Western Washington was a sanctuary for trans youth seeking care — until RFK threatened gender clinics

Fifteen-year-old Rebecca lives with her parents and two siblings in Tacoma. A pride flag hangs outside their house, and their dog Hercules greets visitors loudly from his big crate in the living room.

Rebecca is the teen’s middle name. KUOW has agreed not to publish her full name due to safety concerns.

Rebecca started to think she might be trans when she was 11 years old, in the sixth grade. At first, she tried different names, changed her clothing, and experimented with makeup.

Then, when Rebecca turned 13, she went to the gender clinic at Mary Bridge Children’s Hospital in Tacoma and started puberty blockers.

The Trump administration is trying to end trans youth’s access to gender-related medical care, like that which Rebecca has received. Until recently, though, it seemed that care would continue in more liberal places like Western Washington. That’s why some families relocated to the region for their kids’ treatments. But now, families and advocates say access to gender-related care for transgender young people seems to be threatened even in the Puget Sound area.

RELATED: Seattle Children's halts gender-affirming surgeries after executive order threatens loss of federal funds

The region used to have two hospital-based pediatric gender clinics: one at Mary Bridge Children’s Hospital, and the other at Seattle Children’s. But in late January, Mary Bridge announced it was closing its clinic.

The closure was in response to rules U.S. Health Secretary Robert F. Kennedy’s agency proposed in December to end all Medicaid and Medicare billing for hospitals that provide gender-related treatments to transgender youth. The administration said puberty blockers, hormones, and surgery “expose [trans youth] to irreversible damage.”

The proposed rules haven’t taken effect, but some hospitals have closed or ended medical services at their pediatric gender clinics anyway, including in New York City, Minneapolis, Los Angeles, and now Tacoma.

A spokesperson for the MultiCare Health System, which owns Mary Bridge Hospital, called the closure of the gender clinic “a painful decision.” But, they said in a statement, continuing to provide gender-related medical care to young people put not only Mary Bridge but all of MultiCare at risk.

About three quarters of MultiCare patients are on either Medicaid or Medicare, so loss of that funding would “undermine MultiCare’s ability to operate [and] threaten patients' access to essential care,” the statement continues.

RELATED: 19 states sue HHS over a move that could curtail youth gender-affirming care

A health care provider who works at a pediatric gender clinic in the Puget Sound region expressed disappointment about MultiCare's decision.

“It is frustrating that so many large institutions have complied in advance,” said the provider, who spoke to KUOW on condition of anonymity due to fear of losing their job or being targeted by anti-trans activists. “[The U.S. Department of Health and Human Services] doesn’t even need to follow through because people are already closing, so you’re doing the work for them.”

The provider said things have changed dramatically over the last six months.

“I have definitely seen an increased sense of anxiety and worry that this health care might not exist six months down the road,” they said.

Patients at the health care provider’s clinic are trying to make sure they have enough medication stockpiled in case anything changes, they added.

After Rebecca started puberty blockers, her parents didn’t let her start hormone replacement therapy — estrogen — for another year and a half. They were worried she might not have settled on her final identity.

“That was probably the longest year and a half of my life,” Rebecca said. “It was hard, especially because [in] eighth grade, puberty’s kicked in for most everybody. And seeing my peers looking as they do while I — if it weren't for my height, you'd think I could be a sixth grader.”

Finally, her parents gave her the go-ahead, and she learned to give herself the weekly injections.

“They taught us [how to give injections] on a little stress toy thing, because that was similar-ish to skin and fat,” Rebecca said. “They gave us a little empty, fake vial that said ‘girl juice’ on it. It was really funny. It had the trans flag.”

The first noticeable change was in her face.

“The first time I looked in the mirror and I didn’t see a different person — when I first looked in the mirror and saw myself, it’s a feeling that I just — it’s hard to describe,” Rebecca said.

“You came downstairs and you were kind of weepy,” replied Anne, Rebecca’s mom. KUOW agreed to also use her middle name due to safety concerns.

“And you said, ‘Mom, I saw me. I saw me today,’” Anne continued. “And then I was kind of weepy.”

At the clinic where the health care provider who spoke to KUOW works, some things have not changed. Both parents must still sign off on any gender-related care and patients still start with a mental health appointment. Only then can youth whose blood tests show they’ve started puberty start puberty blockers.

“Puberty blockers have been studied for decades around [early onset] puberty, and they are completely reversible,” the provider said.

Then, after kids are at least 13.5 years old, they can start taking hormones.

The provider’s patients used to also be able to ask to get on a waitlist for top surgery.

“This is strictly top surgery,” the provider said. “There are no genital surgeries being done on anyone under 18 and that’s [always] been true.”

But now, the provider said, their employer no longer offers even top surgery to anyone under 19. The only way for young people to get any surgery is at small, private clinics.

RELATED: 'A very, very small number' of teens receive gender-affirming care, study finds

Matthew Wilson is the director of Tacoma’s Oasis Youth Center, which serves LGBTQ young people. He said some of the center’s participants were getting care at Mary Bridge.

“A youth that is 16 called us after they received the notice that they were not going to be able to receive care there anymore,” he said. “It was so distressing to them. They felt very overwhelmed, confused.”

Wilson said some young people he’s talked to aren’t sure how to get a new provider or access to medication.

“Some of our youth were kind of in a state of panic of what to do next,” he said.

So Wilson helped come up with a plan. He’s not disclosing the details publicly, but a health care provider at another nonprofit will offer prescriptions to former Mary Bridge patients until they find a long-term solution, he said.

“Having this chilling effect of trying to target a population and take away their health care will increase the mental health challenges that the community faces,” Wilson said. “This is life-saving care and it needs to be available.”

As for Rebecca, she said she’s going to be O.K. Mary Bridge gave her 180 days of medication. That will get her to her sixteenth birthday, the day she’ll become eligible for care at Planned Parenthood.

Rebecca also left the public middle school where she was bullied and attacked, and now attends an arts-focused high school where she said there are many LGBTQ kids and everyone’s accepting.

“I’ve really found a great community there,” she said. “I have started to love singing. Singing and choir is my number one thing there.”

In a recent concert, Rebecca was in an honor choir.

“She was very specific that for her concert blacks, she wanted a dress — something that she felt fantastic in,” said her mom, Anne. “Her refusal to hide and her desire to stand in her truth is something that made me incredibly proud.”