Just a month ago, Katie, a Texas mom, had no plans to leave her home.

Even after Gov. Greg Abbott urged Texans in February to report cases of minors receiving gender-affirming care, Katie — who has a 15-year-old transgender son and knew she could be investigated — planned to stay and fight.

But things started to change for Katie when the Texas Children’s Hospital announced last month that it would pause gender-affirming services for minors in light of the directive. Her son lost access to his care program for three weeks until a judge paused the state’s investigations.

“That just really shook me,” said Katie, who asked that her full name not be published to protect her family’s privacy. “The things that you never would think would happen somehow are reality, and I can’t live with the uncertainty. It’s eating us up.”

A spokesperson for the Texas Children’s Hospital said in an email that the hospital “remains deeply committed to our transgender and gender-diverse patients” and will “continue to monitor the ongoing legal proceedings in determining how best to proceed.”

Her son’s initial loss of gender-affirming care was the turning point for Katie and her family. Katie decided that after her son finishes 10th grade this summer, the family would move to Denver. 

Her son, N., told NBC News last month that things have been “awful” since the governor’s directive. “It was hard to stay in one piece and not break down on everything,” he said. 

Katie said that since the family decided to move, N. has been doing the best he can to stay positive about it.

“But his heart is broken,” she said. “We’re leaving Texas temporarily on our terms with the hope and prayer that come November, we’re going to get to come back home and it will be a joyous homecoming.” 

Last month, NBC News spoke to a dozen parents of transgender children, as well as to trans teens, following Abbott’s directive. At the time, only one of those families had planned to move. Now, three, including Katie’s family, have said they will leave the state. 

The three families who are departing said they didn’t make their decisions overnight. But they had watched Texas officials become increasingly bold in targeting transgender people in recent years. 

In 2015, the state began to consider a “bathroom bill” that would have banned transgender people from using public and school restrooms that aligned with their gender identity. 

Since then, the Legislature has ramped up its efforts. Last year, it considered more than 50 bills targeting transgender people. Only one made it to Abbott for a signature: a bill that bars transgender students from playing on school sports teams that aligned with their gender identity. 

But one of the other failed bills prompted an opinion from state Attorney General Ken Paxton, who declared on Feb. 21 that gender-affirming medical care such as puberty blockers, hormone therapy and surgery cause “irreparable harm” to minors and were child abuse under Texas law. Abbott followed with his directive to the state’s Department of Family and Protective Services the following day. 

“I’ll do everything I can to protect against those who take advantage of and harm young Texans,” Paxton said at the time, arguing in his opinion that minors cannot consent to gender-affirming medical care.

He has since taken several actions to defend and double down on his position. He appealed both injunctions issued by judges: a narrow injunction on March 2 that paused one of the state’s investigations into a Child Protective Services employee and a statewide one issued March 11 that paused all investigations. An appeals court reinstated the statewide injunction and it remains in place. 

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Paxton also filed investigative demands on March 24 against two pharmaceutical companies, Endo Pharmaceuticals and AbbVie Inc., alleging that they advertised their products as treatment for gender dysphoria rather than the medical conditions they were approved to treat.

The efforts from Paxton, Abbott and the state Legislature have had widespread effects. The Children’s Medical Center in Dallas removed all references to Genecis, its gender-affirming care program for minors, from its website in November and said the program would no longer take new patients. Last month, 850 doctors, medical students and employees at two Dallas hospitals signed a petition opposing the decision.

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Paxton has also tweeted about transgender people, even repeatedly misgendering Dr. Rachel Levine, assistant U.S. health secretary and the first openly transgender Senate-confirmed federal official, prompting Twitter to flag the tweets.

All of it is adding up, and parents and LGBTQ advocates say they are exhausted. The Rev. Remington Johnson, a Presbyterian clergy member and a trans advocate, said she spends her days texting with the parents of trans kids in Texas and doesn’t know of any family who hasn’t considered leaving the state. 

Even if advocates continue to defeat anti-trans bills, and even if the courts ultimately shoot down Abbott’s directive, they will leave behind a persistent “climate of terror,” she said. 

“This is why there have been doctors that have just stopped treating trans kids,” she said. “It’s not because there’s a law, it’s because this is what terror-inducing bills do. It is the same playbook as the bounty-hunter style abortion bill, where it’s about causing anxiety and fear to stop the thing that you don’t want to be happening.”

She noted that Lt. Gov. Dan Patrick has already signaled support for a bill similar to one recently signed into law by Florida Gov. Ron DeSantis, the Parental Rights in Education Act, which bars discussion of sexual orientation and gender identity in some classrooms. Critics of the bill have dubbed it the “Don’t Say Gay and Trans” bill. 

“Texas will work to pass what Florida passed but make it worse,” Johnson said. “It will be harsher, it will be more extreme.”

K., another Austin mom of a 10-year-old trans daughter testified against anti-trans bills at the Capitol last year, when the Legislature held three special sessions to pass the trans athlete restriction. She said that once it was over, she and the other advocates planned to take time off to recover and strategize for the next session. 

But then Paxton and Abbott released their letters two months into the new year. 

“Here we see that these two extremist politicians circumvented the legal process in order to implement these policies,” she said. 

K., who also asked that her full name not be published out of privacy concerns, said that she realized that even though she and the other parents and advocates “followed the rules” and won, they’re still losing. “It makes me uncertain that we would be protected even though our kids have not received gender-affirming medical care at this point,” she said. “And I can’t fight offensively when I’m already down on the ground just trying to fend people off of my kids.” 

She plans to move her family to Oregon this summer.

Parents also expect that the next legislative session, which starts in 2023, will be worse than the last. That’s why Heather Crawford, an Austin mom whose 15-year-old is trans, said she plans to move her family to Minnesota this summer. 

“I have zero faith that it will stop,” she said. Her 15-year-old, Cass, was born and raised in Texas, but “I cannot ask them to spend the last years of their childhood in a state that wants to criminalize their existence.”

Cass, who uses “he” and “they” pronouns, said the idea of moving to a state with a number of pro-LGBTQ laws — and was the first to outlaw discrimination based on sexual orientation and gender identity in 1993 — is a huge relief. He said Paxton’s and Abbott’s efforts will put trans people in danger. “It’s saying that people can get away with transphobia towards everyone in the community, including kids,” he said.