for dysphoria, a feeling of unease in someone whose gender identity differs from their biological sex at birth. Options include medications to suppress puberty and hormones for older teens to promote masculine or feminine features. Only about a half-percent of pediatric transgender patients pursue surgeries, mostly breast reductions.

Recent bans in South Dakota and Iowa have sent some families across the border in search of this care, but some may end up moving, Goepferd said. Minnesota-licensed doctors can't provide care or prescriptions via phone or telemedicine across state lines to those patients.

Politics and a move

Crawford, who called herself a "political refugee," said few people understand the needs of transgender children, making it an easy issue for politicians to exploit.

"If you tell someone who doesn't know any better, 'There are these crazy doctors who want to chop the body parts off of perfectly healthy children,' your initial response to that is going to be, 'Hell no, that's wrong!'" she said. "The reality is that is not how gender-affirming care works."

Crawford didn't understand when her child — who loved sparkly pink and sequin dresses — came out in 2019. Her resistance ended in the emergency room after Cass' suicide attempt. She recalled how her critically ill child reached up from an ER bed and twirled his mother's hair. It was just like when Cass was a baby.

"I had failed them," she said of Cass, who uses they or he pronouns. "I frankly got over myself, did a whole bunch of reading while they were in the hospital and just got on board with recognizing the person that they are."

An estimated 40% of transgender children have attempted suicide, which is one reason the American Academy of Pediatrics and the American Medical Association endorse gender-affirming care.

Children's Minnesota doesn't offer medical treatments until puberty, and then phases in options at appropriate developmental stages.

"We've allowed children to be themselves and seen the impact on their mental health, on their survival and the quality of their lives into adulthood," said Ian Wolfe, a Children's clinical ethicist, who considers state bans unethical.

The Crawfords allowed Cass to take medications at 13 to suppress menstrual cycles. That put them at risk in 2022 when Texas Gov. Greg Abbott ordered child-welfare investigations of parents who obtained gender-affirming care for children.

Even as they spoke out publicly, the Crawfords privately started planning a move before Texas banned gender-affirming care outright. The mother found a paralegal job in Minnesota while the father commutes to a job in Texas.

"We left behind our entire lives," Crawford said.

A shift in attitudes

Daniel, the Florida transplant, said attitudes shifted quickly last year, around the time that Florida Gov. Ron DeSantis rejected a transgender female's victory in the NCAA swimming championships and promoted the cisgender runner-up from his state.

One of Daniel's twins, assigned female at birth, said at age 7 last year that he felt "like a boy on the inside." A short haircut and chance to wear a boy's shirt and tie brought a content smile to the child's face.

Smiles seemed forced in earlier family photographs, Daniel said, "but when you look back at that picture, that was the first genuine smile."

Teachers and parents at their grade school were supportive, even pushing back on one critic who emerged on a group chat, Daniel said. Then last fall's election swept in board members who removed the district's inclusive policies. The child never experienced discrimination, but the parents didn't want to wait for it.

"We're trying to keep it that way," Daniel said, "so he has the childhood he deserves."

Daniel's specialized work as a hospital chaplain limited job prospects, and he felt lucky to find one in a state with a shield law.

"We were able to make a plan and have it largely work," he said. "There are people who are leaving with a lot less certainty."

Parents said the moves are costly and disruptive for their children — and that even refuge states present challenges.

Minnesota's partisan divide was reflected in the narrow legislative votes in favor of the shield law. Rep. Peggy Scott, R-Andover, criticized the bill before its passage for offering too many protections for "children, regardless of age, to seek and receive radical medical treatments."

Minnesota's transgender population matches national estimates; around 1% to 2% of high school juniors in the state identified themselves as transgender, according to student surveys in 2019 and 2022.

Adjusting to a new life

Cass didn't encounter hostility at their new St. Paul high school, but felt watched and found it tough to break into existing social circles. They returned home to online classes.

Cass has wanted to take testosterone to reduce dysphoria and gain a deeper voice. Heather Crawford won't OK the treatment until Cass is 18 because hormones could exacerbate cancer risks that run in the family. She allowed Cass at 16 to pursue a surgery to reduce breast tissue, but step one is getting through the 13-month wait list for an initial visit to the Children's clinic.

"It is possible they will turn 18 before we can get the surgery," the mother said.

Cass has a love-hate relationship with Texas — planning to work as a lifeguard at a camp in the state this summer, but testifying at a state public hearing last month about the damage and loneliness the Texas policies caused.

"I want friends in Minnesota. I want to like Minnesota," Cass testified. "It's a beautiful state that does a lot to protect trans children. But I cannot forget what Texas did to me."