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For doctors in Minnesota who care for transgender youth, the dozens of bans on gender-affirming care in other states have made things hard. They face threats from those who oppose their work while they're seeing a lot more trans patients from out of state. NPR's Selena Simmons-Duffin recently met some of these doctors.
SELENA SIMMONS-DUFFIN, BYLINE: Gender-affirming care for youth is banned in Iowa. It's banned in North Dakota and South Dakota. Then there's Minnesota, which has gone in the opposite direction, passing a bill to make the state a, quote, "trans refuge."
KELSEY LEONARDSMITH: We're this island in the middle of states who are banning and restricting access.
SIMMONS-DUFFIN: That's Dr. Kelsey Leonardsmith of Family Tree Clinic in Minneapolis. She says it can be a scary time to provide this care as it's being politically targeted.
LEONARDSMITH: You have two choices. You can get scared and say, I don't know if we can do that. Or you can take a deep breath and say, we know the work we do. Our patients - they cry tears of joy in this building. OK? And so the other thing you can do is you can say, we're going to do it. We're going to do it more, and we're going to teach everyone else how to do it, too.
SIMMONS-DUFFIN: That is the choice Family Tree Clinic has made. They provide gender-affirming care for patients, and they run the Midwest Trans Health Education Network. So far, they've trained about 50 healthcare providers from all over the region, including in rural areas, to be able to take care of trans patients and not just by giving them the relevant medical education.
LEONARDSMITH: A lot of it is, here are the patient handouts. Here's all the, like, intake forms, the letter templates for when you have to fight with an insurance company.
SIMMONS-DUFFIN: They feel like they need to spread the knowledge on how to do this because patients from around the region are now flooding into Minnesota, says Family Tree executive director Annie Van Avery.
ANNIE VAN AVERY: Just for our small clinic, we saw over 200 people from out of state.
SIMMONS-DUFFIN: Insurance often doesn't pay for out-of-state care. Family Tree uses a sliding scale and doesn't turn patients away who can't pay.
VAN AVERY: We're doing a service, at this point, for other states. And we want to be able to continue that access, but it's such a huge financial burden and challenge.
SIMMONS-DUFFIN: Across town, pediatrician Kade Goepferd runs the gender health program at Children's Minnesota.
KADE GOEPFERD: We saw maybe a 30% increase in calls into the program.
SIMMONS-DUFFIN: Even after hiring more clinical staff to manage the influx, there's still a yearlong waiting list. So what kind of treatments are we talking about here? Goepferd says for young kids - like, around age 5 - who are already strongly expressing a transgender or nonbinary identity, affirming healthcare doesn't involve any medications. It's just talking.
GOEPFERD: We have some families who will call us with their kids that young to find out, how do I talk to grandparents? You know, should they pick out their clothes? What if they are asking to be called a different name? How do we handle that? So they're just looking for support.
SIMMONS-DUFFIN: As patients get older, trans teenagers and their families may decide to use puberty blocking medications or cross-sex hormones. Surgery is extremely rare. Goepferd emphasizes the gender health program is not like a tunnel that you walk into as a boy and walk out as a girl or vice versa. Every patient is different, and there's room for that diversity.
GOEPFERD: The agenda is set by the kids and the families, not by us. They may or may not end up using any medications. They may or may not shift their identity over time. My only goal is helping them thrive.
SIMMONS-DUFFIN: Goepferd has also spent a lot of time recently at the Minnesota State House as laws affecting their patients have come up. That very public work has had a personal cost. Goepferd has faced death threats, but they don't plan to stop.
GOEPFERD: Because if I can't get accurate information out there and if I can't help create the culture change that trans kids need, the medical care that I'm providing is just not going to make a difference.
SIMMONS-DUFFIN: After all, they say, most of what affects a child's wellbeing happens outside the doctor's office. Selena Simmons-Duffin, NPR News, Minneapolis.
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