An undercover investigation published October 29 by City Journal reports that a nationwide network is helping families keep giving children puberty blockers and cross-sex hormones in states that ban them.
Christina Buttons, an investigative reporter at the Manhattan Institute, posed as the mother of an 11-year-old girl in Nashville, Tennessee. Tennessee has banned these drugs for gender transition in minors since 2023. Buttons told the group she contacted that her daughter had recently started calling herself "nonbinary." She said the girl had no long history of this and had never been seen by a doctor about it.
Buttons applied to the Trans Youth Emergency Project, run by the Campaign for Southern Equality, a North Carolina LGBT advocacy nonprofit. According to City Journal, the project started in 2023, now works in all 27 states with bans, has more than 130 local and regional partners, and has given more than $1 million in travel grants to over 1,200 families.
"That is exactly correct"
Buttons was put in touch with a "care navigator" named Amanda. Buttons asked whether it was accurate to call puberty blockers a "pause button on puberty."
"That is exactly correct," Amanda replied, according to City Journal. She said 11 was a good age to start considering the drugs. Asked whether the girl calling herself "nonbinary" could keep her from getting puberty blockers, Amanda said, "Absolutely not."
Amanda said providers usually need approval from only one parent, even when parents disagree. She also said the drugs themselves are legal because they are prescribed for other conditions. "It is the prescribing for gender dysphoria from a local doctor that would not be okay," she said. She added that "a lot of folks are able to get the meds locally," including through pharmacies in Tennessee or by mail.
Amanda offered a $500 travel grant, available up to four times a year. In a second call, a navigator named Gracey offered a caller posing as an Idaho parent a $500 grant by Venmo or PayPal before any appointment was booked. "We do not require any receipts," she said. City Journal says it did not accept any money.
Other diagnosis codes
Buttons reports that some referred providers discussed using diagnoses other than gender dysphoria.
At a private practice in Bloomingdale, Illinois, an employee told her the clinic used a general "endocrine disorder" code for labs and drugs, so pharmacies would not know why the drugs were prescribed. He said the clinic could mail estradiol and testosterone to her home or send prescriptions to her local pharmacy. City Journal notes that using false diagnosis codes to get insurance coverage has drawn federal fraud investigations.
At Main Line Health in Pennsylvania, a nurse said the clinic's nurse practitioner knew "all the different tricks," including codes that "don't specifically say anything about gender." A representative at Oregon Health & Science University's Doernbecher Children's Hospital called another diagnosis "one possible avenue" and said, "we'll absolutely do that" if insurance allows it.
A clinic in Kalamazoo, Michigan, was described as possibly using such codes. Its communications director told City Journal it does not change diagnosis coding "to circumvent applicable legal restrictions."
Mailed drugs and virtual visits
City Journal reports that clinics in Michigan, Wisconsin, Colorado, Minnesota, and California discussed shipping drugs to patients' homes or sending prescriptions to Tennessee pharmacies.
The office manager at QueerMed, a telehealth provider, described families driving into a state where the drugs are legal, holding a video visit from their car, and going home. She said puberty blockers could be shipped to a Tennessee address and that patients did not have to prove their location. QueerMed's founder later told City Journal the company does not mail drugs and that its providers verify every patient's location.
Some clinics, including Cedars-Sinai in Los Angeles and UCSF Benioff Children's Hospital Oakland, required patients to attend visits and pick up prescriptions in California.
Funding
According to City Journal, the Campaign for Southern Equality's 2024 tax filing reported nearly $3 million in revenue. Gifts of at least $1 million each came from MacKenzie Scott, the Arcus Foundation, and the Chicago Community Trust.
City Journal cites systematic reviews that rated the evidence for puberty blockers and cross-sex hormones in minors as "low quality" and "very low certainty."
---
Sources
- Christina Buttons, "Inside the Network Helping Families Evade Bans on Pediatric Gender-Transition Treatments," City Journal, Oct. 29, 2026: https://www.city-journal.org/article/pediatric-gender-transition-treatments-bans
Cover image is an illustration.
- united states
- tennessee
- puberty blockers