The Struggles of Providing Gender-Affirming Care: A Look at Dr. Kade Goepferd’s Work
In recent years, the landscape of healthcare for transgender youths has become increasingly fraught with challenges. Dr. Kade Goepferd, the medical director of the Gender Health Program at Children’s Minnesota Hospital, stands at the forefront of this struggle. Despite facing death threats for their work, Goepferd emphasizes that the most pressing concern is not the harassment but rather the overwhelming waitlist for care. “The waitlist is what keeps me up at night,” they say, highlighting a growing crisis in access to gender-affirming healthcare.
A Growing Demand for Care
The Gender Health Program at Children’s Minnesota is the only multispecialty pediatric gender clinic in Minnesota, and it has seen a staggering 30% increase in calls since surrounding states enacted bans on gender-affirming care for minors. The waitlist for new patients has now stretched to at least a year, even after Goepferd hired additional staff to accommodate the influx of requests. This surge in demand is not isolated to Minnesota; it reflects a nationwide trend as transgender youths seek care in states where it remains legal.
According to the LGBTQ think tank Movement Advancement Project, 26 states currently impose restrictions on transgender healthcare for minors. This has forced many families to seek care out of state, creating logistical challenges for both patients and providers. Clinicians across the country report similar experiences, with many struggling to keep up with the demand while navigating a complex legal landscape.
The Legal and Emotional Toll on Providers
The environment for healthcare providers has become increasingly dangerous, with many facing threats and harassment. Kellan Baker, executive director of the Whitman-Walker Institute, notes that there is a growing awareness of the risks associated with providing gender-affirming care. “The environment is only getting more and more dangerous for providers,” Baker states, reflecting a sentiment echoed by many in the field.
While some states have enacted shield laws to protect gender-affirming care providers, these laws remain largely untested in court. Many healthcare professionals have taken added security measures as anti-trans rhetoric intensifies. Dr. Molly McClain, medical director of the University of New Mexico’s Deseo clinic, describes the situation as a “tenuous protection,” emphasizing the uncertainty that providers face.
The Impact of Legislative Bans on Care Access
The rise in laws targeting gender-affirming care has coincided with a decrease in the percentage of transgender youths seeking medical intervention. Data from Reuters and Komodo Health Inc. indicates that while the number of minors diagnosed with gender dysphoria has increased, only about 13% pursued medical intervention in 2021, down from 17% in 2017. This paradox highlights the chilling effect that legislative bans have on access to care.
Proponents of these laws argue that they protect minors from making life-altering decisions. However, this perspective contradicts the consensus among major medical associations, which advocate for gender-affirming care as a necessary treatment for gender dysphoria. The care process typically begins with social changes, such as adopting a new name and pronouns, and may progress to medical interventions like puberty blockers and hormone therapy.
The Consequences of Noncompliance
The consequences for violating transgender care bans can be severe, ranging from loss of medical licenses to criminal charges. In six states, it is now a felony to prescribe puberty blockers or hormone therapy to transgender youths. This legal landscape creates a chilling effect, discouraging providers from offering necessary care and leaving many families in a state of uncertainty.
Jennifer Pepper, president and CEO of CHOICES Center for Reproductive Health, likens the tactics used in these bans to those employed by the anti-abortion movement. “You make it about safety, and you make it about these providers who don’t actually care about patients,” she explains, drawing parallels between the two movements.
The Strain on Healthcare Systems
As more transgender youths seek care out of state, the remaining clinics are becoming overwhelmed. Many providers report waitlists of several months, with some extending to a year. Dr. Sumanas Jordan, medical director of Northwestern Medicine’s Gender Pathways Program, notes that her clinic is flooded with calls every time a ban passes, leading to a constant state of overcapacity.
Insurance issues further complicate access to care, as many plans do not reimburse for out-of-state treatments. This forces families to bear the financial burden of out-of-pocket expenses, which can be prohibitively expensive. Dr. McClain highlights that even families who manage to travel for care may struggle to afford medications, creating a significant barrier to treatment.
The Future of Gender-Affirming Care
The Supreme Court’s decision to hear its first case on gender-affirming care next term could mark a pivotal moment for providers and patients alike. The court will consider whether Tennessee’s ban violates the equal protection clause of the 14th Amendment, potentially setting a precedent for similar cases across the country.
In the meantime, telehealth has emerged as a potential solution for some patients, allowing them to access care from providers in states without bans. However, this approach is not without its challenges, as patients often face pushback from pharmacists and insurance issues.
Conclusion: A Call for Compassionate Care
The challenges faced by Dr. Kade Goepferd and their colleagues underscore the urgent need for compassionate and accessible healthcare for transgender youths. As the demand for gender-affirming care continues to rise, it is crucial for society to recognize the importance of supporting both patients and providers in this vital work. The fight for equitable healthcare is far from over, and the voices of those advocating for transgender rights must be amplified in the face of adversity.
