After Texas banned puberty blockers and hormones for trans kids, adults lost care, too

By Eleanor Klibanoff, The Texas Tribune

“After Texas banned puberty blockers and hormones for trans kids, adults lost care, too” was first published by The Texas Tribune, a nonprofit, nonpartisan media organization that informs Texans — and engages with them — about public policy, politics, government and statewide issues.

Sign up for The Brief, The Texas Tribune’s daily newsletter that keeps readers up to speed on the most essential Texas news.

When the Texas Legislature moved to ban puberty blockers and hormone therapy for minors in 2023, Colin Zicko worried about trans teens.

Zicko, 22 at the time, knew what it was like to be a teenager seemingly trapped in the wrong body, desperate to stop the gendered changes brought on by puberty and better align his physical features to the person inside.

He also knew what it was like to be denied that option. Assigned female at birth, Zicko came out as trans when he was a teen. Without his parents’ permission, he couldn’t begin puberty blockers or hormone therapy, ushering in what he calls the “tunnel years,” when darkness closed in, his mental health plummeted and he contemplated suicide.

When he finally started hormone therapy as an adult, it felt like he could breathe again, the constant noise in his head about his body and gender presentation quieting enough to allow him to think. Zicko was angry that legislators were trying to take that peace from teens whose parents supported their transition.

And then he got a call from his doctor.

“The nurse, her voice was broken up and she was trying not to cry,” he remembers. “She said, ‘I’m sorry, but we’re going to have to stop caring for you.’”

Even though he was an adult, Zicko’s doctor was at Dell Children’s Medical Center in Austin. In May 2023, all the providers suddenly left the clinic after Attorney General Ken Paxton opened an investigation, citing a video sting by Project Veritas, a right-wing activist group, that claimed the practice provided certain gender-affirming care to patients as young as eight.

Zicko had two months of hormones left. Everywhere he called had monthslong wait lists. As an adult, there is no law preventing Zicko from accessing hormone therapy. But as he and other trans adults are learning, the state’s hostility toward trans-related health care for minors has sharply curtailed their ability to access care as well.

“An attack on any trans person, regardless of their age, is an attack on the entire community,” said Laura Terrill, CEO of Planned Parenthood South Texas, which provides transition care to adults. “While the bans have been focused on minors, which is heart wrenching, the impact that it’s having on adults, trans adults is in shame and stigma, and questions of whether or not they’re going to be able to continue to access the health care that they need and deserve.”

Escaping the tunnel

As a young kid in rural Louisiana, Zicko didn’t think much about gender. All the kids played together, had the same interests and dressed similarly.

Then he moved to suburban Texas to live with his dad.

“All of a sudden, I was told that I needed to wear a dress. If I wanted to wear jeans, it was only while I was playing. I had to wear pink,” he remembers. “And very immediately, it felt wrong.”

When Zicko was 14, he came out to his family as trans. Confused and frustrated, his dad made him sew and wear a dress to prove he was a girl. Without his dad’s permission to get on hormones, Zicko started binding his breasts, eating foods that he thought might boost his testosterone and rapidly losing weight to try to stave off puberty.

The more his body changed to look like a woman’s, the worse his gender dysphoria, the distress someone can feel when their body doesn’t match their gender identity, became. He started smoking marijuana and disassociated from reality as much as possible, unable to stomach living in a body that felt so foreign.

When he was 19, he finally went to see a gender-affirming gynecologist, who connected him with doctors at Dell Children’s. They offered not just transition-related care but a holistic experience — he met with a dietician who helped him after years of disordered eating, a phlebotomist who kept up with his blood work, and a wide range of other health care providers to help manage his chronic conditions.

Getting on testosterone changed his physical appearance. It also calmed the anxiety and gender-fixation that had plagued him for years. Things that had loomed so large for him, like what he perceived as girlish hands, receded to a normal-sized worry.

“Gender dysphoria is a lying little bitch,” he said.

After years stuck in the tunnel, Zicko came into the light and started living as the trans masculine person he always knew he was. He got a job, found a community and reconnected with his dad. He finally got his dad’s support by framing it as an issue of personal freedom from government oversight, which seemed to do the trick.

“I know people who are like, if somebody’s been transphobic to you before, never forgive them,” he said. “But I’m very, very forgiving with people who have changed. People are just ignorant. Ignorance isn’t a sin.”

Texas tackles trans issues

In the years since Zicko came out, being trans in Texas has gotten both easier and harder. More people are coming out, creating more community, connection and strength in numbers. But the backlash has been fierce, especially from conservative lawmakers in the Texas Legislature.

Texas, like most red states, has primarily focused on legislating what children can do. They’ve restricted what sports teams trans students can play on, tried to limit what they can be taught about gender and sexuality, and banned minors from medically transitioning. Gov. Greg Abbott ordered the state’s child welfare agency to investigate parents of trans kids, and Attorney General Ken Paxton brought investigations and lawsuits against doctors that offered these services.

Even though these efforts targeted trans children, the effects have rippled across age groups. Some doctors left Texas proactively, while others who were targeted for treating minors also treated adults, leaving those patients without providers.

Planned Parenthood South Texas provides gender-affirming care to adults at its clinics in San Antonio and the Rio Grande Valley. Demand has quadrupled since 2018, as more people transition with fewer doctors to treat them.

“There’s so much misinformation from patients about what they are still able to access in Texas,” Terrill said. “So much of our work is providing patient reassurance and making sure our patients know their rights.”

When Zicko’s doctors suddenly left Texas in spring 2023, he had two months of testosterone left. He called clinics and gender-affirming gynecologists across the Austin area, each with a waitlist longer than the last. The soonest appointment he could get was October, six months away.

When his medication ran out, the old, familiar darkness returned. His period came back, his voice started to go high again and he felt his body changing, bringing with it crippling physical pain. He was often unable to get out of bed, unable to go to work, unable to imagine things ever getting better.

Desperate, he made another round of calls and was able to get a last-minute appointment with Planned Parenthood, where they refilled his testosterone and set him up with a new care team.

“And thank god, because I got to the point that I could not go another week,” he said. “I wanted to die, not because of my thoughts, but because I was hurting so much.”

Since then, he’s gotten a new job and moved in with his girlfriend. He’s living a life he never could have imagined when he was a teenager. He’s happy.

But he knows the fight isn’t over. Those months without care foreshadowed the pain and suffering trans people may experience if conservatives get their way, he said. The Texas Legislature will return in January, emboldened by incoming President Donald Trump, who has promised to enact an aggressive anti-trans agenda. Zicko knows more restrictions, more hostility, more debates over his right to live his life as he desires are on the horizon.

His dad offered to pay for him to move out of state so he can reliably access health care and maybe feel safer. He knows trans people who have left Texas, but he’s decided to stick it out.

“They want us to leave, because the more of us that leave, the less people there will be to fight,” he said, echoing a sentiment from his girlfriend. “But I want to stay. Because as long as there’s one trans person in Texas, then there are trans people in Texas.”

This article originally appeared in The Texas Tribune at https://www.texastribune.org/2024/12/04/texas-trans-adult-care-diminishing/.

The Texas Tribune is a member-supported, nonpartisan newsroom informing and engaging Texans on state politics and policy. Learn more at texastribune.org.