Standing before dozens of community members at the Labor Temple in Eureka, Alexis Villegas said he tries not to remember last summer because of how painful it was. He couldn’t decide if he was angrier at himself for not being more proactive despite the circumstances, or more furious with the system that left him to navigate Humboldt’s confusing, complex network of healthcare.
Once Villegas graduated from Cal Poly Humboldt, he no longer had Campus Health Center medical staff helping with his testosterone injections. While grappling with severe burnout from school, he also didn’t have the capacity to look for a provider ahead of time. Queer Humboldt’s Clinical Director Aisha Morton recommended he establish care with Open Door, having confirmed with a staff member that the Arcata Community Health Center would take in any patients seeking gender-affirming care (GAC) at the time.
This route proved to have more roadblocks than Villegas anticipated. His intake was initially denied, then he had an appointment scheduled a month later and was denied again. An official intake appointment wouldn’t be scheduled until August of 2025, leaving Villegas without his prescription for three months.
Without testosterone, he began menstruating and felt like crying more often, adding to his increased depression and anxiety. Despite telling himself he was overreacting, he said he was losing a sense of himself and wasn’t comfortable talking to people about it. The lack of regular hormone doses also resulted in reduced strength, to the point where he couldn’t open a prescription bottle. His mental turmoil came to a peak in that moment, causing him to scream and throw things around his room.
To this day, he feels he’s still recovering from this gap in care. “I felt like a joke to myself. I felt like I abandoned myself. I felt like I was being abandoned. It was not great. I was 23, 24 when that happened,” Villegas said. “I can’t imagine being a teenager and going through that and having less legal or medical autonomy. I can’t imagine that I would still be here talking to you if I was going through that as a teenager.”
New teenage Open Door patients may face this same struggle given recent changes to the center’s GAC services. It’s for this reason Villegas recently shared his experience on a panel of transgender community members and organization representatives as part of a town hall hosted by the Democratic Socialists of America’s Humboldt chapter.
The federal government under the Trump administration has made progressive attempts to restrict access to GAC for the trans community, starting after Trump took office in January of 2025. This led to the federal Department of Health and Human Services cutting Medicaid and Children’s Health Insurance Program Funding for GAC in October. In July, Open Door stopped offering hormone therapy and puberty blocker prescriptions for those under 19 years old who are new patients or patients who did not already have prescriptions. Many local organizations and Humboldt residents are in strong opposition to the policy change and are working to provide new access to GAC medications or reinstate it at Open Door.
Trump’s second term has seen significantly stronger pushes for anti-trans policies compared to his first term. Among hundreds of executive orders signed last year was one calling for health centers to stop offering hormone therapy and puberty blockers to patients under 19. This order refers to GAC as “chemical and surgical mutilation.” California’s Attorney General Rob Bonta and other states have been filing lawsuits to block the executive order and other attempted bans.
In April, Health Secretary Robert F. Kennedy Jr. declared GAC harmful and attempted to restrict the services offered by healthcare providers receiving federal funding. However, a federal district court ruled the declaration unlawful under the Administrative Procedure Act and so it should have no legal effect. But despite this ruling, the federal Department of Health and Human Services decided in August that Medicaid and CHIP funding will not be used for GAC prescriptions and surgeries, effective Oct. 13.
The American Civil Liberties Union tracked 1,680 state anti-LGBTQ+ bills proposed since January of 2024, 165 of which passed into law. The Human Rights Campaign reported that 27 states have currently banned GAC medications for minors, affecting around 347,500 children.
Gender affirming care is an umbrella term for hormone-related treatments that delay puberty or promote the development of masculine or feminine sex characteristics. Anyone can receive this treatment for hormone imbalances caused by various medical factors. The term is often, though not exclusively, used in reference to trans patients who receive hormone therapy or cosmetic surgeries to align with their gender identity, which can relieve the psychological stress caused by gender dysphoria. UCLA’s Williams Institute published a report last year that found 2.8 million people over 13 identify as transgender in the United States, a quarter of which are between 13 and 17 years old.
Multiple national organizations support the benefits of GAC for trans children. A study published by the American Medical Association found trans youth experience a high rate of depression, anxiety, suicidal ideation and suicide attempts due to social rejection, such as a lack of support from parents, bullying and general social stigma. But, despite those factors, the study found those who received GAC reported significantly lower odds of depression and suicidality over 12 months.
Morton has worked with trans patients at a variety of ages and has witnessed firsthand the significant, life-changing benefits of hormone therapy, saying she sees “the amazing shift of finally being themselves and seeing themselves.” Most patients, before having access to care, she added, experience “abject depression or anxiety to ever go out of the house … complete disassociation, like maybe you’re faking it all the time, that there’s no authenticity to your experience, suicidality” and found that patients’ quality of life increased almost immediately once they were on hormones.
“I don’t want to say it’s like a magic wand, but it almost feels like it sometimes,” Morton said.
Part of the Trump administration’s targeting of trans youth has been the spread of misinformation about GAC. As a Cal Poly Humboldt lecturer, Loren Cannon has spent years studying the impacts of the politicization of trans identity and how other parties benefit from it. He also said that even with the wealth of studies on the safety and importance of access to GAC, a government with an agenda will try to change that narrative for its own benefit.
“What we now see the government doing is putting pseudo studies out in order to support that alternative view of reality,” Cannon said, one that demonizes trans people. “Trans people are not dangerous in bathrooms. Children are not being transitioned in school. All of that is clickbait for somebody else to get in a political position for them to make a lot of money and [gain] power.”
Normalizing those ideas gives other organizations and individuals permission to follow suit, according to Cannon. Referencing academic discussions on government tyranny, one of the first things Cannon said healthcare centers must not do is cave to pressure early. “What that does is that tells the regime, ‘Yeah, go ahead.’ They’re going to open the way for you to oppress trans people more than you have before,” Cannon said. “And that is going to be worse for all of us, [if we are] not thinking about the people that it affects very, very carefully.”
Open Door is the area’s largest provider of medical care with 11 clinics across Humboldt and Del Norte counties serving 65,000 patients a year. It is also considered a Federally Qualified Health Center (FQHC), relying on federal funding to provide healthcare in high-need areas. Open Door CEO Tory Starr explained FQHC status yields a wide range of benefits, including the ability to bill Medicaid and Medicare, covered malpractice insurance and eligibility for federal grants and funding.
That also means the requirements and guidelines of Open Door’s FQHC contract are regularly updated by federal agencies, which the center’s leadership team then reviews. Starr said Open Door has no say in what those contract terms are and that this presidential term is the first time he has seen service restrictions added. The contract changes were established by federal agencies while annual funding awards were distributed before Medicaid/CHIP funding was restricted in October, according to Starr.
Unlike an executive order, the new contract language is considered legally binding.
“It’s like they’re upping accountability and the ramifications if you don’t follow the contract,” Starr said, like potentially losing FQHC status and funding. “So when you’re a federal grantee, you don’t get to choose which parts of the contract you get to implement or not. And before, the ramifications of not being compliant were not nearly as severe.”
The new contract language also stipulates that only patients who receive a diagnosis of gender dysphoria are barred from receiving hormone therapy or puberty blockers. Hormone deficiencies or endocrine disorders in cisgender patients, however, do not face this restriction.
“It all depends on the diagnosis. Certainly, there are other conditions that require hormone therapy, so it’s targeting the gender-affirming component,” Starr said.
Pippa Coulter, a pediatrician with Open Door, said that as access to healthcare gets restricted, communities may have to develop underground systems of distributing hormones. With widespread access to the internet, Coulter said, people who are in dire need of hormone therapy will find it, though perhaps through less secure means.
“For testosterone, the athlete demand, the weightlifter demand, there’s all sorts of gray market sites. We would prefer for people to be able to get this covered by their insurance because, you know, for obvious [financial and legal] reasons, and to know the quality of the products they’re getting,” Coulter said. “There’s absolutely no way that the government is going to be able to stop people from getting access to these products. There are plenty of perimenopausal people who are taking estrogen or people who could ask their physicians for estrogen who might know trans people who might need it.”
Open Door mainly handled the change internally, according to Starr, notifying providers and staff who would then speak with their directly impacted patients (not those over 19) about how to navigate changes in care. Open Door, he said, maintained access to hormone therapy and puberty blockers until the language in their contract officially changed in July.
After long periods of discussion and looking at frameworks in other clinics that are adjusting their services due to new federal policy, Starr said Open Door decided to take a risk in keeping its current patients under 19 who are on hormone therapy or puberty blockers, even though it doesn’t comply with new FQHC regulations. Starr said those patients will eventually age out of the restriction, adding that less than 30 patients under 19 received GAC medications from the center this year, most of which are over 18. He hopes that amid ongoing lawsuits against the federal government, Open Door will be able to stay under the radar.
“As we were having conversations around this, it became really clear … that if we disrupted the care that was currently being taken by patients … that would have been really disruptive to people,” Starr said. “So, we said, ‘OK, we’re going to take a calculated risk, and we’re going to continue to serve the people that we have there.’”
The initial announcement redirected patients who couldn’t receive GAC from Open Door to Planned Parenthood, which only serves patients 16 and older, or to True U Clinic, a virtual provider based in Colorado that does not take insurance. True U’s website lists intake appointments for hormone therapy costing $259 and follow-up appointments for $195 each.
Humboldt Democratic Socialists of America Secretary Vee Loring said Open Door didn’t publicly provide enough context for what led to the decision or give patients many alternatives. Since the number of providers in Humboldt is limited, Loring believes this puts a significant burden on trans children and their families to find GAC elsewhere.
“Before this group decision, you could go to your doctor and say, ‘Hey, I think I want to start this,’ and your doctor can help you,” Loring said. “They know your healthcare; they can communicate with your other specialists. Now you just get a phone number, and you don’t have any connection between your gender care and your regular healthcare. Instead of being able to have prescriptions for Open Door’s pharmacy for discounted rates, you have to find a different prescription or figure something out, visit clinicians far away, more than five hours away.”
In June, the state announced its 2026-2027 budget would include a $56 million pot for gender-affirming and reproductive healthcare facilities impacted by Medicaid cuts. However, Starr said it would be impossible to replace Open Door’s federal benefits through other avenues. The center bills the state for patients over 19 on Medi-Cal receiving GAC prescriptions, but not for those who are younger.
“That money is being utilized, it’s just not for this particular treatment by us and by many other health centers,” Starr said. “Most of the health centers … haven’t had as large of a population and they kind of quietly started to do those services. The hospitals have been much more the center of focus [for legislation and funding] with surgery … and we’ve seen lots of focus by both the feds and the state.”
Loring said Open Door could rely on state funding and that other options should have been considered. She also criticized the center for halting GAC to new trans patients under 19 before the Medicaid cutoff in October without specifying what new contract clause mandated it. California’s Department of Health Care Services, she noted, has urged healthcare centers to not cancel services or redirect patients and instead use funds from the state’s new budget.
The Medicaid restriction, according to Loring, “doesn’t ban the provision of gender affirming care under 18. It doesn’t change what private insurance will pay for or what people can pay for out of pocket. And it doesn’t stop states from funding their own Medicaid systems with their own money to pay for this care. It doesn’t take away the provider’s other federal funding for offering this care, like … has been threatened many times in other arenas of the federal medical funding system.”
Chrysalis Care, started by a group of local medical professionals, several of which are members of the Humboldt Trans Health Care Coalition, is being planned as a GAC clinic in response to Open Door’s policy change. Slated to open in November and sharing a building alongside With Open Arms Reproductive Health Care Services, it’s set to be open two Saturdays a month and offer access to hormone therapy, puberty blockers and referrals to mental health professionals. While people of any age are accepted, its care will focus on patients under 19.
Malia Honda, an internal medicine physician with Open Door, said she felt like the writing was on the wall before the center’s decision became public and the idea of a separate clinic was already being discussed. Most of Chrysalis’ staff also work with Open Door, which Honda said wanted to help with the new clinic’s mission and its volunteers.
“Freedom of choice is a really important [benefit] and being able to not be limited by one entity,” Honda said. “I think the current situation is the perfect example as to why there needs to be some options, that if there is an unprecedented time where our main access point is no longer able to offer care, we need to know that there’s going to still be something else.”
Chrysalis won’t be impacted by federal policy because it doesn’t plan to bill insurance and will be running off donations and grants that, said Sarah Kerr, a co-facilitator for the Humboldt Trans Health Care Coalition, will hopefully allow patients not to have to pay for prescriptions and visits. So far, the clinic has received a $25,000 startup donation from Open Door (meant to fully cover prescriptions and supplies for the first year, according to Starr), $5,000 from Queer Humboldt and $7,500 from the Humboldt Area Foundation. Chrysalis’ GoFundMe page has raised more than $8,000 out of its $14,000 goal. Chrysalis is meant to be “additive and not duplicative,” according to Kerr.
Kerr also said trans children need the support of the adults and medical professionals in their lives to be successful. Given that suicidal ideation among trans youth is significantly higher than cisgender youth, she said, GAC acts as both suicide prevention and another form of primary care.
“To be affirmed in who you are and that you matter, and that your uniqueness is valued, that’s such an important message for kids in general, to give them the best opportunity to grow up healthy and well-adjusted, all the things to help them have a flourishing life,” Kerr said.
Coulter echoed this sentiment, describing how having a range of available services will help counter federal pressure to restrict healthcare, and that Chrysalis will add to Humboldt’s layers of protection.
“We have to be very firm in countering this narrative that it’s a trolley problem, with trans kids on one track and everybody else on the other,” Coulter said, referring to the ethical exercise of determining who to sacrifice and who to save. “If it’s a trolley problem, we’re all on the tracks together, and we have to fix it.”
Chrysalis Care can be reached at chrysaliscare707@gmail.com or through its GoFundMe page.
Griffin Mancuso is a California Local News Fellow placed with North Coast Journal, Inc. Reach him at (707) 442-1400, or griffin@northcoastjournal.com. The California Local News Fellowship is a state-funded initiative to support and strengthen local news reporting. Learn more about it at fellowships.journalism.berkeley.edu/cafellows.
This article appears in Caring for Trans Youth.