Trans-affirming medical providers face increased stress & risk as states ban trans health care

As more states around the country ban gender-affirming care for minors, the number of trans people who flee their home states is increasing, leading to an influx of patients in areas with legal practices that back trans people. This is putting stress on healthcare providers in more progressive states.

Children’s Minnesota Hospital is one such clinic, and the number one anxiety of staff there is not harassment as a result of increasingly hostile right-wing attitudes towards such care but instead about how it’s getting difficult for those seeking care to get it.

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“The waitlist is what keeps me up at night,” Dr. Kade Goepferd, medical director of the hospital’s Gender Health Program, told NBC News. The hospital now has a large, year-long waitlist for treating new patients because of the influx of new patients. “It has grown every year, and it got particularly long after the bans went into effect.”

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Clinicians across the country’s 16 states with shield laws protecting medical professionals who provide gender-affirming care have faced an influx of new patients, leading to increased waitlists, worries about insurance denials, and an intense fear of attacks – some of which have come to fruition.

This especially increases as Republican state officials like Texas Attorney General Ken Paxton seek to go across state borders to enforce their home states’ bans on gender-affirming care, putting doctors at risk of legal repercussions. In six states – Alabama, Idaho, Florida, North Dakota, Oklahoma, and South Carolina – it is a felony to give minors gender-affirming care, whereas in twenty other states, civil and/or professional penalties for medical professionals are in place. This includes lawsuits and discipline from the state’s medical board.

“It’s having the same nightmare all over again,” said Jennifer Pepper, president and CEO of CHOICES Center for Reproductive Health, an organization providing both LGBTQ+ and women’s healthcare, including to minors, to NBC News. “You make it about safety, and you make it about these providers who don’t actually care about patients. And those are all the same words and plays that we saw right after the Roe v. Wade decision.”

Providers are often instructed by legal professionals not to rely on shield laws, as these have yet to be tested in court, leading them to feel that they’re putting their livelihoods at risk.

This also affects providers of national telehealth platforms, such as QueerMed. One thing Dr. Izzy Lowell asks patients to do is to travel to the nearest state where gender-affirming care is safe to provide. With her team of attorneys working around the clock to be compliant with state laws, she works to ensure that the only state laws affecting patients are those in affirming states.

“The way the telemedicine law works is that wherever the patient is located at the time of the visit, that state’s laws apply,” Lowell said. “So we have patients drive or fly or whatever from wherever they are over the border into a state without a ban.”

Trans providers understand these worries well, as they’re often at risk of the very same policies and persecution, if not more so due to their status as trans people. Dr. Crystal Beal, the founder and CEO of QueerDoc, feels this prominently as a nonbinary femme. Nevertheless, they continue to provide care as a form of civil disobedience.

“I provide care in a different way than my allied colleagues. I’m worried about my community dying,” said Beal.

These worries aren’t unfounded, as many providers say they’ve been attacked by the far-right, anti-trans crowds. Dr. Johanna Olson-Kennedy, president-elect of the U.S. Professional Association for Transgender Health (USPATH) and medical director at the Center for Transyouth Health and Development at Children’s Hospital Los Angeles, said that these threats are a shock but aren’t particularly surprising to trans people either.

“These are probably not the things that pediatricians and pediatric hospitals are used to,” she said. “But these are things that trans people are used to.”

Goepferd agrees as a nonbinary doctor, saying, “It’s always kind of simmering in the background. It strengthens my resolve that this is really important work.”

“It’s emotionally exhausting to be targeted,” Goepferd continued. “It’s also really sad and painful to watch the patients and families that you care for be targeted. I’m glad that I can offer them care, but I can’t take that away from them.”

Dr. Joshua Safer, director of the Mount Sinai Center for Transgender Medicine and Surgery in New York, said that he had to take his practice’s street address off the internet to protect against some attacks. But he still keeps the website up in an effort to reach teens across the country.

“If you’ve got some kid, and their only access to information is in their bedroom on their computer, I wanted them to find Mount Sinai.”

Still, the risk continues to increase. Lowell’s practice in Georgia was completely burned, with graffiti left to make the intent clear. The fire is being investigated as a hate crime.

“Mine was the only office that was burnt, and it was burnt completely. To the point where they had to ask, ‘Was there a computer on the desk?’”

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