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In June 2021, Connie Kathary asked her mom to go on a walk. Though she knew she’d be accepted, it took the then 14-year-old more than 20 minutes to work up the courage to tell her mom that she’s transgender. She still laughs at the significance of choosing Pride Month for the conversation.
“I walked her outside. We were just talking about stuff, and I told her, ‘Yep, I’m a girl.’ And she was very accepting,” Connie said. With a laugh, she added, “At first, I was a bit upset, because she didn’t give me, like, the fanfare, because I’ve always been a real attention whore.”
Since then, Connie has had to overcome the legal complexities of changing her name and the search for medical providers who could offer her the treatment she needed. Finding treatment took more than a year. And then, three months after her treatment started, Connie had to contend with a new challenge — an Indiana state law banning minors from receiving gender-affirming health care.
As she and her family scrambled for solutions, Connie, like many other transgender youth under 18, found help across the border in Illinois.
Indiana is among 26 states — many in the Midwest and South — that have outlawed youth gender-affirming care statewide since 2021. In Illinois, political leaders have moved in the opposite direction.
Gov. JB Pritzker signed the Patient and Provider Protection Act into law in 2023, after lawmakers passed it following the overturning of Roe v. Wade; it solidified access to abortion and gender-affirming care in Illinois and protects physicians who treat out-of-state youth like Connie.
Today, Illinois lawmakers and advocates say that law is more important than ever. In addition to states passing increasingly strict bans on gender-affirming care, Donald Trump, in his second term as president, is advancing numerous federal policies affecting transgender people. This includes executive orders seeking to prohibit transgender women from competing in women’s sports and ban the use of federal funding on gender-affirming treatment for individuals under 19.
A judge has temporarily blocked the order banning the use of federal funds on gender-affirming care, and Illinois state Rep. Kelly Cassidy, a chief sponsor of Illinois’ shield law, said the Trump directive has not impacted access to care in Illinois. “I think that’s the most important thing people need to know: His signature on that paper changed nothing (in) regard to access to care in Illinois today or tomorrow,” she said.
Cassidy said Illinois’ law is among the strongest in the country, though it hasn’t been tested. She said lawmakers are “bracing for that, but we’re bracing for it with a solid litigation strategy and the belief that we can slow the harms, we can minimize the harms.”
In the two years since the law’s passage, Illinois has become a critical refuge for transgender youth, providers and families say. Planned Parenthood of Illinois said around 7% of their gender-affirming patients come from out of state – an increase since nearby states have restricted care – seeking estrogen and testosterone therapy, a treatment for gender dysphoria. As defined by Mayo Clinic, gender dysphoria is “a feeling of distress that can happen when a person's gender identity differs from the sex assigned at birth.” Complications include discrimination, difficulty maintaining relationships and mental health concerns such as anxiety, depression and self-harm.
In Indiana, Connie would have had to wait four years — until she turned 18 — to start gender-affirming care, a treatment that experts say can ease depression, anxiety and suicidal thoughts in transgender youth.
“If I didn’t transition, I’m not even sure I would still be here,” Connie said. “There is probably a universe out there where I didn’t transition, which, I don’t want to think about it, but that’s the thing — you have to.”
Starting the journey
With her mom, Julia, and her dad, Greg, in her corner, Connie took the first steps in her transition journey: changing her name and gender in the legal system. While the school responded quickly to Julia’s request, the full legal process took over a year.
In the months before the court hearing, Connie elected to start attending therapy. It wasn’t required, Julia said, but it helped the legal process run smoother. “Sometimes a county that may not be as accepting as (our) county is, the judge might ask for a letter from a therapist,” she said. “Kind of like, ‘Prove to me that you’re not just changing anything for the heck of it’ or whatever. People do think that. They think … that you just get on a whim.”
It was after her name was changed in the legal system that Connie decided to pursue gender-affirming hormone therapy. She recalls facing a lot of skepticism during this time.
“You have to go through a few different doctors, where they can be like, ‘Are you sure?’ ‘Are you sure you’re sure?’ ‘Are you sure?’ ‘You sure?’” she said.
While a statewide ban was not in place at the time, Connie still faced limited options. Julia said that Connie’s pediatrician – albeit supportive – could not prescribe medications due to the hospital’s Catholic policies. She was referred to Riley Children’s Hospital in Indianapolis, where she spent a year waiting for an appointment. When the time finally came, she was able to receive medication — a feminizing hormone therapy of spironolactone and estrogen — the same day.
“It’s really about the bureaucratic hoops you have to jump through, because it could really be so easy,” Connie said. “I’m not saying it should be ‘say it and then immediately get a prescription’ … I’m just saying it shouldn’t be that hard.”
In 2023, Indiana Republicans were at the forefront of a national move to restrict transgender rights. Hundreds of protesters, including the Katharys, jammed the Indiana Statehouse when a state House committee considered Senate Bill 480, a law prohibiting gender transition procedures and treatments for children, even if the patient’s parents approve of the treatment.
The bill passed committee on an 8-5 vote three months after Connie began treatment. The primary sponsor of the legislation, Republican Sen. Tyler Johnson, said in a statement that the measure would protect “vulnerable Hoosier children.” Johnson, an emergency physician from northeast Indiana, said he had “compassion” for children experiencing gender dysphoria and said they deserved counseling, but he questioned the need for medical treatment.
“Since these procedures have irreversible and life-altering effects,” he said, “it is appropriate and necessary for our state to make sure these procedures are performed only on adults who can make the decisions on their own behalf.”
Despite more Statehouse protests, Republican Gov. Eric Holcomb signed the law in April 2023. The ACLU of Indiana sued almost immediately, leaving Connie and her family to anxiously await updates.
The initial news was promising. In June 2023, a judge issued a temporary injunction that blocked the law from taking effect, giving them a brief sense of relief. But in February 2024, a panel of the Chicago-based Seventh Circuit U.S. Court of Appeals lifted the injunction, and the Katharys received a heartbreaking email from the ACLU notifying them that “care can no longer be provided in Indiana.” Initially, a grandfather clause left those receiving treatment with six months to continue treatment, but when the injunction was lifted, so was the clause.
With Connie running low on medication, Julia said she immediately signed her up on Planned Parenthood of Illinois’ online patient portal.
Crossing state lines
One month later, Julia and Greg called off work, signed Connie out of school, and drove from Indianapolis to Flossmoor, Illinois, a suburb 30 minutes south of Chicago. Connie spent the 170-mile car ride watching a season of “Invincible” and wishing for a visit to Six Flags.
“I think the thing that makes me mad about the whole thing is, like, as a taxpayer in Indiana — me and Greg both — we pay our taxes here in Indiana, we work here in Indiana,” Julia said. “We were told we can’t parent our child and make health care decisions for her without driving outside the state.”
Despite frustration, they said they made sure to enjoy themselves on the trip.
“Besides the fact that I really should not have had to do that, it was a really fun day in my mind,” Connie said. “The part of me that has to think about this stuff is like, ‘I shouldn’t have had to do that.’ Then the part of me that just wants to be a kid is like, ‘Yeah, no school, driving up to Chicago, all right!’”
Illinois’ political leaders have worked for years to make the state a friendly destination for transgender patients. Cassidy, a Chicago Democrat, has been on the forefront of those efforts. She is a long-term advocate for LGBTQ+ and reproductive rights. Her partner is nonbinary. She’s the only openly gay member of her chamber. These experiences made becoming the chief sponsor for Illinois’ shield law a fight she was not going to back away from, she said.
Cassidy said the legislation ensures there is Medicaid coverage of gender-affirming care, prevents Illinois from participating in investigations when other states seek to penalize those who are traveling to access health care, and protects the Illinois licensure of medical professionals who are dually licensed.
Edwin Yohnka, director of communications and public policy for the ACLU of Illinois, said it was “designed to ensure that no one who is providing lawful health care in Illinois is subject to punishment as a result of having provided that care.”
“As we see, other states not only implement these bans but then also try to enforce their bans from their state in Illinois,” Yohnka said.
Cassidy feels it’s important that decisions impacting bodily autonomy are made without governmental interference.
“Ultimately, I have never had a lawmaker question whether I needed my two heart surgeries,” she said. “They saved my life, and so did my abortion, but I’ve had to justify that.”
Local protections
Protections for transgender patients extend to the local level in Illinois, too. In the small college town of Carbondale, a bodily autonomy ordinance protects autonomous medical decisions, including gender-affirming care.
“It’s expressly written … that anyone in the city of Carbondale who is caught working with some law enforcement agency attempting to extradite someone for coming here to exercise their right to health care, they'll be held liable,” Carbondale City Councilmember Clare Killman said. “The individual who is cooperating with an outside law enforcement agency will be held liable. And no member of Carbondale city staff, Carbondale Police Department included, is authorized to comply with, say, an extradition order.”
Killman is the first openly transgender person to be elected to a city council in Illinois. As a teen growing up in Missouri, Killman said she wasn’t accepted and was forced into conversion therapy. At 17, she fled what she called a “dire situation” and moved to Carbondale. Today, she considers herself an “interstate refugee.”
“It's not like I can come here and be declared a refugee and seek asylum, but Carbondale essentially did that for me, where they opened their arms and they integrated me, and I was able to build a life here,” she said.
Like Cassidy, Killman questions whether state and federal authorities should be able to override an individual’s medical care decisions. She praises Illinois for deferring that right to the individual, regardless of what is being done at the national level.
“Illinois affirms your right to own your body, and so instead of kicking something back to the states, instead of the federal government mandating one way or the other, Illinois is giving people the choice,” she said. “They're not sending it back to themselves to regulate. They're giving a choice to people.”
Mallory Klocke, director of gender-affirming hormone therapy at Planned Parenthood of Illinois, said the organization has seen an increase of transgender youth traveling from out of state.
“As a program director, I review all the records of people who have already initiated care and are transferring their care to us,” Klocke said. “So I’ve definitely seen lots of people coming in from Indiana (and) people as far as Texas or Florida.”
From 2017 through 2021, 121,882 children ages 6 to 17 in the U.S. were diagnosed with gender dysphoria, according to a research analysis by Reuters Investigates and Komodo Health Inc. That’s less than 0.1% of the nation’s total population, yet the majority of states in the Midwest and South have passed laws banning medical practice for transgender youth in recent years, according to the Movement Advancement Project, an independent, nonprofit think tank.
To Charles Kolesar, a clinical director at CHOICES Center for Reproductive Health, open access in Illinois is crucial. CHOICES, which offers gender-affirming care to transgender people ages 16 and up, opened in Memphis, Tennessee, in 1974 and expanded to Carbondale in 2022.
For older adolescents, the Carbondale clinic is now their only option. Tennessee banned health care workers from providing hormones, puberty blockers and other treatments to trans youth in 2023 with the passage of Senate Bill 1, which is currently being challenged in the U.S. Supreme Court.
“For whatever reason, places like Tennessee, it’s like their top agenda is to shut down gender-affirming care,” Kolesar said. “I mean, it’s a bizarre fixation, but yeah, I think it’s critical for places like Illinois to have the access so people can receive the care they need.”
No easy feat
While Connie was able to travel to Illinois for care, she knows not every young person in Indiana comes from a family that is supportive of their desire to transition, or has the means to travel out of state. She worries about what it means for them.
“A majority of my family is accepting and they love me, but not all people have that,” Connie said. “And the way that this (Indiana) law is made, there’s going to be blood on their hands — there’s probably already — and I think they’re evil for that.”
For many families, traveling out of state is no easy feat. Connie and her family have had to drive six-plus hours roundtrip for doctors’ appointments and rely on a network of friends and family to pick up her prescriptions from Illinois pharmacies.
Nadine McSpadden, director of advocacy and general counsel at IYG, a nonprofit organization that serves LGBTQ+ youth in Indiana, said traveling for care requires many expenses.
“You have to have a working vehicle. You have to be able to pay the gas money. You have to be able to take time off of work. You have to be able to take your child out of school. You might have to drive far enough that you have to pay for a hotel overnight, and then, of course, there’s potentially an insurance issue. Are you insured at all? If you are insured, is your insurance going to cover this out-of-state provider and whatever treatment it is you’re going to be receiving? … So it’s becoming a very cost-prohibitive exercise for a lot of these families to provide what is truly life-saving care for their kids,” she said.
The visits can also be frequent. Kolesar said patients at CHOICES come in around every three months when they first start receiving care.
“When you initiate hormone therapy, people have to have lab work,” he said. “They have to be monitored typically for liver, kidney function, that kind of stuff. … So it’s a big commitment for parents to have to follow through and support their child that way, especially when they’re having to travel and all the expense of traveling and taking time off work and that kind of thing.”
According to McSpadden, the bans have much more than just a financial impact.
“It’s hard to even describe how emotionally taxing it is for these youth and their families to feel like your own state government has such low value and esteem for your well-being that they would make it this hard for you to get the basic medical care that you need to just live your life,” McSpadden said. “Youth feel scared and isolated and stigmatized, and their parents feel, I think, a little bit panicked about how they’re going to be able to continue caring for their kids in the way that they feel like they need to as parents, because it’s becoming so challenging in so many ways.”
A recent study published in Nature Human Behavior found that anti-transgender state laws led to an increase of suicide attempts among transgender and nonbinary youth. The study, which surveyed 61,000 transgender and nonbinary youth and controlled variables such as state differences, race and age, found that suicide attempt rates increased by up to 72% among those age 13 to 17 living in states with anti-trans bans compared to those without.
“For a lot of trans and nonbinary people, being on hormone therapy is part of how they’re able to feel good in life,” Klocke, the Planned Parenthood of Illinois director, said. “Sometimes, if people have, like, medical conditions like high blood pressure or diabetes or things like that, if people feel more at home in their bodies, they’re able to manage their other medical conditions more easily and with more confidence than they might otherwise. And so stopping those hormones for young people risks people’s well-being, and oftentimes, it can risk their lives. And that’s something that we have seen time and time again.”
Connie received gender-affirming hormone therapy for around a year before Indiana outlawed it. Klocke said if patients abruptly stop receiving treatment, it can be “really, really rough.”
“When you change your hormone levels, that can be challenging,” they said. “Ask anybody who has gone through puberty if hormonal shifts affect their mood, and they will probably tell you yes. And when that’s not an active choice by a person, that can be even harder.”
A glimpse forward
Connie turned 18 in December, a critical milestone for her since the Indiana ban on transgender care is specific to minors.
“I mean, I’m glad I don’t have to go to Illinois anymore for my meds,” she said from her home in Indianapolis.
But the days of traveling to Illinois aren’t in the rear-view mirror just yet. While Connie is now able to retrieve prescriptions from Indiana pharmacies, Julia said they did not feel it was safe to switch her care back to Indiana. Trump’s rhetoric and the changing policies at the state and federal level toward transgender people still loom large. But Connie is still a senior in high school, and like anyone else at that age, she’s thinking about her own future.
At the end of the month, she’ll don a cap and gown and graduate. Senioritis hasn’t been easy, she said, but she’s looking forward to starting the next chapter of her life. She’s proud to be open and give her voice to this cause, but she longs for a day that she’ll be interviewed for more than just her gender identity — perhaps for her creative writing skills, which she plans to study in college.
“I really don’t think I should have to be a model or like a symbol,” she said. “I don’t want to be that. I just want to, you know, live my life.”
Carly Gist is a journalism student at Southern Illinois University Carbondale. This story was produced for Capitol News Illinois through the Saluki Local Reporting Lab, supported by grant funding from the Pulitzer Center and the Illinois Press Foundation.
Capitol News Illinois is a nonprofit, nonpartisan news service that distributes state government coverage to hundreds of news outlets statewide. It is funded primarily by the Illinois Press Foundation and the Robert R. McCormick Foundation.
This article first appeared on Capitol News Illinois and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.