Calvin Kasulke was living with his parents when he came out to them as a transgender man. All of a sudden, he recalled gingerly, “I was disinvited from living at home.”

He needed a new place to stay. And Ithaca, New York, where he had gone to college, was the obvious choice. He would have friends there, he figured, and a place to live.

“And also,” he said, “Planned Parenthood was there.”

Unbeknown to many, Planned Parenthood is one of the largest sources in the US of transgender healthcare. The embattled provider offers hormone replacement therapy, which helps a person’s body appear more masculine or feminine, at dozens of its locations, and a growing share of its staff are trained to perform routine sexual health exams for trans patients.

“They are one of the most important providers of trans healthcare in the country,” said Harper Jean Tobin, the director of policy for the National Center for Transgender Equality, adding that their clinics are some of the few transgender healthcare providers located outside major cities. “Many of their clinics are the only places for miles around that trans people can go to for hormone therapy, HIV tests, and pap smears, and not face discrimination.”

With Congress on the brink of attempting to defund Planned Parenthood because of its role as an abortion provider, those services could easily be caught in the crossfire. Each year, Planned Parenthood is reimbursed hundreds of millions of dollars for family planning services it provides at little or no cost to low-income Americans. If Congress were to freeze Planned Parenthood out of those funding streams, it could force an unknown number of health centers to close. Health providers have long warned that this would have a detrimental impact on women’s health. But, Tobin said, the cuts could be particularly “disastrous” for trans people.

“As it is getting more real, in the back of my head I said, ‘Oh shit. What am I going to do now?’” said Raven Green, a patient of Planned Parenthood of the Southern Finger Lakes. “I don’t know where else I would go.”

The state of transgender healthcare in the US is already a fragile one. In one survey after another, large numbers of transgender people report difficulty accessing both basic and specialized services because of biased providers or the distance to the nearest provider with adequate knowledge of trans health issues. Only about two-thirds of trans people who want hormone replacement therapy, a common treatment during gender transition, have actually received it, according to a major survey of transgender adults taken in 2015, and 23% have avoided getting essential care out of fear of harassment. Thirty-three percent have had a negative experience with a healthcare provider, like needing to teach their doctor the fundamentals of transgender care. And 29% reported having to travel at least 25 miles for transition-related care.

The result is that thousands go without care every year.

“Everything is stacked against trans people” in the healthcare system, said Kasulke, who now volunteers with Planned Parenthood part-time. “There’s always an extra layer of, am I going to have to educate my own provider? Is it safe to come out to this person? You’re having to advocate for yourself in a really vulnerable situation.”

Planned Parenthood in recent years has sought to address that problem. And it has made its clinics a magnet for thousands with few other options. Starting with Planned Parenthood of the Southern Finger Lakes, in upstate New York, a growing number of its health centers have become places where trans people can begin to transition medically, as well as get basic reproductive services. Its centers use a newer model for gender transitioning that gives the patient input on whether to start their transition, rather than turning the decision over entirely to a psychiatrist. Some clinics have staff with detailed knowledge of how to update driver’s licenses, passports and social security cards to reflect someone’s name and gender.

“It’s this little oasis in the middle of nowhere,” said Luca Maurer, the program director for Ithaca College’s LGBT center. His center has a partnership with Planned Parenthood. Previously, he said, many trans students and locals would drive to Manhattan or Philadelphia, at least four hours each way, for prescriptions and the routine checkups that accompany gender transition. A handful even crossed the Canadian border for treatment in Toronto.

Luca Maurer, the program directors for Ithaca College’s LGBT center, which partners with Planned Parenthood. Photograph: Jenn Foy Photography

“If I didn’t have them available to me, I’m not sure what I would do,” said Maurer, who is trans. “It would be a crisis. And I’m saying this as a person whose job it is to help others navigate healthcare systems.”

Upstate New York is a microcosm of the hurdles facing transgender people when it comes to medical care. In 2015, LGBT healthcare providers surveyed local trans people and learned that 57% had run into barriers because there were not enough providers trained to address their needs. A full quarter had been turned away by one of their doctors. Without the Planned Parenthood in Ithaca, there would be limited places for several hundred trans patients to turn. The only local endocrinologist, who specializes in hormonal therapy, is not able to absorb so many new patients. And a local primary care doctor who offers transgender care is near capacity.

The need is not limited to transgender-specific care. Doctors and other healthcare providers frequently refuse to treat trans people for conditions having nothing to do with their gender identity – what trans rights activists have sardonically termed “trans broken arm syndrome”.

In Florida, where Planned Parenthood recently began to offer transgender care at about a dozen of its health centers, some of the group’s physicians are offering trans patients basic treatments for diabetes, high blood pressure and the common cold.

Gina Duncan, an advocate with Equality Florida, said Planned Parenthood’s affiliates in Florida have been instrumental in pushing other providers to acquire the knowledge to care for trans patients. “Where Planned Parenthood has filled such a huge gap, is it’s a known, reliable, quality source for healthcare,” Duncan said.

In that region, too, Planned Parenthood is the major provider to trans people of hormone replacement therapy and general care.

Dinah, a trans woman who did not want her real name printed, used to drive 120 miles round-trip every time she needed basic blood work before the Planned Parenthood in her city began to offer hormone therapy.

“We have patients who are grateful that they only have to drive two hours,” said Dr Suzie Prabhakaran, the vice-president of medical services for Planned Parenthood of south-west and central Florida. The 11 health centers Prabhakaran oversees began offering hormone replacement therapy in October and are now treating 80 patients and counting. Four out of every five are starting hormone therapy for the first time.

As Planned Parenthood comes under fire, the prospect of possibly losing those services is throwing patients into turmoil.

Dinah says the care she has received at Planned Parenthood has been lifesaving. Recently, she worked up the courage to schedule her first physical in years. It was her first such exam since her transition, and during the breast cancer screening, she began to cry.

“It’s another thing that makes it real,” she said. “It meant that I’m a woman and I have to be treated like one.”