Editor's note: This story was originally published in the Richmond Capital News Service.
CHARLOTTESVILLE – When 15-year-old Micah Stafford first received gender-affirming treatment, she said she felt a great deal of relief.
Micah said she knew that she was transgender when she was 3 or 4 years old. Since then, she has used puberty blockers and estrogen as part of her treatment, which she said gave her support and uplifted her mental health.
Beth and Micah Stafford.
“She came out of her shell then and really saw a huge improvement in her mental health and wellbeing,” said Beth Stafford, Micah’s mother.
But for Micah, who is from Charlottesville, and other transgender youth across the country, access to medication and surgery-based care is now at risk.
After an executive order signed by President Donald Trump barred medical institutions that receive public funds from providing gender-affirming surgeries or medication to youth under 19, hospitals have been grappling with how to comply.
On Feb. 13, a federal judge blocked the executive order, sowing confusion among providers and inciting jumbled responses from healthcare systems across Virginia.
Initially, institutions such as the University of Virginia Health and Virginia Commonwealth University Health systems suspended gender-affirming surgeries and medication for youth as outlined in the executive order.
According to the Association of American Medical Colleges the term gender-affirming care includes a range of services like “psychological, behavioral and medical ‘designed to support and affirm an individual’s gender identity.’”
For transgender youth, common interventions impacted by the executive order are puberty blockers, which patients take to prevent the onset of male or female puberty and hormone therapy, by taking testosterone or estrogen to align the patient’s sexual development with their gender identity, according to the AAMC.
Surgeries are rarely provided to youth patients in the U.S., according to a study from the Harvard T.H. Chan School of Public Health
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The executive order caused families like Micah’s, who originally received such care at UVA Health system, to change providers. Beth Stafford said this was for the sake of “continuity of care.”
“We had the best care team,” Beth Stafford said. “Our doctors are fabulous.”
After the judge’s order, UVA Health announced it would resume care to youth on Feb. 13. On Friday, Feb. 21, the UVA Board of Visitors approved a resolution to treat current UVA Health patients “in a manner consistent and compliant with existing law.”
The resolution also supported doctors referring current patients to “alternative private providers” who are less susceptible to legal and funding challenges faced by the university on this issue.
According to the resolution, new UVA Health patients under 19 seeking gender-affirming surgical or medication-based care should be referred to private healthcare providers until further notice.
Unlike UVA Health, hospitals such as Norfolk-based Children’s Hospital of The King’s Daughters and Richmond-based Virginia Health both initially kept their stances not to provide the gender-affirming treatment outlined in Trump’s executive order, despite the second order blocking it.
On Tuesday, Feb. 25, VCU Health released an update adopting a similar policy to that of UVA Health. The VCU health system will resume gender-affirming medication for existing patients and transfer their care to non-VCU providers “as soon as feasible.” New patients would receive “education, counseling and mental health services,” according to the statement.
VCU opted to continue its suspension of gender-affirming surgeries for youth.
CHKD first released a statement about Trump’s executive order on Feb. 3.
“I promise to remain vigilant in monitoring guidance related to this Executive Order and will make sure everyone is prepared to adapt rapidly if the situation changes,” wrote Amy Sampson, president of the CHKD Health system, in a letter to families after Trump’s executive order.
As of Thursday, Feb. 27, the CHKD health system posted a statement to their website on gender-related care that it is in communication with affected families.
“[CHKD] will provide updates to our status after the courts address the temporary restraining orders that are set to expire on March 5,” according to the CHKD website.
With the rapidly changing interpretations from major Virginia hospitals, access to care for youth has become more difficult — pushing some to consider extreme measures.
For Micah, her family has started to stockpile estrogen, a hormone that is often used in gender-affirming therapy.
“We got a year’s supply so it’d be able to last us through this mess and all,” Micah said.
Despite their preparation, should Trump’s executive order hold, Micah worries about the distance she would have to travel to receive care.
“Now, if the executive order goes through, we’re going to have to drive like three, four hours just to see a doctor for my gender-affirming care, which really sucks.” Micah said. “I need my healthcare here…I really don’t want that to change, it’s hard.”
Contact editor-in-chief Nick Mossman at nick.mossman@richmond.edu
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