As the Supreme Court weighs one of the most significant transgender healthcare cases to date, access to gender-affirming care hangs in the balance for youth across America. Twenty-six states have passed bans on such care, with Tennessee’s law—now before the nation’s highest court—representing a critical test case.
Those supporting the ban argue gender-affirming care for trans and nonbinary youth is not only harmful, but that the transgender community is unprotected by the Constitution.
Tennessee is among a cohort of 26 states to pass a ban on such care, despite all of them being challenged on a federal court level, Tennessee lands one of the most major transgender healthcare cases to date, reaching the highest court in the land.
The implications stretch far beyond Tennessee’s borders.
“The waitlist is what keeps me up at night. It has grown every year, and it got particularly long after the bans went into effect,” said Dr. Kade Goepferd, a nonbinary medical director of Minnesota’s only multispecialty pediatric gender clinic who uses they/them pronouns told NBC News in August. “It has grown every year, and it got particularly long after the bans went into effect.”
Their program has seen a 30% surge in calls since surrounding states outlawed gender-affirming care for minors. Even after hiring additional staff, the waitlist stretches at least a year for new patients.
In Berkeley, Calif., pediatrician Mahtab Danai watches these developments with growing concern.
As the Supreme Court weighs a landmark transgender healthcare case,Berkeley, Calif. pediatrician Mahtab Danai is worried about her patients new risks of suicide.
“I fear that suicide rates and mental health crises in general will rise for trans youth in light of the recent Supreme Court [case],” said Danai, an incoming adolescent medicine fellow at Children’s Hospital Los Angeles (CHLA). While she is not LGBTQ-identified herself, Danai cares for kids and teens—many of whom are trans, nonbinary and gender-nonconforming. “I worry about the mental health of trans youth as they navigate the political climate—especially in more conservative states.”
Those supporting the ban argue that gender-affirming care for trans and nonbinary youth is not only harmful, but that the transgender community is unprotected by the Constitution. With access to healthcare and their constitutional rights hanging in the balance, trans communities and LGBTQ families nationwide might rush to access the care they need before Trump takes office.
However, medical professionals like Danai are standing firm in their beliefs that gender-affirming care is crucial regardless of elections and court rulings.
Why medical professionals choose this work
Mauricio “Jimmy” Franco, a queer and Latine primary care provider in San Francisco’s East Bay area, provides critical primary care to trans and nonbinary youth at his outpatient clinic. His experience began before medical school, working with trans and nonbinary youth—particularly those who were unhoused.
Among his patients, gender identity intersects with broader challenges of job security, employment and fears of harassment. Franco understands these struggles personally. Growing up in an immigrant family, he witnessed firsthand how healthcare access could vary dramatically depending on providers and clinics.
“As a queer person growing up in a Latine family, [they] have always been supportive, and that’s something I want for every young person,” he explained. “And that includes being able to access medical care that is respectful of who they are.”
This experience shapes his medical approach. He believes healthcare access shouldn’t depend on location or identity—especially for transgender and nonbinary patients who face increasing restrictions nationwide.
For Danai, though she’s a cisgender and heterosexual pediatrician, the urgency of providing this care is profound.
“Getting to provide gender-affirming care has been one of the happiest parts of my job—to help a teen feel seen, cared for and supported in reaching their gender identity goals has been incredibly meaningful and powerful,” she said. “Gender-affirming care literally saves lives.”
Rather than continue referring patients to specialists, Danai is pursuing an adolescent medicine fellowship to provide gender-affirming hormone therapy directly to trans youth, expanding access to essential care.
The reality beyond California
While many states move to restrict care, California took the opposite approach in 2022, becoming the first state to declare itself a sanctuary state for trans youth. Signed by Gov. Gavin Newsom signed Senate Bill 107, which protects trans youth from other states to seeking gender-affirming care by shielding families from child abuse allegations or criminal prosecution for pursuing such care.
Danai admits to feeling “incredibly lucky being in California,” where medical support systems are equipped to provide for youth facing gender dysphoria. With half of the country’s states passing anti-trans bills, California remains a beacon for young trans and nonbinary people—even for those coming from out of state.
The reality in other regions is increasingly dire. Goepferd’s Minnesota clinic exemplifies the mounting pressure on remaining providers in accessible states. Beyond the growing waitlists, providers like Goepferd face personal challenges, including death threats for their work.
Even California isn’t immune to threats seen in hostile states. One of the best-known practitioners of gender-affirming care, Dr. Johanna Olson-Kennedy, who leads the Centre for Transyouth at CHLA, is currently being sued for negligence over a patient who underwent gender-affirming care as a child and has since detransitioned.
Dr. Navin Kariyawasam, a trans physician, wrote for Creators on Monday about how vital it is to speak with young people about gender. Kariyawasam pushed back against the notion—the same one currently challenging Olson-Kennedy—that doctors providing gender-affirming care are maliciously intended and working against the betterment of young people and their families.
“As a physician, I am not looking to “diagnose” a gender, but to support young people and their families as they figure out their sense of self,” Kariyawasam wrote. “No one makes the decision to seek out gender-affirming care on a whim.”
Looking ahead
For Franco, progress starts at the ground level: beyond politics, a proper patient experience for trans and nonbinary youth starts with the clinical team, even before the medical provider.
“The entire clinical team needs to embrace the very real fact that trans and nonbinary people exist and that they deserve to be treated as we treat other patients in their full humanity,” he said. “But that’s a huge cultural shift that I think folks have been working very hard for many years to continue to push and drive, and I think recent political changes are going to make it that much more difficult.”
This reality drives allies like Danai to become medical providers that work directly with young trans people. She feels hopeful about starting her adolescent medicine fellowship with Trump taking office only weeks away. For her, the significance is crystal clear.
“It is an act of resistance to advocate for and support trans youth, and it is exciting to be able to provide gender-affirming hormone care as an adolescent doctor while learning with like-minded individuals.”
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Publish date : 2024-12-13 00:00:00
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