Minnesota is a haven for trans healthcare. Here’s how doctors are meeting the need

Gender-affirming care for youth is banned in Iowa, North Dakota and South Dakota. It is more than forbidden 20 other states also throughout the country, after a flood of legislation in the past two years.

Then there’s Minnesota, which has gone in the opposite direction and a last year’s invoice That turned the state into a ‘trans-sanctuary’.

“We are an island among states that ban and restrict access,” he says Dr. Kelsey Leonardsmithdirector of youth gender services at Family Tree Clinic in Minneapolis. She says it’s difficult to provide this care in the political spotlight.

“You have two choices: You can get scared and say, ‘I don’t know if we can do that,’” she says. “Or you take a deep breath and say: we know what we are doing. We looked at the research. We’ve been doing this for a long time and we’re doing a good job; our patients cry tears of joy in this building.”

Providers like Family Tree and others NPR spoke with say they are adapting as quickly as possible to serve an influx of patients from out of state.

Instead of freezing in fear, says Leonardsmith, “the other thing you can do is 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.’ do it too. ”

That attitude is why Family Tree started running the company Midwest Trans Health Education Network. So far, they have trained about 50 healthcare providers from across the region, including rural areas. In eight virtual sessions, they prepare members of each cohort to care for trans patients.

This goes beyond the relevant medical training, but also concerns part of the bureaucracy.

“A lot of it is, ‘Here these are all the patient brochures, the intake forms, the letter templates if you have to fight with an insurance company,’” Leonardsmith explains. She leads the initiative together with project manager Dylan Flunker.

The trans patients coming from across the region and now heading to Minnesota pose challenges, clinic staff say.

Last year, “we saw over 200 people from out of state just for our little clinic alone,” says Family Tree CEO Annie VanAvery.

Children’s Minnesota has also seen an influx, with a 30% increase in calls to its gender health program, and the hospital has hired more doctors to help. One pediatrician from Minneapolis told NPR he personally treats 15 trans patients who come from out of state.

The bans have delivered financial blows to both patients and healthcare providers. For patients, traveling abroad for care can mean fewer follow-ups, plus travel expenses for things like gas and hotel rooms, and time off work. For hospitals and clinics, patients’ health insurance often does not cover out-of-state physicians.

Family Tree uses a sliding scale and does not turn away patients who cannot pay, Van Avery says. “We are doing a service – right now – to other states, and we want to be able to continue to have that access, but it is such a huge financial burden and challenge,” she says.

On the other side of town, Dr. Kade Goepferda pediatrician who directs the gender health program at Children’s Minnesota says many of their patients’ families eventually moved to the state, rather than traveling there periodically for appointments.

“They’re Minnesotans now,” Goepferd says. “Because they knew they were going to (move), they called and were put on our waiting list in advance.” Even after hiring more clinical staff, the wait for the program is still about a year.

For families with young children, such as 5-year-olds who already strongly express a transgender or non-binary identity, it is possible to wait many months for an appointment, because gender-affirming care at that age is all talk.

“We have a number of families who call us with their young children to ask, ‘How do I talk to grandparents? Do they have to pick out their clothes? What if they ask to be called by another name, how do we deal with that?’ So they are just looking for support,” says Goepferd.

Timing becomes much more important as patients get older. Trans teens and their families may decide to use puberty blocking drugs or cross-sex hormones or both. (An operation is very rare for minors.)

These are the kinds of interventions that some lawmakers object to, despite the fact that major U.S. medical organizations, including the American Medical Association and the American Academy of Pediatrics, support access.

When lawmakers in Iowa, Minnesota’s southern neighbor, debated that state’s ban last March, the bill’s sponsor, Republican Rep. Steven Holt, said explained why he thought the ban was necessary. “Our children deserve the time to grow within themselves, to find themselves, to go through phases, without medical interventions whose effectiveness has not been proven,” he said.

Goepferd emphasizes that the gender health program is not a tunnel that you walk into as a boy and walk out as a girl – or vice versa. Every patient is different and there is room for that diversity.

“The agenda is set by the children and the families, not by us,” they explain. “They may or may not be on medication, they may or may not be going through a social transition, they may or may not change their identity over time – my only goal is to help them thrive.”

They say that care is slow, well thought out and multidisciplinary. “We work with our rehabilitation team on speech pathology; we work with our psychiatry team, with medication management. We have nursing care that helps families find appointments, resources and the like.”

With all the political attention on transgender children right now, Goepferd has also been spending a lot of time in the Minnesota statehouse lately as laws have been drafted that affect their patients. “Sometimes it takes someone who is a pediatrician to stand up and correct misinformation,” they say. “I had some disingenuous questions from legislators, but I also had some very sincere questions from legislators who were just trying to understand.”

That very public work has come at a personal cost. Goepferd says they have received death threats. But they have no intention of stopping.

“If I can’t get accurate information and if I can’t help create the culture change that trans kids need, the medical care I provide simply won’t make a difference,” Goepferd says.

After all, they say that most of what affects a child’s well-being happens outside the doctor’s office.

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