Today, 16 states, plus Washington, D.C., require insurance to cover gender-affirming care: California, Colorado, Connecticut, Delaware, Illinois, Massachusetts, Michigan, Minnesota, Montana, Nevada, New York, Oregon, Pennsylvania, Rhode Island, and Vermont. But in all other states, insurance is not required to cover gender-affirming care—so trans people and their families are stuck paying the costs.

How much does it actually cost to transition without insurance coverage? And how are trans people in unprotected states persevering?