NORTHAMPTON — When Scotia MacGillivray moved back to Northampton four years ago after spending decades away, the flags were the first thing she noticed. Hanging from people’s homes and businesses, their colors catching in the sunlight, were dozens of rainbow-colored pride flags lining the streets.

And, even more surprising to MacGillivray, were the trans flags — light blue, pink and white — fluttering in the breeze.

“Wow, my hometown has really changed,” MacGillivray recalled saying to herself. “This is pretty … awesome.”

MacGillivray, a 61-year-old transgender woman who was born and raised in Northampton before moving away for college, has spent 40 years in California’s Bay Area. She lived on-and-off in Thailand for 25 years and worked in Cambodia and Haiti, too. Now, she splits her time between California and Massachusetts. But despite all her travels, Northampton’s enthusiastic embrace of its queer community is unlike anything she’s seen before. That also drove her to want to protect it.

“I mean, people felt bold enough to do that type of thing here,” she said about the flags. “So I was like, ‘Well, there should be some protections for being kind of a pretty vulnerable population.’”

She was right to be thinking about extra protections.

During the last election cycle, Republicans put trans people — a mere 1% of the United States population — directly under the spotlight. They turned trans lives into political battlegrounds, using gender-affirming care and participation in sports as wedge issues to cleave a deeper cultural divide.

Northampton, once famously dubbed “Lesbianville, USA” by the National Enquirer, has long been considered a safe haven for the LGBTQ+ community. As other states introduced bills to restrict transgender rights, Northampton remained insulated by its liberal bubble. But now, with policy rollbacks spearheaded by the federal government, even Northampton is scrambling to adjust.

The city had already begun the process of protecting trans rights before Trump came to office.

Last October, the City Council passed a resolution declaring Northampton a sanctuary city for trans and gender-diverse people. Though nonbinding, it reiterates Northampton’s support for its substantial transgender community while acknowledging the uncertain political climate that made its passage necessary.

“Some people would say it’s more dangerous to take stands now. And I think it’s actually critical that we actually are very clear about what we expect from our community,” said City Councilor Rachel Maiore, who worked with MacGillivray to craft the resolution.

Though the resolution was proposed and passed before the presidential election, both sponsors and supporters of the bill were concerned by the increasingly aggressive rhetoric that Donald Trump’s campaign used to attack transgender people.

“I am so thrilled to live in a community that sees me and cares enough about me and people like me to do this,” said Mariel Addis, a Florence resident who spoke in support of the resolution at community hearings. “And at the same time, I just wonder how much teeth it has in the face of the power of the federal government.”

Less than two weeks after taking office, Trump’s administration unleashed a wave of executive orders targeting transgender people — stripping away protections in health care, education, sports and the military.

One of the most sweeping changes was a federal directive redefining sex under the law. Federal agencies were ordered to recognize only male and female identities based on birth-assigned sex, a move that effectively erased legal recognition of transgender and nonbinary people.

In addition to mandating binary sex classifications, Trump has also rolled out executive orders restricting access to gender-affirming care for those under the age of 19, barred transgender women from participating in women’s sports, and directed the Department of Defense to formulate a new policy for transgender people serving in the military, a potential step toward an outright ban.

“Having seen right-wing governments go and right-wing governments come, this is a little bit different,” MacGillivray said. “These people are on a mission to destroy things.”

Transhealth’s impact

For Mel DeSilva, director of development and communications at the Florence-based health care clinic Transhealth, the executive orders are as insulting as they are devastating.

“If we care about kids, and everyone claims to care about kids, then we need to let health care providers and families and parents support their kids and do their jobs. Politicians should not be practicing medicine,” they said.

DeSilva has seen firsthand how access to gender-affirming care can positively impact youth mental health. They were first introduced to Transhealth by their child, who is transgender, and was looking to switch health care providers.

“When my kid started going to Transhealth there was an immediate increase in confidence, an immediate improvement in their sense of self that I’m extremely grateful for. They were supported in being themselves, and that is priceless,” DeSilva recalled.

Founded by entrepreneurs and advocates Dallas Ducar and Perry Cohen in May 2021, Northampton was chosen as Transhealth’s inaugural location after a study found there were 20,000 people in the region who could benefit from its services. Before the clinic’s opening, western Massachusetts was a “treatment desert” for gender-affirming care, meaning people were often forced to travel to Boston to see specialized providers.

Sometimes, the length of that two-hour trek jeopardized patients’ health.

When Mariel Addis was undergoing a series of gender confirmation surgeries at a Boston hospital in 2018, she had to travel back and forth across the state multiple times. One night, the day before she was supposed to travel to Boston for follow-up surgery, she started feeling sick. Far away from her medical team but feeling bad enough that she couldn’t stay put, Addis packed up her array of medical equipment and went to the ER at a local hospital.

“I felt like I was an old Volkswagen brought into a Chevy garage,” she recalled of the experience. “It was a very weird feeling because I just felt like they were really not up to speed. I mean, they knew I had gender confirmation surgery, but they didn’t do them here so it was kind of beyond them in the ER.”

Addis ended up being sent by ambulance to her team in Boston to get the care she needed. Looking back, she believes the care landscape in Northampton has improved — something she partially credits to the arrival of Transhealth.

In creating a space tailored specifically for trans and gender-diverse clients, Transhealth CEO Jo Erwin hopes experiences like Addis’s become less and less common. In addition to providing care, Transhealth prides itself on hiring staff with the cultural literacy and lived experience to better help trans patients. That means they have the forethought to offer services that other providers may not think of.

“One of the things that some of our trans women have expressed is that when they first transitioned, it was really difficult to find shoes that fit right, because they are typically a little bit larger,” Erwin said. By offering a community closet where people can drop off and take clothes, those small gaps are filled.

“People ask like, ‘what do you do that’s gender affirming?’ Erwin said. “And the answer is everything.”

Safety precautions

Now, Erwin runs through the laundry list of additional safety precautions Transhealth has added since the election: visitor buzz-in rules, robust camera and alarm systems, and security drills preparing for a wide range of potential threats.

“[We’re] really just thinking with our staff about what they need to feel safe, and how do we make sure that we’re providing that environment for them,” Erwin said.

While the policy landscape is shifting on all fronts, the executive order Transhealth is monitoring most closely targets gender-affirming care for people under the age of 19. At this time, they do not expect any disruptions of care as a result of the executive order.

Transhealth does not receive meaningful federal funding from agencies such as the National Institutes of Health or the Center for Disease Control, which, in Erwin’s words, gives them “some nimbleness that some of the big hospitals may or may not have.”

Still, that doesn’t make the political climate any less concerning.

“One of the things that happens when fascism rises in a country is that the most marginalized people are attacked and scapegoated as part of that rise, and that’s what we’re seeing,” DeSilva said.

Particularly when it comes to children, critics argue that drugs taken for gender-affirming care are experimental and too freely given. However, according to a study published by the peer-reviewed medical journal JAMA Pediatrics this January, fewer than 0.1% of adolescents received drugs for gender-affirming care between 2018 and 2022, and zero prescriptions were issued for any transgender patient under 12 years old. Additionally, the most frequently given drugs to pediatric patients are puberty blockers, which are reversible and have also been used for non-trans youth who experience early onset puberty.

“The politicization of gender-affirming care for transgender youth has been driven by a narrative that millions of children are using hormones and that this type of care is too freely given. Our findings reveal that is not the case,” Landon Hughes, the lead author of the paper, told The Harvard Gazette.

Gender-affirming care is supported by major medical organizations including the American Medical Association, the American Academy of Pediatrics and the American Psychiatric Association, which all concur that it is lifesaving medical care.

“I’ve just never felt this happy in my life,” said Mariel Addis. “Happy isn’t quite the right word, but I feel like I can do things that I never could have done [pre-transition].”

Past can inform the present

In trying to understand the current shifts in public opinion, Scott LaCombe, a government professor at Smith College, looks to the past. He points to the evolution of public sentiment toward marriage equality in the early 2010s, when LGBTQ+ activists began seeing significant gains after rhetorically tying the movement to existing American cultural values.

“A lot of the opposition to same-sex marriage was, ‘This is an attack on traditional family values,’ right? ‘This is an attack on marriage which has existed as an institution,’ and I think they really struggled to show a really concrete harm,” he said.

In attacking transgender rights, conservative activists have tried to hone in on proving some kind of “harm,” even if it’s contrived. LaCombe points to two main issues where public support has eroded: gender-affirming care for minors and trans women in sports.

On both, he says, conservatives have inflamed the culture war by arguing harm — either by invoking “save our children” rhetoric to paint trans youth as victims of predatory medical practices, or by platforming the stories of female athletes who placed behind their trans competitors in various events.

A February 2025 Pew Research Center poll found that 66% of adults support requiring trans athletes to compete on teams that match their assigned sex at birth, an eight-percentage-point increase from 2022. At the same time, 56% of those polled supported banning medical professionals from providing “medical care for a gender transition” to minors, up from 46% in 2022.

Trump’s talking points aren’t solely concentrated in conservative circles, either.

In the aftermath of last year’s election, U.S. Rep. Seth Moulton (D-MA) suggested the Democratic Party’s unwillingness to fully address transgender issues was partially to blame for their loss. He suggested the question of trans women in sports, in particular, was one Democrats would have to equivocate on to start rebuilding a winning coalition. While advocates and fellow politicians sharply criticized Moulton’s comments, they reflect a growing divide in perceptions of how the party should operate going forward.

“Are there issues we’re willing to cede ground on in order to win elections, and are those concessions going to be too large for trans activists to stomach?” asked LaCombe, who heads a research lab tracking state-level policy adoptions that affect LGBTQ+ rights.

With that question up in the air until at least the next election cycle, LaCombe pointed to local politics as a way to take the temperature of the electorate.

“The vast, vast, vast majority of progress or harm that’s going to happen on LGBTQ rights is going to be at the state and local level,” he said. Understanding shifts in discourse there is critical to “reading the tea leaves” of what could happen nationally.

Laura Fay is a recent graduate of Smith College. This article was written for the Smith College Journalism Capstone class advised by Dusty Christensen.