THE FUTURE OF TRANS MEDICAL CARE IN AMERICA COULD LOOK A LOT LIKE PROHIBITION

If the law makes living your life effectively illegal, you have to sidestep the law to remain yourself:

With her insurance about to run out and Republicans in her home state of Missouri ramping up rhetoric against gender-affirming health care, Erin Stille nervously visited a foreign pharmaceutical site as a “last resort” to ensure she could continue getting the hormones she needs.

Stille, 26, sent a $300 bank transfer to a Taiwan-based supplier for a 6-month supply of estrogen patches and androgen-blocking pills. For three weeks she feared she'd been scammed but breathed a sigh of relief when a large package arrived at her home in St. Peters....

Stille, and others nationwide, are scrambling to form contingency plans as Republican politicians rapidly erode access to the gender-affirming treatments many credit as life-saving.

In mid-April, Missouri attorney general Andrew Bailey issued what he called an "emergency rule" placing an extraordinary number of restrictions on medical care for trans adults in the state. Among the restrictions:

The order institutes a three-year waiting period for medical intervention and requires psychological or psychiatric assessment.

The assessments must consist of at least 15 sessions over 18 months, at least 10 of which must be with the same therapist, to "explore the developmental influences on the patient’s current gender identity and to determine, among other things, whether the person has any mental health comorbidities."

Those who transition would be a required to get medical follow-ups for 15 years.

And:

Patients also must first be screened for autism and “social media addiction,” and any psychiatric symptoms from mental health issues will have to be treated and resolved.

A judge temporarily prevented the rule from taking effect. But this could be the future for trans people throughout Red America -- and possibly in all of America.

The alternatives?

... the gray market ... is comprised of unregulated suppliers who sell legitimate medications, sometimes name-brand, outside the distribution channels authorized by the manufacturers. Some trans people in GOP-controlled states that have not yet enacted bans are buying from these suppliers to build an emergency stockpile.

But self-administering hormones without adequate supervision can be “extraordinarily dangerous,” especially for those taking testosterone, said Dr. Robert Lash, chief medical officer at the Endocrine Society, which represents specialists who treat hormone conditions.

Last year, I speculated that abortion will be kept available in a Republican-controlled America by people operating outside the law, or at least outside official medical channels.

I'm imagining a future in which obtaining abortion drugs will be like buying cocaine or meth -- you'll be able to make the purchase because shady characters make it possible. If you have the money and the right connection, you'll get the pure abortion pills imported from Europe or Canada; if not, well, good luck. Probably you'll get something that's not (or not very) adulterated, but it'll come with no guarantees....

Doctors who perform abortions might need organized crime protections, too. When a group of pre-Roe feminists known as the Janes began providing abortions in Chicago in the late 1960s, "it was rumored that many Chicago abortion services paid for Mob protection," according to Chicago magazine. One history of the group says that "Mike, the man who taught the first Jane volunteers how to perform abortions, had learned from a Mafia doctor." All this could be our future.

Maybe we won't arrive at that future soon because of the national backlash to Republican anti-abortion absolutism. But the future for trans people might look a lot like this.