Some of Oklahoma’s most vulnerable residents face stark shift in care as harmful law takes effect

Fight over 2STGNC+ gender-affirming care access distracts from bigger health problems plaguing state

October 12, 2023 5:29 am

Oklahoma youth will be barred from accessing gender-affirming care treatment after a judge allowed a new law to take effect. (Getty Images) (This image cannot be republished unless you have a subscription to Getty.)

Oftentimes when talking about attacks on Two Spirit, transgender, and gender nonconforming+ (2STGNC+) folks, people will lead with facts about disproportionately high suicidality or violence our community members face when trying to live as their authentic selves in societies where compulsory heteronormative, cisgenderism is still the norm.

But research suggests that if you’re unfamiliar with 2STGNC+ folks, or haven’t made up your mind about whether or not we deserve the safety to thrive as ourselves, that you’ll be turned off by those statistics.

The most effective messaging is proximity — the chance to meet, to know someone who is 2STGNC+.

And while I wish we lived in a society where we could honor one another’s humanity without having to have a personal experience with someone who is being attacked or marginalized or excluded or harmed, I know that we’re not there yet.

It’s why our 2STGNC+ community faces disproportionate harm in Oklahoma. The state is one of the few remaining states where members of the public and experts cannot give on-the-record testimony during the legislative process.

So, let me be your entry point to knowing a 2STGNC+ person if you don’t already.

My name is Nicole McAfee. I use they and she pronouns, and I am trans-nonbinary.

I grew up in a small town, graduated from a public, countywide school with a class of 14. I earned my American FFA degree with market rabbits as my supervised agricultural experience program, my 4H Gold Star Award, and lettered in academic competitions and cheerleading.

I didn’t come out for the first time until college, and I didn’t fully step into my queer and nonbinary identities until I was an adult, settled in Oklahoma City, where I discovered the best language to communicate who I am, and found more queer community than I had ever before known.

My gender journey hasn’t involved physical medical interventions thus far, though my partner’s has, off and on. And I can’t say that is typical, because there is no singular trans experience. We aren’t a monolith, and gender-affirming care is different for each person, rooted in best practices and rigorous scientific research, and meeting the needs of each individual person to best live as their authentic selves.

But now the state of Oklahoma has inserted itself into the ability to access best practice, gender-affirming medical care.

SB 613 will go into effect on Nov. 1, and 2STGNC+ youth in Oklahoma who have been receiving best practice, gender-affirming care may no longer receive such care due to the court’s denial of the injunction request. As a result, doctors cannot provide best practice care to their patients due to their age, gender, and the unfortunate circumstance of being born and raised in Oklahoma during an anti-transgender policy wave.

And, even in the context of this policy, which I won’t make light of, as it will cost some 2STGNC+ youth their lives, the folks moving these harmful bills are trying to keep us from discussing the bigger picture problems.

Oklahoma has one of the highest uninsured rates in the nation, and 2STGNC+ folks, especially those who live at the intersections of exclusion and hardship because of race, ethnicity, and class, are disproportionately represented among the un- and under- insured. We also exist among the 5 worst states for pediatricians per capita, a worsening problem as laws like SB 613 drive away doctors who provide care for far more than just 2STGNC+ patients. They refuse to practice in a state that bars them from meeting the medical needs of young people purely for partisan, political gain.

So maybe you aren’t aware of 2STGNC+ folks in your community.

Maybe it takes it becoming personal for you to help 2STGNC+ Oklahomans. But know that as you pause to determine if this is something worthy of your interest or action, we’re losing providers, we’re losing families, and 2STGNC+ folks are losing their lives, waiting for there to be enough political courage for folks who don’t know us to help us build a present, and a future, where we all have the safety to thrive as our authentic selves.

November may mark a season of gratitude for you and your community, but this year it also marks a stark shift in available care for some of our most vulnerable community members. May your generosity in this season extend to your 2STGNC+ neighbors and relatives, as we fight for access to medically necessary gender-affirming care.

I also want to note that news stories about the increasing hate-based rhetoric and violence targeting our communities have a measurable impact on suicidality. It is critical to amplify affirming mental health resources. There are mental health supports available, such as Trans Lifeline (877-565-8860), the Trevor Project (call 1-866-488-7386 or text START to 678-678), SAGE Elder Hotline (877-360-5428), and the LGBT Hotline (888-843-4564).

For families of 2STGNC+ youth seeking resources in response to the gender-affirming care ban that takes effect in November, the Campaign for Southern Equality has low-barrier funds and resources available through their Southern Trans Youth Emergency Project at

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Nicole McAfee
Nicole McAfee

Nicole McAfee, who uses they and she pronouns, is a queer, nonbinary person living and working in Oklahoma. They serve as the executive director of Freedom Oklahoma, an organization dedicated to building a future where all 2SLGBTQ+ folks have the safety to thrive.