Offering LGBTQ+ youth gender-affirming care

Gender-affirming care is an important service to many LGBTQ+ youth. Many states across the U.S. have been trying to restrict access to gender-affirming care, including Florida and Arkansas. Meanwhile, lawmakers in Minnesota have passed legislation protecting access to this care.

But as safe as Minnesota is, the process to get gender-affirming care is lengthy and the misconceptions about it don't help.

Gender-affirming care is a resource that helps people, in this case adolescents, find ways to become comfortable with their identity, said Dr. Angela Kade Goepferd, chief education officer and medical director of the Gender Health Program at Children's Minnesota. People often think that the general idea of this care is surgeries and medications that make drastic changes, but that's not at all what they do.

"Most of what we do is have conversations with kids and families, answering questions, offering support and helping them learn how to express who they are in a way that feels good to them," Goepferd said.

This care includes using someone's chosen name and pronouns, haircuts and new clothing or shapewear that makes them feel more comfortable, voice therapy and help with changing legal documents. When the care does include medications, most are completely reversible.

Research from the National Institutes of Health shows that people who receive gender-affirming care have a 60% lower risk of depression, and a 73% lower risk of self-harm and suicide.

Minnesota has mental health care resources available to the LGBTQ+ community, and Goepferd said there are a few steps needed to access it.

The first step for an adolescent getting gender-affirming care is to find a guardian to bring them to the appointments and consent. And while this can be challenging, parental consent is mandatory for the work that they do. "So many young people don't even get through the door of the clinic because they can't identify a safe person they can disclose that to," said Goepferd.

Step two is to make an appointment with Children's Minnesota, though waiting lists can be more than a year long. Because of the wait, people at the clinic keep in touch with families to direct them to local therapy and mental health providers.

"Those visits are about, 'What can we help you with? How do you identify? What's hard for you right now?'" Goepferd said.

During this time, families, therapy providers and the clinic formulate a plan, which can look different for each person.

Another obstacle for providers in Minnesota is the restrictions on gender-affirming care coming from neighboring states.

Due to the 2023 "trans refuge" bill, which legally protects people both accessing and providing transgender care, Minnesota has become a safe space for transgender patients. But some neighboring states have taken a different approach. For example, North Dakota recently passed a law that makes it illegal for minors to receive gender-affirming care. "We've got North Dakota, South Dakota, Iowa, other states, and all of those kids and families who want to either move here or come here for care, but we don't have the capacity to provide that care for them," Goepferd said.

Gender-affirming health care involves recurring appointments that make traveling back and forth problematic and expensive. Another obstacle for patients coming into Minnesota is how much insurance networks can cover out-of-state care. So, without support on a federal level, accessing gender-affirming care will remain difficult across state lines.

With the new influx of people from out of state, the calls to the already busy clinic from interested patients have increased 30-40%.

"The hard thing is that our health care system is not designed that way," Goepferd said.

This story was created by ThreeSixty Journalism's summer 2023 News reporter Academy high school students under MinnPost's leadership and in partnership with the Center for Prevention at Blue Cross and Blue Shield of Minnesota.

ThreeSixty Journalism empowers diverse students with valuable leadership and storytelling skills, prepares them for college and career success, and fosters more representative truth telling. Leading the way in developing multicultural storytellers in the media arts industry, ThreeSixty invites highly motivated high school students to discover and amplify their voices through immersive college success programming at the University of St. Thomas College of Arts and Sciences. Launched in 1971 as an Urban Journalism Workshop chapter, the program has been part of St. Thomas for more than 20 years.

To learn more, visit threesixty.stthomas.edu.