But that fall morning, Vanderbilt was thrown into chaos, and the clinic for gender-affirming surgeries, which serviced both trans youth and adults, had been shut down for the day. The health care worker, who is using a pseudonym in fear of retaliation from their employer, said the atmosphere among their colleagues in the trans health clinic was a mix of “fear and concern.”

Riley’s clinic remained open, and their colleagues debated whether they were safe at work or should go home. Riley said local police were lined up outside the medical center’s doors, serving as extra security for employees.

All day people whispered about the social media posts by right-wing blogger Matt Walsh, which had gone viral the day before for claiming that doctors at Vanderbilt’s transgender health clinic “castrate” and “sterilize” children.

At the time, Riley hadn’t heard of Walsh. They didn’t have social media and rarely watched the news.

But over the next year, Riley would witness firsthand — again and again — how misinformation and right-wing attacks on the transgender health clinic severely restricted the kinds of care they could provide at Vanderbilt. In those months, trans Tennesseans have felt more intimidated and desperate than ever, as they have been forced to decide whether to pack up their lives to find a place where they can exist without the fear of the government, or right-wing provocateurs, meddling in their private medical information.