As states crack down on gender-affirming care, transgender youth and families consider Minnesota

CATHY WURZER: Around the country, Republican-led states have cracked down on gender affirming care services for minors. 20 states have banned such care, including North Dakota, South Dakota, and Iowa. Meanwhile, 13 states, including Minnesota, have gone the opposite direction and enacted legal protections for patients seeking gender care and for providers.

On Sunday, National Public Radio is set to air a special feature that delves into the realities on the ground for transgender youth and their families, along with medical providers, in two states, Utah, which has adopted restrictions, and Minnesota, which has added legal protections for care. NPR political reporter Dana Ferguson is here to tell us about her reporting, along with KUER reporter Sage Miller, who joins us from Salt Lake City. Dana and Sage, welcome.

DANA FERGUSON: Thank you for having us, Cathy.

SAGE MILLER: So happy to be here. Thank you.

CATHY WURZER: Sage, Thank you. I'm going to start with you. Tell us a little bit about the landscape for gender affirming care in Utah.

SAGE MILLER: Absolutely. So Utah was the first state this year to pass a ban on gender affirming care for minors. The bill restricts access, passed overwhelmingly in the GOP-controlled legislature. Only three Republicans voted against it, so I think that shows just the overwhelming amount of support that it had.

The law prohibits transgender youth from receiving hormone therapy or undergoing gender affirming procedures like top surgery or a full mastectomy, and the only exception is if a trans youth was already prescribed hormone therapy prior to the bill being signed by the governor. And they can take the medication, but all gender affirming surgery is completely off the table.

Supporters of the bill say the restrictions were necessary. They cited a lack of evidence on the impacts that such care can have on minors, and they also questioned if minors can consent to such procedures. It's worth noting that around 30 medical associations say gender affirming care for trans youth is safe and effective.

But the ban has been a very difficult pill for trans youth and their families to swallow. And these families with transgender children are considering leaving the state or have actually already fled because of the law.

CATHY WURZER: Now, I understand your story delves into one of these families, so tell us a little bit about them.

SAGE MILLER: Yeah. And as a heads up, I'm only using first names due to safety concerns from the family. So Jen and her family have lived in Utah for decades. They loved it. It's where they bought a house. It's where they raised their kids. But her youngest child, Kat, is 14, and they're transgender. They're non-binary and they use he/they pronouns, and when the gender affirming care ban was introduced, the family was on very high alert. Jen was incredibly stressed and concerned about what this would mean for Kat and the access of care that they could potentially have or not have.

And Kat was already having a rough time with their peers accepting their gender identity prior to the bill, but they say things got worse once it was brought up and ultimately passed.

KAT: I mean, especially my school, I've been constantly harassed and actually bullied out of the school for about a month. I had to stay home, and I'd get shivers of even thinking of going to school.

SAGE MILLER: So after the bill went into effect-- it was immediately went into effect after the governor signed it, about a few days after it was passed by the legislature. And Jen, Kat's mom, says the family's mental and physical health started to really decline. Kat went from the honor roll in school to 20-plus absences, and Jen says the constant fear and worry, along with the lack of access to medical care, prompted them to just leave Utah.

CATHY WURZER: So how did the family make that decision?

SAGE MILLER: Jen says it was the legislature in Utah that really forced their move.

JEN: How can I possibly stay and let my child be treated like this, let Kat be treated this way? Like, I would be a horrible parent if I didn't use the resources that I can gather to get out.

SAGE MILLER: So that's exactly what they did. The family started looking for places to live where they felt safer. And they actually considered moving to Minnesota, which is how I kind of sort of got connected with Dana for this reporting, but they actually decided against it because they were concerned Minnesota would actually reverse the trans care protections if Republicans gained control of the legislative and executive branches.

CATHY WURZER: So Dana, I'm going to bring you in here right now. Obviously, lawmakers, there's the trifecta DFL lawmakers won in this past election, House, Senate, and the governor's seat. And clearly, Minnesota took a different tack this year in response to bans like Utah. So remind us, what did the legislature do to shield those trying to access care here?

DANA FERGUSON: Sure. The governor earlier this year issued an executive order reaffirming the right of patients from other states to access care in Minnesota. And as you'll remember, this spring, DFL majorities approved and the governor signed into law a bill that grants legal protections to patients coming to Minnesota for gender affirming care, as well as for those who provide it. Democrats at the Capitol said it was important to provide legal refuge for those seeking care services, and for doctors, so that they don't face penalties from other states that have outlawed gender affirming care, like Utah.

CATHY WURZER: OK, let me talk about that. Let me ask you about that. I know you talked to gender affirming care providers here in Minnesota who are seeing more patients from states like Utah. What are they dealing with?

DANA FERGUSON: They said they're experiencing a surge in calls as patients from around the country try to access gender care, and they're also trying to keep up with the demand that they face here in Minnesota. They're trying to train up more doctors in gender affirming care so that they can meet the need, but they say it's tough. Here's Dr. Kelsey Leonardsmith who works at Family Tree Clinic in Minneapolis.

DR. KELSEY LEONARDSMITH: You run a real risk of doing wrong by trying to do right, trying too hard to take care of everybody, so that you're not doing a good enough job. And finding the right balance is really tough.

DANA FERGUSON: Family Tree gets calls from out of state patients every week, compared to a few that they used to get each year. And Children's Minnesota says its gender program has seen a 40% increase in calls in the last year. They also have a one year waitlist right now.

CATHY WURZER: So that is a big increase. Did the doctors talk about how their patients are doing?

DANA FERGUSON: Yeah, they did. And they said they're really scared. The doctors I spoke with, as well as LGBTQ+ advocacy groups, said this wave of gender care bans has caused a lot of anxiety for transgender people and for their families. Some people are getting all their documents, like passports, ready in case they feel like they need to leave the country quickly. And even people who move to refuge states like Minnesota say they're still preparing to get out of the country because they worry that additional policy changes could put a target on their backs. Here's Dr. Katie Miller, who works at Children's Minnesota.

DR. KATIE MILLER: I think another challenge is that people feel very afraid of what might happen next. People feel victimized by the government. It's led to just a degree of fear and anxiety about accessing medical care that I haven't seen before.

CATHY WURZER: Sage, I'm going to bring you into the conversation right now. Have you talked to gender care providers in Utah? How are they responding?

SAGE MILLER: I have, and when the bill was introduced to restrict this care, they were also on very high alert. And now they're limited on the care that they can provide to trans minors. But they said they don't have a plan to leave Utah, because they feel like they serve a very important role here. They want to keep doing what they're doing for the trans and non-binary community here.

And Utah also has a really long wait list for trans youth to see a gender affirming care doctor. Even though they can't get certain medical care, those doctors are working with them to understand their options. So in some cases, that means referring patients to another state, like Colorado, where they can receive hormone therapy and even surgery. And there isn't a statue in the law that prohibits doctors in Utah from referring patients out of state to provide this care. Doctors just face potential consequences like losing their medical license if they practice gender affirming care by prescribing hormone blockers in the state.

And they're really-- some of them are kind of crossing their fingers, hoping that this ban will be challenged in court. That hasn't come to fruition yet, but the ACLU of Utah says we should be on the lookout. That lawsuit could be coming down the pipeline soon.

CATHY WURZER: Say, Dana, Sage mentioned earlier in our conversation that Kat's family thought about moving to Minnesota but chose not to because they were worried that the state's shield law might get walked back later. Is that possible?

DANA FERGUSON: It is possible, but I should mention that it's not likely to happen in the near term. Members of the House here are up for re-election next year, but the State Senate and Governor Tim Walz are going to remain in office through 2026. So Democrats are going to be in control of two of the three levers of power at the Capitol, no matter what happens in next year's election.

But it's worth mentioning that Democrats and advocacy groups are mindful that the law could be overturned by a future legislature, and they're weighing putting a constitutional amendment on equal rights before voters next year. And that measure could safeguard access to care no matter what a legislature would do.

CATHY WURZER: All right. I appreciate your time, both of you. Dana and Sage, thank you.

DANA FERGUSON: Thank you, Cathy.

CATHY WURZER: You can listen to all this Sunday on All Things Considered. You can also read more about how the disparate outcomes are shaping access to care in both of these states. MPRNews.org is where you find that. Sage Miller's been with us with KUER. Dana Ferguson, of course, one of our political reporters here at MPR News.