Doctors in trans refuge states fight for more resources as demand skyrockets

At the start of 2023, the wait time for new patients at the Children’s Minnesota Hospital’s Gender Health Program was nearly a year long. When neighboring states began banning gender-affirming care for trans youth, the program’s call volume increased 30 percent. At one point, the wait time was as long as 18 months, which placed immense stress on trans youth, their families, and the doctors and staff trying to serve them.

This chaos led Dr. Angela Kade Goepferd, Chief Education Officer and Medical Director of the Gender Health Program, to testify in early March in support of HF 3386. Introduced by state Rep. Leigh Finke (D) – the state’s first out trans legislator – the bill would provide $1 million to train Minnesota physicians to provide gender-affirming care. As Dr. Goepferd knows all too well, this care can be life-saving.

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About half of transgender youth seriously considered suicide in the past year, according to the Trevor Project. For Black trans youth, the number is even higher, with 58% seriously considering suicide in the past year.

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Dr. Goepferd told LGBTQ Nation that when trans and gender-diverse youth can access care, their risk of suicide drops by as much as 60 percent. What’s more, the impact is lifelong: Trans and gender-diverse adults who had access to puberty blockers have a lower lifetime risk of suicide, Dr. Goepferd explained. That’s why the physician training bill is so important.

“What if their families aren’t able to support them because they’re not getting their questions answered?” Dr. Goepferd lamented, referring to the many kids on the waitlist for care. “What if they’re dealing with unsupportive family members or communities or schools, and they don’t know how to access resources, and they’re just sitting on our waiting list? What if one of these young people is experiencing a significant amount of mental health distress and becomes one of the many trans and gender-diverse young people who consider ending their own life? These are the things that keep me and my team up at night.”

The responsibility of a refuge state

At the start of the year, the Children’s Minnesota gender clinic hired two new staff members, a medical and a mental health provider, and is now open two days a week instead of one. Dr. Goepferd says they are reducing the wait times, but they started the year with 400 children on their waitlist. Minnesota simply needs more doctors to meet the needs of trans kids in the state.

When Minnesota passed its Trans Refuge bill last March – which prevents out-of-state laws from interfering with folks obtaining gender-affirming care – community organizations like OutFront Minnesota, Rainbow Health, and the PFund Foundation knew there would be an influx of trans people seeking healthcare in the state and tried to get ahead of the problem. Kat Rohn,  executive director of OutFront Minnesota, told LGBTQ Nation the organization identified three main bottlenecks for gender-affirming care.

First, it is difficult for trans people and their families to find doctors who are trained to offer gender-affirming care. There’s no public database to look through, and it can be dangerous to create one.

“As much as I would love to put together a really robust network to show all the care providers in the state of Minnesota and all the details about their care, that puts care providers’ safety at real risk,” she explained, referring to dangerous threats that gender-affirming care providers have received in the last few years. Groups like Rainbow Health have stepped in as care navigators, helping trans people and parents of trans youth find the care they need.

But that doesn’t solve everything.

There is also a shortage of qualified doctors. Long wait times already plagued clinics before nearby states began banning or restricting gender-affirming care, and the waits have only grown. Rohn said there has been “universally increased demand and wait times” across the state.

And finally, most qualified doctors practice in the Twin Cities, located on the eastern edge of the state. People coming from Nebraska or the Dakotas have to cross the entire state to access gender-affirming care, and rural Minnesotans have difficulty getting the care they need in their own communities.

Aaron Zimmerman, executive director at the PFund Foundation, says the organization produced a survey in partnership with other LGBTQ+ organizations last year. The first round of responses found 150 households with trans adults or children that had moved to Minnesota after gender-affirming care was banned in their home state. Zimmerman believes that is almost certainly an undercount.

They received responses from another 40 households in the first three months of 2024, for a total of 190 households with 243 trans individuals. Zimmerman said Minnesota needs to pass HF 3386 to fulfill the promise it made with the Trans Refuge bill.

“We told trans communities that if they came here, they would be welcomed, and they would be safe. But they get here and they can’t see a doctor. They can’t go to a therapist. They can’t find a job. They can’t find an affirming school or neighborhood.” HF 3386 will start to fix that.

What they’re fighting for

The bill would provide a $1 million grant to the PFund Foundation, which will then distribute the money to train doctors and help provide wrap-around services to transgender people and families that have moved to Minnesota for safety. Zimmerman also testified in favor of HF 3386 in a committee hearing, where he said the wrap-around services would help create pathways out of poverty by funding job readiness training, among other services.

PFund, which started 36 years ago during the HIV/AIDS crisis, uses a model Zimmerman calls “community-centered grant making,” where community members score grant applications to determine who receives the funding. In 2015, PFund committed to uplifting LGBTQ+ Black, Indigenous, and people of color, trans people, and people in rural areas, making the organization uniquely qualified for this work. Last year, PFund’s Equity Fund program distributed $300,000 to LGBTQ+ entrepreneurs in the state. Nearly 40 percent of grantees lived in rural areas, over half were trans-owned businesses, and 70 percent were BIPOC-owned businesses.

During their testimony, Dr. Goepferd said the bill would “leverage existing expertise to increase access [to gender-affirming care] without sacrificing high quality, excellent care.” The way the training programs are structured is one of the primary reasons they support the bill. Doctors and nurse practitioners who want to learn to provide gender-affirming care would come to work at existing gender health clinics, learning from people who see hundreds of trans patients each year.

“They’re getting the benefit of working directly with programs who are seeing large volumes of patients, with multiple specialists on the team who can give them insight and knowledge as to how to practice, and then they are bringing that back to their communities,” Dr. Goepferd said, adding that the program will help their team at Children’s Minnesota as well by expanding the number of staff they have when trainees are present. 

PFund expects to partner with two to four hospitals or clinics to train about eight doctors per year. Each of those doctors can see about 250 patients a month, according to surveys conducted by the organization. That means Minnesota will be able to care for around 2,000 more patients per year for every year the program is funded. Doctors they train will provide necessary, sometimes life-saving care for Minnesota residents and those traveling to the state to access gender-affirming care.

Dr. Goepferd emphasized, “We want a patient who crosses the border from South Dakota into Minnesota to get just as good of care as a patient who makes it all the way to the Twin Cities.”  

If you or someone you know is struggling or in crisis, help is available. Call or text 988 or chat at 988lifeline.org. The Trans Lifeline (1-877-565-8860) is staffed by trans people and will not contact law enforcement. The Trevor Project provides a safe, judgement-free place to talk for youth via chat, text (678-678), or phone (1-866-488-7386). Help is available at all three resources in English and Spanish.