States that have declared themselves safe havens for transgender individuals have, in essence, extended an invitation to obtain gender-affirming health care without fear of persecution at home. Now that bans on such care for juveniles are in effect across the country — Texas could be next, dependent on the outcome of this week’s court hearing — patients and their families are testing the capacity of clinics. There are only a limited number of providers of gender-affirming care, and they can only see a limited number of patients per day. For these refuge states — California, Connecticut, Colorado, Illinois, Massachusetts, Maryland, Minnesota, New Jersey, New Mexico, Washington, and Vermont, as well as the District of Columbia — the question is how to create a network to serve more patients beyond the promises of legal protection.
Dr. Angela Kade Goepferd, medical director of the gender health program at Children’s Minnesota hospital in the Twin Cities, stated, “We’re doing our best to make sure we can get those children in so they don’t experience an interruption in their care.” “For patients who have not yet been seen and who would be added to a general waiting list, the prospect of waiting a year or more to be seen by someone is daunting.” Children’s Hospital is inundated with appointment requests from across the nation, including Texas, Montana, and Florida, which all have restrictions. In a year, requests have increased from approximately 100 per month to 140-150. It will take time, according to Goepferd, for the program to recruit more staff to meet demand.
AMA Study: 89,000+ Transgender Teens Face Restricted Gender-Affirming Care
According to a research letter published in the Journal of the American Medical Association in late July, more than 89,000 transgender people ages 13 to 17 reside in states that restrict their access to gender-affirming care, although not all trans people choose or can afford gender-affirming care. This month, 17-year-old transmasculine and nonbinary Rhys Perez will move from Houston to Los Angeles to begin college. The adolescent, who stated that they are “escaping Texas in the nick of time,” stated that California’s protection for gender-affirming care was a major factor in their college choice.
Perez has just begun their search for a physician in Southern California, but has already encountered several institutions with initial consultation wait times ranging from nine to fourteen months. They were dismayed to discover that they could not likely commence hormone replacement therapy until their sophomore year. “Hormones and other stuff were never something my family fully comprehended or supported,” Perez stated. It seemed prudent to wait until I moved to college, but it’s disheartening to learn that I’ll have to wait even longer.
“I wish I could begin college as my authentic self,” they said. Advocates assert that the initial sanctuary laws and executive orders were an emergency measure to protect transgender people and their families from the threat of prosecution by the more than 20 states that have restricted or prohibited such health care. In general, they do not include provisions to strengthen health systems, but proponents argue that this should be the next stage. Kat Rohn, executive director of the LGBTQ+ advocacy organization OutFront Minnesota, stated, “Over the next year to two years, we hope to ensure that not only are we living up to our promise of being a safe haven for people, but also that those who come here have access to care when they need it.”
Kellan Baker, executive director of the Whitman-Walker Institute, the policy and education branch of a clinic with the same name in Washington, D.C., stated that legislators, governors, large employers, Medicaid plans, and medical boards will likely need to be involved. Baker stated, “I would hope that it would be a comprehensive effort, and that everyone at every level enacting these shield laws is aware that it is not enough to promise access on paper; it must be backed up by the availability of providers.”
The Republican governor of Texas, Greg Abbott, was the first to order an investigation of families of transgender adolescents who receive gender-affirming care, and this year legislators banned such care. A state judge in Austin will determine whether this law goes into effect on September 1 after hearing arguments Tuesday and Wednesday in a lawsuit filed by families and physicians seeking a temporary restraining order. The lawsuit asserts that the legislation violates parental rights and discriminates against transgender adolescents. Uncertain as to when the magistrate will determine. Ginger Chun, the education and family engagement manager for the Transgender Education Network of Texas, stated that she had contact with approximately 15 families with transgender family members in the past year. Already this year, she has spoken with approximately 250 families who have inquired about everything from legislative clarification to care access. Those seeking care outside the state of Texas encounter waiting lists.