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Minnesota as a trans refuge state: Our arms are open, but they are full.

Please note: The names in this blog have been changed to protect patient privacy.


Zoe’s story

It was a day not unlike many others in the Johnson household. Zoe, age 12, came home from school thinking about the conversation she had just had with her best friend, the soccer game she had coming up this weekend and the birthday party she was going to with her friends she had been close with since elementary school.

When she got home, she found her parents both sitting at the table, wanting to have a conversation with her. What they explained to her through tears, theirs and hers, was that due to a recent change in the laws in their state, their family was going to have to move.

Zoe, who had known since she was about 4 years old that she was a girl, and who was known to everyone in her life as female, could no longer attend the gender health clinic where she and her family had established relationships with a supportive medical and mental health team. She could no longer take the puberty suppression medication she had started six months ago, which was preventing her from undergoing male puberty until she was old enough to start female puberty with feminizing hormones.

The choice the family was facing was to either stop treatment and “detransition” Zoe, which means having her go through male puberty (deepening her voice, adding facial and body hair and other changes), remove her from the girls soccer team and disclose to her school, community and all of her friends that she had been assigned male at birth, or uproot the entire family (including her two siblings, dog and hamster) and move to Minnesota. Her parents were already looking for jobs, researching schools and where to live and telling their friends and family that they would be leaving the state that both of their families had called home for three generations now.

Gender health care in the United States today

Right now, in 23 states, transgender and gender diverse youth under the age of 18 have no access or restricted access to the essential health care they need to thrive. This means almost 50% of young people who are exploring their gender identities have no clinic or doctor to go to in their home state to seek care – just as they are approaching puberty and/or late adolescence when medical interventions have been proven to have a significant impact on their health and well-being.

In those 23 states, parents can’t call a specialist to get care for their child, and in some cases, parents risk prosecution or child protection for simply affirming their child’s identity. Affirming a child’s identity is a practice that is endorsed by every major medical association in this country and across the globe.

Close to care

For those families who are close enough to a state where they can access care (for us in Minnesota that includes states like North Dakota, South Dakota, Iowa, Nebraska, Montana and Missouri), they still face incredible challenges.

Often families miss school and work to travel for care that may not be covered by insurance and to access medications that they may not be able to fill at their local pharmacies. The time and financial burden on these families is large. Access to care remains difficult, with long clinic wait times that add additional stress to already stressed kids and families.

Minnesota as a trans refuge state

In 2023, our Gender Health program at Children’s Minnesota saw a 30% increase in new patient calls as states surrounding us restricted or outright banned gender affirming care. After the trans refuge law was passed in Minnesota last year, a PFund survey found that 150 plus individuals and families were moving to Minnesota. And while moving to Minnesota or traveling here for essential health care is a hardship for the youth and families finding refuge here, they are hopeful that we will be ready to welcome them with open arms and help them get the care they need.

The problem is that our arms are already incredibly full.

Children’s Minnesota’s Gender Health program

Prior to the passage of the trans refuge law, our waiting list for the Gender Health program was already more than a year long. More than 300 families are currently waiting to access care with our team of kid experts.

Our team at Children’s Minnesota and our colleagues in the Twin Cities who specialize in this essential health care are outmatched by the demand. There are families here in Minnesota who need us, and refuge families from other states who are coming to Minnesota because they need us as well.

The trans refuge law passed last year was an important first step to protect essential health care for transgender and gender diverse youth, and now it’s vital that we improve access to this care.

Advocating for increased access

That is why I, and our team at Children’s Minnesota, are currently supporting House File 3386, which would increase access to essential health care for families currently living in Minnesota, as well as those moving to Minnesota to seek refuge.

This bill establishes resources to not only help families like Zoe’s, who are uprooting their lives and communities to move to Minnesota for essential health care, but it also seeks to grow the number of clinicians to thoughtfully expand developmentally appropriate, high-quality care according to well established clinical guidelines.

It takes an in-depth apprenticeship approach that leverages the expertise and care systems already in place, to increase access without sacrificing the excellent quality of care we are proud to provide here in Minnesota.

This investment in health care infrastructure will improve health outcomes, particularly mental health outcomes, for transgender and gender diverse youth in Minnesota. At the same time, it will attract new families to our state who will bring with them workforce skills, financial resources, real estate investment and will contribute to a culture of inclusion.

We live in a country where far too many transgender youth are harassed and scared to engage in their daily lives as their authentic selves. I am proud of the state of Minnesota for acknowledging that all young people deserve to be their authentic and wonderful selves, and for protecting their legal right to access the essential health care they deserve.

But it’s time for us to take the next step. It’s time to make good on our promise to have room in our arms to embrace the families that need us. It’s time to make sure that transgender and gender diverse young people get to move beyond survival and can step into the beauty and joy of fully thriving as the gifts that they are to their families and to all of us.

Dr. Kade Goepferd, (they/them)
Chief education officer and medical director of the Gender Health program

Dr. Kade Goepferd, (they/them), is the chief education officer, pediatrician and medical director of the Gender Health program at Children’s Minnesota. Dr. Goepferd is an advocate for advancing equitable health care for all children – including trans and gender-diverse youth. They have been named a Top Doctor by both Minneapolis/St. Paul Magazine and Minnesota Monthly for the last several years and gave their first TED talk, “The Revolutionary Truth about Kids and Gender Identity” at TEDx Minneapolis in 2020.
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