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Health


STATES THAT PROTECT TRANSGENDER HEALTH CARE NOW TRY TO ABSORB DEMAND

1 of 5 | 

Dr. Katy Miller, the medical director of adolescent medicine for Children’s
Minnesota, sits for a portrait at the hospital in Minneapolis, Thursday, June
29, 2023. The quest for gender-affirming care has been complicated, as bans on
such care for minors are taking effect around the country. Clinics in states
like Minnesota that have declared themselves refuges for transgender people are
feeling the pressure. (AP Photo/Abbie Parr)

Read More
2 of 5 | 

A cyclist passes a sign encouraging the protection of transgender children at
Central Presbyterian Church near the Texas Capitol, Tuesday, Aug. 15, 2023, in
Austin, Texas. Waiting lists for gender-affirming health care are growing in
states that declared themselves refuges for transgender people as bans for such
care for minors take effect around the country. Texas, one of the largest
states, has a ban that’s set to take effect Sept. 1. (AP Photo/Eric Gay)

Read More
3 of 5 | 

Dr. Angela Kade Goepferd, medical director of the gender health program at
Children’s Minnesota hospital, sits for a portrait at the hospital in
Minneapolis, Thursday, June 29, 2023. Bans on gender-affirming health care for
minors in a number of states have put pressure on clinics in states that have
declared themselves refuges for transgender people. (AP Photo/Abbie Parr)

Read More
4 of 5 | 

A sign encouraging the protection of transgender children stands at Central
Presbyterian Church near the Texas Capitol, Tuesday, Aug. 15, 2023, in Austin,
Texas. Waiting lists for gender-affirming health care are growing in states that
declared themselves refuges for transgender people as bans for such care for
minors take effect around the country. Texas, one of the largest states, has a
ban that’s set to take effect Sept. 1. (AP Photo/Eric Gay)

Read More
5 of 5 | 

A sign encouraging the protection of transgender children stands at Central
Presbyterian Church near the Texas Capitol, Tuesday, Aug. 15, 2023, in Austin,
Texas. Waiting lists for gender-affirming health care are growing in states that
declared themselves refuges for transgender people as bans for such care for
minors take effect around the country. Texas, one of the largest states, has a
ban that’s set to take effect Sept. 1. (AP Photo/Eric Gay)

Read More
States that protect transgender health care now try to absorb demand
1 of 5 | 

Dr. Katy Miller, the medical director of adolescent medicine for Children’s
Minnesota, sits for a portrait at the hospital in Minneapolis, Thursday, June
29, 2023. The quest for gender-affirming care has been complicated, as bans on
such care for minors are taking effect around the country. Clinics in states
like Minnesota that have declared themselves refuges for transgender people are
feeling the pressure. (AP Photo/Abbie Parr)

Read More
1 of 5

Dr. Katy Miller, the medical director of adolescent medicine for Children’s
Minnesota, sits for a portrait at the hospital in Minneapolis, Thursday, June
29, 2023. The quest for gender-affirming care has been complicated, as bans on
such care for minors are taking effect around the country. Clinics in states
like Minnesota that have declared themselves refuges for transgender people are
feeling the pressure. (AP Photo/Abbie Parr)

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Read More
2 of 5 | 

A cyclist passes a sign encouraging the protection of transgender children at
Central Presbyterian Church near the Texas Capitol, Tuesday, Aug. 15, 2023, in
Austin, Texas. Waiting lists for gender-affirming health care are growing in
states that declared themselves refuges for transgender people as bans for such
care for minors take effect around the country. Texas, one of the largest
states, has a ban that’s set to take effect Sept. 1. (AP Photo/Eric Gay)

Read More
2 of 5

A cyclist passes a sign encouraging the protection of transgender children at
Central Presbyterian Church near the Texas Capitol, Tuesday, Aug. 15, 2023, in
Austin, Texas. Waiting lists for gender-affirming health care are growing in
states that declared themselves refuges for transgender people as bans for such
care for minors take effect around the country. Texas, one of the largest
states, has a ban that’s set to take effect Sept. 1. (AP Photo/Eric Gay)

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Read More
3 of 5 | 

Dr. Angela Kade Goepferd, medical director of the gender health program at
Children’s Minnesota hospital, sits for a portrait at the hospital in
Minneapolis, Thursday, June 29, 2023. Bans on gender-affirming health care for
minors in a number of states have put pressure on clinics in states that have
declared themselves refuges for transgender people. (AP Photo/Abbie Parr)

Read More
3 of 5

Dr. Angela Kade Goepferd, medical director of the gender health program at
Children’s Minnesota hospital, sits for a portrait at the hospital in
Minneapolis, Thursday, June 29, 2023. Bans on gender-affirming health care for
minors in a number of states have put pressure on clinics in states that have
declared themselves refuges for transgender people. (AP Photo/Abbie Parr)

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Read More
4 of 5 | 

A sign encouraging the protection of transgender children stands at Central
Presbyterian Church near the Texas Capitol, Tuesday, Aug. 15, 2023, in Austin,
Texas. Waiting lists for gender-affirming health care are growing in states that
declared themselves refuges for transgender people as bans for such care for
minors take effect around the country. Texas, one of the largest states, has a
ban that’s set to take effect Sept. 1. (AP Photo/Eric Gay)

Read More
4 of 5

A sign encouraging the protection of transgender children stands at Central
Presbyterian Church near the Texas Capitol, Tuesday, Aug. 15, 2023, in Austin,
Texas. Waiting lists for gender-affirming health care are growing in states that
declared themselves refuges for transgender people as bans for such care for
minors take effect around the country. Texas, one of the largest states, has a
ban that’s set to take effect Sept. 1. (AP Photo/Eric Gay)

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Read More
5 of 5 | 

A sign encouraging the protection of transgender children stands at Central
Presbyterian Church near the Texas Capitol, Tuesday, Aug. 15, 2023, in Austin,
Texas. Waiting lists for gender-affirming health care are growing in states that
declared themselves refuges for transgender people as bans for such care for
minors take effect around the country. Texas, one of the largest states, has a
ban that’s set to take effect Sept. 1. (AP Photo/Eric Gay)

Read More
5 of 5

A sign encouraging the protection of transgender children stands at Central
Presbyterian Church near the Texas Capitol, Tuesday, Aug. 15, 2023, in Austin,
Texas. Waiting lists for gender-affirming health care are growing in states that
declared themselves refuges for transgender people as bans for such care for
minors take effect around the country. Texas, one of the largest states, has a
ban that’s set to take effect Sept. 1. (AP Photo/Eric Gay)

Share
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Read More
By JEFF McMILLAN and HANNAH SCHOENBAUM
Updated [hour]:[minute] [AMPM] [timezone], [monthFull] [day], [year] Updated
9:24 PM GMT+2, August 15, 2023
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States that declared themselves refuges for transgender people have essentially
issued an invitation: Get your gender-affirming health care here without fearing
prosecution at home.

Now that bans on such care for minors are taking effect around the country —
Texas could be next, depending on the outcome of a court hearing this week —
patients and their families are testing clinics’ capacity. Already-long waiting
lists are growing, yet there are only so many providers of gender-affirming care
and only so many patients they can see in a day.

For those refuge states — so far, California, Connecticut, Colorado, Illinois,
Massachusetts, Maryland, Minnesota, New Jersey, New Mexico, New York, Washington
and Vermont, plus Washington, D.C. — the question is how to move beyond promises
of legal protection and build a network to serve more patients.



“We’re trying our best to make sure we can get those kids in so that they don’t
experience an interruption in their care,” said Dr. Angela Kade Goepferd,
medical director of the gender health program at Children’s Minnesota hospital
in the Twin Cities. “For patients who have not yet been seen and would be added
to a general waiting list, it is daunting to think that it’s going to be a year
or more before you’re going to be seen by somebody.”

Related stories
Families with transgender kids are increasingly forced to travel out of state
for the care they need
Transgender health care restrictions gain steam in North Carolina
Missouri governor signs ban on transgender health care, school sports

Appointment requests are flooding into Children’s from all over the country —
including Texas, Montana and Florida, which all have bans. Requests have grown
in a year from about 100 a month to 140-150. The program hopes to hire more
staff to meet demand, but it will take time, Goepferd said.



More than 89,000 transgender people ages 13 to 17 live in states that limit
their access to gender-affirming care, according to a research letter published
in late July in the Journal of the American Medical Association, though not all
trans people choose or can afford gender-affirming care.

Rhys Perez, a transmasculine and nonbinary 17-year-old, is preparing to move
this month from Houston to Los Angeles to start college. The teen, who said
they’re “escaping Texas in the nick of time,” said California’s protection for
gender-affirming care was one of the main factors in their decision on where to
go for college.



Perez has just begun their search for a provider in Southern California but
already has encountered several clinics with waits for an initial consultation
between nine and 14 months. They were disappointed to learn they likely could
not begin hormone replacement therapy until their sophomore year.

“Hormones and stuff, that was never something my family fully understood or
supported, really,” Perez said. “I figured it was best to wait until I move for
college, but now it’s frustrating to know I’m going to have to wait even
longer.”

“I wish I could start college as fully me,” they said.



Initial sanctuary laws or executive orders were an emergency step to protect
transgender people and their families from the threat of prosecution by more
than 20 states that have restricted or banned such health care, advocates say.
They generally do not contain provisions to shore up health systems, but
advocates say that needs to be the next step.



“That’s what we’re hoping to set up over the next year to two years, is making
sure that not only are we making this promise of being a refuge for folks, but
we’re actually living up to that and ensuring that folks who come here have
access to care when they need it,” said Kat Rohn, executive director of the
LGBTQ+ advocacy group OutFront Minnesota.

Those efforts will likely need to involve legislators, governors, large
employers, Medicaid plans and boards of medicine, said Kellan Baker, executive
director of the Whitman-Walker Institute, the policy and education arm of a
clinic with the same name in Washington, D.C.

“I would hope that it would be a comprehensive effort, that everyone at every
level enacting these shield laws is aware that it’s not just about making a
promise of access on paper, but that it needs to be backed up by the
availability of providers,” Baker said.

Texas Gov. Greg Abbott, a Republican, became the first governor to order the
investigation of families of transgender minors who receive gender-affirming
care, and legislators this year passed a ban on such care.

Whether that law takes effect on Sept. 1 will be decided by a state judge in
Austin, who is hearing arguments this week in a lawsuit filed by families and
doctors seeking a temporary injunction. The lawsuit argues the bill violates
parental rights and discriminates against transgender teens. It is unclear when
the judge will rule.



A plaintiff, identified only by the pseudonym Gina Goe, testified Tuesday about
her 15-year-old transgender son’s efforts to continue testosterone treatments:
“I have reached out to a Colorado facility, but there is, like, a waiting list.
... There is going to be a gap in his medical care.”

Ginger Chun, the education and family engagement manager at the Transgender
Education Network of Texas, said she was in contact last year with about 15
families with trans family members. This year already, she has talked to about
250 families, who are asking about everything from clarification on legislation
to looking for ways to access care. Those who are looking for care outside Texas
are encountering waiting lists.

The research published in JAMA found that Texas youths’ average travel time to a
clinic for gender-affirming care increased from just under an hour to over 7 1/2
hours.

“It’s like a daily, ever-changing process to figure out where people can access
care,” Chun said.

Minnesota state Rep. Leigh Finke, a Democrat who sponsored a bill to protect
gender-affirming care, predicts “thousands” of people will travel to the state
for care within two years. She’s also seeking solutions to the provider shortage
and expects to take a closer look when the next legislative session begins in
February.



“I’m not sure what as a legislature we can do to increase the number of people
who provide a certain kind of medical care,” said Finke, a transgender woman who
represents part of the Twin Cities area. “I’m not sure as a policymaker what the
mechanisms are to say we need more of one kind of specific health care provider,
assuming that those exist. I’m certainly going to be interested in looking at
them.”

The number of providers nationwide is limited, and for many, it’s not their
full-time job. Minnesota, for instance, is home to 91 providers, according to a
search on the website of the World Professional Association for Transgender
Health. The state has 29,500 transgender people 13 and older, according to the
Williams Institute, an LGBTQ+ think tank at the UCLA School of Law.

Dr. Katy Miller, the medical director of adolescent medicine for Children’s
Minnesota, estimates “probably at least hundreds of families” are moving to the
Twin Cities for gender-affirming care.

“People are going to kind of extraordinary lengths, like pulling kids out of
school, moving.” Miller said.

In many ways, the quest for gender-affirming care parallels that of abortion
access, for which people also cross state borders, sometimes under threat of
prosecution. The main difference with gender-affirming care is that treatment is
ongoing, generally for the rest of a person’s life, so permanent access is key.

Anticipating long waits, some parents preemptively sought out gender-affirming
care providers for a child, like Minnesota activist Kelsey Waits. Her
10-year-old transgender child, Kit, got into the system at a hospital that could
eventually provide blockers or hormones so that they wouldn’t have to start
puberty without a doctor’s support.

“A lot happens in puberty in one year,” Waits said. “Just the stress of that on
a family — the kids, the parents who are trying to find care for their child —
it’s a lot.”


___

Associated Press journalists Jamie Stengle in Dallas, Jim Vertuno in Austin,
Texas, and Mark Vancleave in Minneapolis contributed to this report. McMillan
reported from Scranton, Pennsylvania, and Schoenbaum from Raleigh, North
Carolina.

HANNAH SCHOENBAUM
Schoenbaum covers government and politics in North Carolina.

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