ST. LOUIS COUNTY — Sara and Erez Haluf bought their “forever home” six years ago in west St. Louis County, a walking path away from Creve Coeur Park. They added a patio in the backyard with a fire pit for late-night marshmallow roasting.

Their three kids spend summers at the neighborhood pool and play make-believe games in the basement rec room. The Halufs could picture themselves as grandparents there, hosting rambunctious family dinners.

In July, they are leaving those dreams behind and starting over a thousand miles away.

“We planted ourselves here,” Sara Haluf said. “And it all got ripped away.”

Last month, after years of failed attempts, Missouri joined 18 other Republican-led states in passing a law or policy that prohibits gender-affirming care for minors — leaving parents at a crossroads. Some are stockpiling medications or researching doctors in neighboring states. Others, like the Halufs, are uprooting their lives. The “political refugees,” as they call themselves, are teachers, lawyers, pastors, nurses and therapists. They are packing up, pulling their kids from school, and saying goodbye to friends and neighbors, cousins and co-workers.

“We love it here. We don’t want to leave,” said Jennifer Harris Dault of Maryland Heights, who has a transgender daughter. “But the mental stress is too hard.”

Harris Dault and her husband scrutinized a map of LGBTQ policies by state. They wanted a place with established protections, and landed on New York. They will head to Rochester next month with their children, 8 and 5.

Under Senate Bill 49, which Missouri Gov. Mike Parson signed into law on Wednesday, no one younger than 18 will be able to start puberty blockers or hormone therapy, interventions for gender dysphoria endorsed by major professional organizations such as the American Medical Association. The restrictions for new patients kick in Aug. 28 and expire four years later. The legislation also bars Medicaid payments for gender-affirming medical care and prohibits gender surgery for prisoners.

“We are simply trying to protect children,” said Rep. Brad Hudson after the bill was approved by the House on May 10. The Republican from Cape Fair sponsored the measure.

Adolescents already taking hormones can continue to do so. But the specter of more stringent regulations looms large, even for adults. A proposal that advanced in the House last session aimed to discontinue treatment for all minors. And an emergency order enacted — and later withdrawn — by Attorney General Andrew Bailey would have erected barriers for gender-affirming care regardless of a patient’s age.

The push to limit hormone therapy accelerated after a whistleblower report, released in February, alleged malpractice by the Washington University Transgender Center at St. Louis Children’s Hospital. The accusations by former case manager Jamie Reed, which the university has refuted, prompted an investigation by the attorney general.

Apprehension over legal and professional consequences has led some clinics — in Missouri and other states — to stop accepting new patients, postpone appointments and even cancel adult procedures.

In some ways, families in the St. Louis area have an advantage over transgender folks in states that are landlocked by bans. Missouri’s law does not indicate that there will be penalties for taking minors across the river to see a doctor.

Planned Parenthood’s eight offices in Missouri have already increased their hours for transgender patients, ages 16 and older, and held pop-up clinics in April to shoehorn new people into the system. The provider is expecting a rush at its Fairview Heights location in the Metro East come fall.

“We’re doing everything we can do to get patients what they need,” said spokesperson Julie Lynn.

Planned Parenthood has seen nearly as many transgender patients in the first five months of 2023 as it did all of last year. Some adults have reported that their doctors are no longer treating trans patients, Lynn said, or they are stuck on a waitlist at another health center.

Becky Hormuth of Wentzville completed an intake appointment for her 16-year-old son at Lurie Children’s Hospital of Chicago but was told two days later that its Gender Development Program was no longer going to treat out-of-state patients due to the influx in requests from border states that have passed care restrictions. A Lurie spokesperson declined to comment.

Terry Willits, 58, decided more than a year ago that he was ready for surgery, after four years on hormones and a lifetime of knowing he was transgender.

“I had been hiding,” said Willits, who lives in St. John. “It’s not a magic wand kind of thing. But I feel healthier now than I have in 30 years.”

Two weeks before his May 23 appointment, his surgeon, a Washington University physician, called Willits. The surgery was canceled. Things felt too unsettled, the surgeon told him.

A university spokesperson would not comment on Willits’ surgery or how the transgender center plans to proceed when the law is enacted in August.

Willits is frustrated for himself but worries more about young people just coming up. He remembers what it was like, as a kid on a farm in Iowa, knowing he was different and there was nothing he could do about it.

“I consider myself collateral damage in all of this,” he said. “There are ways for adults to get what we need. But kids are just getting kicked in the head.”

Families with children who are already under the care of endocrinologists say that although the watered-down bill that passed the Senate has spared their children — at least for now — they are not assuming they are in the clear.

“The fear is always there,” said the mother of a 16-year-old from Ballwin, who has taken to shielding her daughter from watching the news. “Could this be a slippery slope?”

Over the past few years, the number of people identifying as transgender, especially those younger than 25, has mushroomed, though the total is still estimated at less than 1% of the population. The debate over medical care is one facet of the cultural chasm that has engulfed complex and evolving views of gender identity.

A bill requiring athletes to compete on sports teams aligned with their sex assigned at birth also was just signed by Parson. Across the country, drag shows, bathroom access and classroom instruction have turned into political landmines. Several Florida cities have canceled Pride festivals, citing concerns for performers.

The rancor has spilled into marketing, with Anheuser-Busch and Target retreating from campaigns that drew ire from conservative commentators and threats from shoppers.

“I break down in private. I give myself 10 minutes,” the Ballwin mother said. “Then we gotta go crush the world.”

Susan Halla, president of TransParent, a national support and advocacy group based in St. Louis, has spent the past few months fielding calls from parents across the country.

“They’re all equally freaked out,” Halla said.

Nearly a third of transgender adolescents in the United States will be affected by new medical prohibitions, and another 15% are at risk of losing access to treatment, according to the Human Rights Campaign, an LGBTQ lobbying organization.

Halla’s son, who is transgender, no longer lives in Missouri. He graduated college in the spring and is putting down roots on the East Coast. Halla and her husband, both architects, are empty nesters in south St. Louis. They don’t like the idea of paying taxes in a state that “disavows my family’s very existence,” Halla said.

But they have mixed feelings about leaving others who don’t have the means to move.

“We talk about it a lot,” said Halla. “Do we stay here and continue to fight? What does it look like when the national election cycle rolls around again?”

Families of older children — most of whom aren’t directly affected by Senate Bill 49 — have been working on contingency plans for months, if not longer.

“We have multiple layers of safety plans,” said the mother of a 12-year-old from Wildwood. “It’s like a game of chess: ‘If this happens, we’ll have to do this. If that happens, we’ll have to do that.’”

A dad in south St. Louis meticulously measures out the testosterone his 16-year-old takes each day. They’ve acquired a small stockpile by not opening a new vial until the previous one is bone dry.

Michael Walk of west St. Louis County thinks his family will make it through until their 17-year-old daughter, an aspiring Eagle Scout, graduates next year. But they’ve applied to a high school in Los Angeles and contacted doctors there, just in case.

“You can’t stint on your kids. You have to take care of them,” said Walk. He knows families who have left, and college-age kids who won’t come back home.

“It’s a shame because these are wonderful and caring and brilliant people, and they are fleeing,” he said.

Who is leaving and where they are going is difficult to quantify.

“Does it matter how many move? If it’s two families, it’s too many,” said Cathy Renna of the LGBTQ Task Force, a nonprofit based in Washington. “And the reality is, if someone is so scared they’re going to move, they’re not going to broadcast it.”

Katherine Sasser did announce her family’s decision to leave Missouri — at a Columbia School Board meeting last month.

Sasser, a mother of three, was elected to the board in 2021. The former teacher works for an educational nonprofit, and the board position felt like a good way to serve the district where her children attend and her ex-husband, their father, still teaches.

Sasser did everything she could to thwart the medical ban. Like dozens of other parents, she has been a regular in Jefferson City, sharing her family’s story:

As a toddler, Sasser’s daughter, now 11, clomped around the house in her mother’s high heels. She swiped a dress from her sister’s closet and refused to wear anything else. By first grade, she had socially transitioned and was “thriving” in school, Sasser would tell lawmakers.

At first, she felt like she might be getting through to them. But by last year, the tone had shifted. An onslaught of anti-trans bills petered out before the final day of the session, but Sasser and her ex-husband could see what was coming.

“We defined where our line in the sand was,” said Sasser.

If a medical ban passed, they would leave the state where they grew up, fell in love, had their babies. Even after they split up as a couple, they lived blocks apart. Their new partners get along. All eight grandparents are nearby. They love their friends and neighbors.

But the tight network they had cultivated would not be enough if they could not get their daughter what she needed.

“None of us are safe,” Sasser said. “It’s not just the laws, but what’s in the water, what gets normalized in conversation.”

Transgender people are more vulnerable than the population at large to mental health conditions such as anxiety, depression and suicidal ideation. Research has shown that family and community support, as well as evidence-backed medical care, reduces those risks. 

The 11-year-old’s next step will most likely be puberty blockers to pause the physical changes of her biological sex. After a couple of years, when she is ready and her doctors and parents agree, she will start estrogen so that she develops breasts and wider hips, like other girls. She won’t grow facial hair. Her voice won’t deepen.

Sasser has been outspoken about the agony that fueled her family’s decision to move, but buoyed by unexpected support. When she explained at the school board meeting last month why she had to resign, she received a standing ovation.

“It was probably one of the most touching moments of my life,” said Sasser.

Still, she’s not telling people where the family is headed — just that it’s a sanctuary state with enshrined protections.

More than a dozen cities or states have identified themselves as refuges for trans people, mostly on the West Coast, New England and the Upper Midwest. Last month, St. Louis and Kansas City passed resolutions in support of trans residents.

Anne Kraus and her wife, Becky Biermann, have always felt safe with their two children in St. Louis, in their little oasis neighborhood of Tower Grove South. They thought that might be enough for them to hold their ground. By March, they knew it wasn’t.

“We have two big feelers as kids,” said Kraus. “When you have a young child who is targeted, it’s too much.”

This summer, they will relocate to Minnesota, which passed legislation designating it a haven for transgender people, like their 7-year-old daughter.

Moving day is coming up quickly for the Haluf family, too. Two months ago, Sara and Erez had a long talk after the kids were in bed. They could not risk the health of their 10-year-old, they decided.

“Getting a child the care she needs is not a choice,” said Sara Haluf. “It’s not fair to our kid to stay here.”

Their forever home went on the market May 5 and was under contract two days later. Haluf, a nurse practitioner, was offered a job at Johns Hopkins in Baltimore. They found a house there, the kids finished school, and the packing started.

“It’s been sad and upsetting,” Haluf said. “But we’re excited for a new adventure. That’s how we are framing it with the kids.”

Before they hit the road for Maryland on July 6, they’ll celebrate one last holiday here: Independence Day.