On a recent afternoon, a teenager nicknamed Bug came home from his middle school in the Berkshires and started to play with a new iPad he got for his 14th birthday.
“It's supposed to have a newer processing chip, so it'll go faster for stuff,” he explained.
Soon he turned to doodling. He’s creating a fantasy world based on the book series called "Warrior Cats."
“This is my character, Calix,” he pointed out while leafing through his drawings.
Bug keeps his hair spiky and half-shaven. To get comfortable, Bug took off his binder, a piece of clothing he wears at school to keep his chest flat.
In other words, his adolescence is sometimes fairly typical, And sometimes it’s at the center of a political maelstrom.
Last summer, Bug, who was assigned female at birth, told his parents he was a boy.
(NEPM agreed not to identify Bug and his family because they fear harassment.)
“I just came out because I wanted to,” he said. “It started feeling weird being referred to as she/her and my old name.”
His mother, whom we’re calling her by her first initial J, asked Bug how he wanted to proceed.
“Like, ‘what do you need to be supported?’” J said. “And he asked to get health care. So I asked around.”
“I didn't think that would happen in Massachusetts”
The previous year, J and her husband had moved the family from Texas to Massachusetts. J said Bug and his sister are autistic, and she assumed they would have better access to health care and social services in Massachusetts than in the south.
To move quickly, they bought an old house in the Berkshires without even visiting.
“I had a fear of being like the frog in the boiling water and not realizing what was happening until it was too late,” she said.
Once Bug came out, J wanted to make sure they approached his transition safely. They got an appointment with an endocrinologist at Baystate Health, a hospital in Springfield that prescribed puberty blockers and hormonal treatment for transgender children. Bug was excited about starting on Testosterone, often called T.
“I really wanted to get on T,” Bug recalled. “Like my voice is changing. ‘Oh my God.!’ Like every part of it sounds fun. Except for I recently learned that they give it to you via shots. So that was scary a little bit.”
The family was aware the Trump administration planned to strip Medicaid and Medicare funding from any hospital providing gender-affirming care to minors. But several states, including Massachusetts, challenged that policy in court. Plus Massachusetts has a shield law meant to protect providers of this care.
But in February, Baystate announced it would stop gender-affirming treatment for children, offering only counseling. A letter they sent to families didn’t explain why.
J was shocked.
“Maybe this is naive, but I didn't think that would happen in Massachusetts,” J said. “And certainly not preemptively.”
J thought Baystate should have hung in there until the court challenges ran their course. In fact, in March a judge did rule against Trump’s policy.
Baystate declined an interview but the media representative sent a statement saying the decision to end treatment reflected “hundreds of millions of dollars in government reimbursement" that they could lose as a result of the Trump administration's proposed policy. "Nearly 70 percent of Baystate Health’s patients rely on Medicaid and Medicare for coverage,” the statement said.
“Kids were disappointed and sad and frustrated”
Meanwhile, J was confused by what she saw as a political disconnect in the region.
“We did find so much support here,” she said. “There are summer camps geared towards queer kids. “[Bug has] met so many people who are just like him and other people who also moved away from states that they didn't feel safe in. So I really had no idea that we were that close to just giving in.”
It’s not just hospitals that are scared. The American Academy of Pediatrics - which has come out in favor of gender affirming treatment for minors and against the Trump policy, would not provide NEPM an interview. The group’s media representative said every pediatrician she approached was too scared of retaliation.
“Maybe this is naive, but I didn't think that would happen in Massachusetts,” J said. “And certainly not preemptively.”
After Baystate’s decision, some parents filed civil rights complaints with the Massachusetts Attorney General. (The AG's office did not return NEPM emails.)
Bug himself took it hard.
“I felt frustrated that they would do that,” he said. “I bet there's tons and tons of kids who are like, ‘Okay, I'm going for trans affirming healthcare. Yay!’ And then we’re like, ‘no, never mind.’ And then like tons and tons of kids were disappointed and sad and frustrated.”
Some families are more than disappointed; they’re scared. One mother in Hampden County said her child had suicidal thoughts before she came out as a trans girl and started seeing a Baystate endocrinologist. (NEPM agreed to use her first initial L because she also fears harassment.)
“I was hopeful that once we kind of found the right path for her, that things might start to turn around,” L said. “And that's exactly what happened.”
L said she is generally conservative about medical intervention. She felt her 14-year-old daughter was too young to consider gender-related surgery, which is very rare among minors. But medical research shows most standard hormone treatment is reversible. So last summer, they moved forward with puberty blockers and estrogen.
“Her grades started going up. She's on the honor roll,” L said. “She's really, I would say, thriving compared to where she was before she started receiving this care.”
“There's a sense of ‘how could you?’”
So when they got Baystate’s letter ending treatment, L was furious, and terrified her daughter would head back into depression.
“There's a sense of ‘how could you?’” she said. “And there's also the awareness of the impact just pulling care could have on a youth – from a physical health perspective, but also from a mental health perspective.”
Like J, she felt Baystate caved to the Trump administration policy too soon.
“Why would you ... preemptively cause harm instead of having a wait and see approach?”
Baystate did not respond to NEPM’s question on whether the recent court ruling against the federal policy will impact the hospital’s decision.
“People get scared it’s … going to happen to everyone”
Trans patients in western Mass do have other options, at least for now. L has asked the family’s primary care doctor to take over hormone prescriptions. And Bug’s family was referred to TransHealth, a specialized clinic in Northampton.
“TransHealth has been staffing ourselves up for a while now in anticipation of the fact that this may be happening across the state,” said CEO Jo Erwin.
The clinic expects to absorb more than 200 former Baystate patients, in addition to a few dozen that came previously from Boston’s Fenway clinic, which also ended hormone therapy for trans youth.
Erwin said TransHealth can weather the funding threats because the clinic gets large private donations and is not dependent on Medicaid and Medicare.
She said she understands why other providers have stopped gender-affirming care for youth.
“It's a horrible position to be put in by the federal government," Erwin said. "And I'm just fortunate that that TransHealth has not had to face that choice.”
But that doesn’t entirely reassure the broader LGBTQ community, including transgender adults.
“When you see something like that go down,” Erwin said, “people get scared that it's ultimately going to happen to everyone.”
Bug’s mother J does worry about continuing Bug’s treatment in case the government finds a way to stop it again.
She sometimes second-guesses their move from Texas to Massachusetts, wondering if they should have gone to Canada instead.