Arkansas faces a Trans Exodus after passing 3 anti-trans bills in 3 weeks

• The Arkansas state legislature has passed 3 anti-trans bills in less than a month. The latest limits access to medical care.
• Trans people are taking about leaving, but they note that neighboring states are considering similar bills.
• "There's not going to end up being a lot of places to run to, but a lot of places to run from," said one trans woman.

Jacqueline Middleton has lived in Arkansas for most of her life, but she plans on moving away from the state as soon as possible now that state lawmakers have pushed through three anti-trans bills in three weeks.

But it's not yet clear where she will go, or how she will manage building a life away from her current support system and everything she has ever known.

"It's heartbreaking," Middleton told Insider. "It makes me stressed. It's activating my fight or flight response."

The latest blow came on Tuesday, when the state legislature approved a ban on puberty blockers and hormones for trans minors, and cut off access to any medical care or affirmation from mental health professionals or school employees until they turn 18.

Gov. Asa Hutchinson vetoed the bill, calling it "a vast government overreach," but the legislature had enough votes to push it through without him.

The governor, though, is hardly seen as a trans ally. He previously signed a bill banning trans girls from girl's scholastic sports, and a sweeping religious exemption for health care providers who can now turn away LGBTQ patients for non-emergencies.

Middleton, a 23-year-old trans woman, transitioned while attending Southern Arkansas University, but had to drop out after several people in the small college town threatened her safety. She's struggled to find a job since, describing how she'd show up for interviews and employers would realize she's trans and lose interest. Then, last September, Middleton caught Covid, which led to developing tenosynovitis, an inflammatory disease that affects her wrists and thumbs.

Now on Medicaid, she worries about losing access to the hormones keeping her dysphoria at bay. HB 1570, the law banning transition care for minors, bans state funds from being used to fund transition care for all trans people. So state funds towards Middleton's Medicaid will no longer cover the hormones she needs to survive.

The American Civil Liberties Union has promised to challenge the law in court, but trans people in the state are following the developments with dread.

For Middleton, the anti-trans health care bill was the last straw.

"I have to go somewhere where there are people standing behind me and that's not here," she said.

"I would be willing to endure this if it felt like there was any chance that I could overturn it. And if I can't overturn it here, I'll go somewhere else."

Insider spoke to several trans people living in Arkansas who said they were contemplating a move out of state.

Last week, while the governor was considering how to respond to the bill cutting off health care for trans kids, Evelyn Rios Stafford, a Justice of the Peace in Fayetteville and Arkansas' only openly trans elected official, said she had a 40-minute meeting to discuss how the measure would impact trans people in the state.

"Honestly, they're worried," she said of what she told the governor. "They don't know what else is coming down the pipeline."

But finding a trans-friendly place to live could prove complicated, given that other states have taken up similar bills to the one passed in Arkansas. Each of the six states that border Arkansas -- Texas, Oklahoma, Missouri, Tennessee, Mississippi and Louisiana -- are considering legislation that either limits access to transition care for minors or restricts the participation of trans kids in team sports, according to tracking by the ACLU.

Middleton has considered Illinois, the nearest state not currently likely to pass new anti-trans laws.

"It looks like a lot of other states are following suit," she said. "There's not going to end up being a lot of places to run to. But a lot of places to run from."

"WHAT ELSE IS COMING?"

While the ACLU has led opposition to the anti-trans efforts across the country, in Arkansas, a group called Intransitive has been leading the fight locally.

"The majority of trans people in the country live in the South," said Rumba Yambú, the group's director. "There are a lot of trans people here who have been living, resisting, organizing here for years. We just needed help."

According to Rios Stafford, there's currently no one in the state performing gender reassignment surgery. There is only one clinic, the Gender Spectrum Clinic at Arkansas Children's Hospital in Little Rock, that serves trans adolescents.

At the state Senate hearing on the trans health care bill, Dr. Michele Hutchinson, the doctor in charge of the clinic, testified about the impact the legislature's work was having on patients.

"I'm doing everything I can to maintain my sanity here," Hutchinson said.

"Just after this bill passed the House, these kids heard about it. I've had multiple kids in our emergency room because of an attempted suicide. Just in the last week," she told legislators.

Puberty blockers are widely considered to be standard care for trans adolescents and have been endorsed by every major medical association in the US, including the American Academy of Pediatrics, the American Medical Association, the American Psychological Association, the Endocrine Society, the World Professional Association for Transgender Health, and the American College of Obstetricians and Gynecologists.

The only proven treatment for gender dysphoria, the term for a feeling of incongruence between a person's gender identity and assigned sex at birth, is transitioning. Before puberty, a child has no need for medical interventions, so a transition would be a different haircut, clothes, and maybe a new name and different pronouns.

It's not until puberty begins at around 11 or 12 that any sort of medical intervention comes into play. Puberty blockers are not permanent and help trans kids put off the permanent effects of both their natal puberty, while hormone replacement therapy is typically given to older teens and triggers a puberty consistent with their gender identity.

The two step approach is meant to put off permanent body development until the person can make a more informed decision about the future. Genital surgery before age 18 is extremely rare.

"We've witnessed overall such a huge rise in the visibility of trans people in this country over the past decade," said trans historian Jules Gill-Peterson. And yet, she said, there's a common misperception that the existence of trans kids is a fairly new development.

While researching her book, "Histories of the Transgender Child," Gill-Peterson found letters from trans youth to the earliest providers of hormone replacement therapy, in the 1930s, begging for help in stopping their natal pubertal development.

She realized that has long as there have been trans people, there have also been trans children. And, perhaps more importantly, as long as there has been transition-related care, trans adolescents have sought it out.

But, while the federal government has expanded access to trans medical care, conservatives on the state level have weaponized the ability of trans individuals to access care and equal rights.

"It's clear that right-wing politicians and an array of sort of extremist right-wing groups have been gravitating increasingly towards trans issues, taking advantage of that cultural visibility to try and turn it into a sort of wedge issue," Gill-Peterson said.