BALTIMORE — Jake Ferruzzi keeps a picture of himself as a toddler on his desk at home.

In the photo, his younger self is dressed in an oversized turtleneck covered in purple hearts and pink flowers, his light blond hair cut into bangs.

“I never knew the life that I’m living today was possible — like that little kid never knew it was possible,” said Ferruzzi, 29. “I feel like I’m living my life today for him and giving him that joy.”

Even at 3 years old, roughly the age Ferruzzi is in the photo, he knew he was a boy. But he didn’t have a word for the disconnect between his mind and body — transgender — until he was 14. Since then, with support from his family, he’s gotten medical care to help him feel more at home in his body.

This medical treatment, known as gender-affirming care, is lifesaving, according to Ferruzzi and other trans Baltimoreans. It will become more accessible Jan. 1 to the estimated 94,000 trans and nonbinary people living in Maryland. That’s when the Trans Health Equity Act goes into effect, expanding the number and types of procedures that Medicaid will cover in the state.

Advocates celebrated the bill’s passage earlier this year, but it’s expected to put pressure on the state’s infrastructure for providing gender-affirming care. There already aren’t enough doctors trained to provide this type of care, advocates say, and providers are concentrated in cities.

In another stress on the system, other states have moved in the opposite direction, heavily restricting or banning access to such health care, especially for young people. With Maryland Gov. Wes Moore signing an executive order in June to protect gender-affirming care here, advocates say trans people are already arriving for treatment.

It’s like a “double-edged sword,” said M. Tica Torres Bolivar, care coordination manager for Planned Parenthood of Maryland.

“Yes, it’s beautiful,” he said, but “we don’t have the capacity. We already didn’t have the capacity, and now we’re just seeing more and more people coming to get care here.”

Currently, Maryland’s Medicaid program covers some gender-affirming care, such as hormone therapy and some surgeries, for patients 18 and older.

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