Families of transgender youth in the South have to spend much more time and money to access gender-affirming care than they used to because of anti-trans legislation that has been passed in the last two years, according to a new report from the Campaign for Southern Equality.

Two dozen states, predominantly in the South, have passed bans on gender-affirming care such as puberty blockers, hormone replacement therapy and surgeries for transgender youth since 2021.

As a result, many families of transgender youth must travel hours and spend hundreds, if not thousands, of dollars to reach out-of-state gender-affirming providers. (The Campaign for Southern Equality provides grants to families of transgender youth to help them travel and find doctors.)

Researchers found that travel times to clinics more than doubled since bans on care were passed, including from cities that previously had clinics that serviced transgender youth. These bans on care, largely passed by states with Republican supermajorities, have left more than 105,000 transgender youth living in states where they can’t access health care that most major medical associations have deemed as “medically necessary.”

The report estimates that families in Houston, Texas, for example, now have to drive 1,204 miles round trip — which takes about 18.5 hours — to seek care at a clinic. For families in Nashville, it now takes 6.4 hours and 416 miles to reach a clinic that can provide care to youth. The time it takes to reach a clinic is even longer for families who don’t live in urban areas, and for those who live even further South.

Researchers relied upon the Campaign for Southern Equality’s database on gender-affirming care providers and conducted a geospatial analysis to find driving times from locations across South to states like New Mexico, Colorado, Kansas, Illinois, Michigan, Indiana and Pennsylvania where gender-affirming care for youth is still accessible.

And for some families, the closest clinic may not be their best option. Some families may choose to travel to states where they have relatives or friends. Others may seek care via telemedicine, which means they need to travel so they are physically located in the state where their doctor is licensed.

Dr. Izzy Lowell, a gender-affirming care provider, told HuffPost last year that she is trying to get licensed in all 50 states so that she can help meet the demand of patients who need care and aren’t able to travel.

The current reality facing transgender youth and their families is not dissimilar from the thousands forced to travel out of state to get abortions. The families of transgender youth must weigh numerous travel costs, including gas, hotels, meals and flights. The report also highlights that these out-of-state trips often come with a hefty price tag. In one sample itinerary detailing a trip from Austin, Texas, to Albuquerque, New Mexico, the report estimates that roundtrip airfare, a hotel, meals and rental car for two people comes out to $891.

People often have to find child care and take time off of work in order to make such a trip — and have a backup plan in case laws change in the state where they are seeking care. One family based in rural Tennessee, for example, told HuffPost they had to scramble to find new care options after North Carolina — previously a state where gender-affirming care for minors was legal — passed a ban in August 2023.

And unlike abortions, gender-affirming care is not a one-time event. Patients, especially transgender youth, need to have routine follow-up appointments every three or six months, depending on their care plan, to get necessary blood work and other laboratory reports — meaning travel costs could soar into the thousands each year.

“My daughter is deeply affected every time her care is impacted,” one Oklahoma parent of a trans child said in the report. “She said on the drive that having to go to another state ― one that is even more conservative than our own ― was humiliating and scary. It was incredibly stressful to have to stop at gas stations and rest stops not knowing if anyone would comment on what bathrooms we were using.”

Beyond increased travel time and burdensome costs that not every family is able to afford, transgender youth and their families in the South often face a hostile environment created by Republican officials. Tennessee and Texas attorneys general have targeted the private medical records of transgender patients. Numerous states have passed legislation targeting transgender youths’ participation in school sports and their ability to use the bathroom that aligns with their gender identity, and passed bills that erase transgender identity altogether in the law.