What We Learned When We Stayed to Provide Abortion- and Gender-Affirming Care

We’ve been here before. When Dobbs came for abortion care in our states, we did two things: We opened clinics across state lines so our patients would still have a legal option. And we stayed. We kept our original clinics open, expanding the care we'd always offered or always wanted to offer. When Skrmetti came for gender-affirming care, we kept providing that too, because abortion care patients and transgender patients are not separate communities. The calculation patients make before they walk through the door is identical for both communities: Will I be seen? Will I be safe? Will the person across from me treat my body like a problem to be managed, or a life to be supported? June marks anniversaries of both Dobbs v. Jackson Women’s Health and US v. Skrmetti, and that conviction has never felt more urgent.

Long before Dobbs or Skrmetti, the intersection of abortion rights and trans rights was already living in our waiting rooms, in the patients who received reproductive care and gender-affirming hormone therapy (GAHT) under the same roof; in the person who drove hours across the state because we were the only provider they trusted; and in those who trust us with their whole-person care because their grandmothers, mothers, sisters, aunts, and friends have relied on our clinics for care for 50 years. Throughout that history, our organizations have been guided by a simple principle: When members of our community are targeted, excluded, or denied the care they need, we do not look away. We listen, we adapt, and we show up.

When abortion care moved across the border after Dobbs, the patients who remained still needed care they couldn’t access at home. The wall between reproductive healthcare and LGBTQIA+ healthcare that exists in policy language and funding categories has never existed in our exam rooms.

What connects every patient who walks through our doors, whether they’re coming in for an abortion or a hormone therapy appointment, is something our staff recognized long before we had language for it: the experience of arriving at a clinic while carrying the weight of a political target on your back. A clinic’s job of creating a space where people can receive care without shame or fear has always been exactly the same job regardless of why they came.

Bodily autonomy is the foundational principle of reproductive rights, and it only means something if it applies to everyone.

Marty had learned, growing up as a transgender person in rural Maryland, to brace himself before every medical appointment, because finding healthcare that was both competent and genuinely affirming had always required a fight. What he found at our clinic was a staff that met him without conditions, no justifications required, no explanations asked for. His mother has supported the Women’s Health Center (WHC) since its earliest days, and used to volunteer as a clinic escort. Watching the same clinic support her son in his gender-affirming care gave her, in her own words, a peace she hadn’t known she needed. When gaps in care left Ben, a transgender West Virginian, navigating painful dysphoric cycles and a transition that had stalled, he found his way to WHC West Virginia. Today, he says that every time he looks in the mirror, he sees more of himself looking back.

When one of our providers first interviewed to work for CHOICES, she didn't really know much about gender-affirming care. In the time she has been with CHOICES, she has cared for hundreds of gender-affirming care patients across the mid-South. "It's clear how important this care is for patients," she shared. "After patients start hormone replacement therapy, they come back as a much more energetic, vivacious person.” Since the state of Tennessee has restricted gender-affirming healthcare, including banning minors from accessing care, our patients are experiencing increased anxiety and fear about their privacy, safety, and continued access to care. CHOICES' provider shared, "Hormone replacement therapy is routine, like every other service we offer.” If something has such a profound impact on someone's life, why wouldn't we keep this care accessible?

The pattern behind Skrmetti is one reproductive rights advocates should recognize immediately, because it follows the same logic as the restrictions that led to Dobbs: They come for the most vulnerable first, in the states where the political ground is most hostile, and they build from there. Idaho passed the first transgender athlete ban in 2020, West Virginia followed with the Save Women’s Sports Act in 2021, and Tennessee’s restrictions on gender-affirming care for minors moved through the courts the same way abortion restrictions moved state by state in the years before Dobbs. Since abortion care moved across the border, thousands have received gender-affirming and LGBTQIA+ care at our clinics, even as the political, legal, and financial pressure on both organizations has intensified.

Bodily autonomy is the foundational principle of reproductive rights, and it only means something if it applies to everyone. When it becomes conditional, granted to some patients and denied to others, it stops being a principle and starts being a permission slip, and permission slips get revoked. The fights to protect abortion access and gender-affirming care are not parallel struggles that happen to share a difficult political moment. They are the same struggle, rooted in the same conviction, playing out in the same clinics with the same patients, and the forces working to end both of them have always understood that connection even when the rest of us have sometimes lost sight of it.

Between our two organizations, we’ve earned a century’s worth of experience at the practice of staying, enduring. CHOICES has kept their doors open for 52 years, and the Women’s Health Centers of West Virginia and Maryland will celebrate 50 years of care on June 24—the same day Roe v. Wade was overturned four years ago.

Support independent clinics in hard places keeping the doors open. And when the next fight comes, show up for the communities under pressure. Remember that those targeted first won’t be the last, but they will be the ones to lead the way.