Emma Davis
NBC news
Originally posted 28 August 24
Dr. Kade Goepferd has received death threats for their work treating transgender youths at Children’s Minnesota Hospital, but Goepferd said the harassment isn’t the most worrying part of the job.
“The waitlist is what keeps me up at night,” said Goepferd, who uses they/them pronouns. “It has grown every year, and it got particularly long after the bans went into effect.”
Goepferd is the medical director of the hospital’s Gender Health Program, the only multispeciality pediatric gender clinic in Minnesota. The program has experienced a 30% increase in calls since surrounding states outlawed gender-affirming care for minors, and the waitlist is now at least a year for new patients, even after Goepferd hired additional staff to help the hundreds of trans youths requesting appointments.
Twenty-six states now have restrictions on transgender health care for minors, according to the LGBTQ think tank Movement Advancement Project. The laws have left those still able to provide this type of care, like Goepferd, struggling to keep up with demand.
NBC News spoke to a dozen clinicians in states where gender-affirming care for minors remains legal, from Connecticut to California, and found all are treating transgender youths fleeing bans. Not only does the surge in out-of-state and newly relocated patients create logistical challenges — from waitlists to insurance denials — it also presents a legal risk for health care professionals. Although some states have enacted protections for gender-affirming care providers, these shield laws remain untested in court, and they have done little to deter anti-trans attacks. Many doctors said they’ve had to take added security measures as transphobic rhetoric has intensified.
“There’s been a growing awareness over the last year that the environment is only getting more and more dangerous for providers,” said Kellan Baker, executive director of the Whitman-Walker Institute, a nonprofit advancing LGBTQ health care.
Here are some thoughts:
The situation described in this article raises significant concerns across multiple domains. The long waitlists and limited availability of gender-affirming care pose serious ethical issues, conflicting with the principle of beneficence in medical ethics and potentially exacerbating mental health issues among transgender youth.
The threats and harassment faced by healthcare providers not only raise concerns about their safety and wellbeing but also could deter professionals from offering essential care. The legal ambiguity surrounding gender-affirming care in different states puts providers in a difficult position, forcing them to navigate between professional judgment and legal risks. This hostile environment, combined with the constant legal uncertainties, is likely causing significant stress and burnout among healthcare providers, which could impact the quality of care they're able to provide.
The healthcare system itself faces numerous challenges, including strained resources due to the influx of out-of-state patients, insurance and cost barriers creating healthcare equity issues, and limitations on training opportunities for new providers potentially leading to future workforce shortages. These issues reflect broader societal concerns, including the politicization of healthcare and potential discrimination against transgender individuals, raising civil rights concerns.
The current state of transgender rights presents a complex interplay of ethical, psychological, and systemic challenges that require careful consideration and balanced approaches to ensure both patient care and provider safety. Moving forward, it will be crucial for policymakers, healthcare professionals, and society at large to engage in thoughtful dialogue and evidence-based decision-making to address these multifaceted issues.
