State restrictions on gender-affirming care for children have doubled the average travel time to a provider in the US, study shows
By Deidre McPhillips, CNN
(CNN) — At least 20 states have enacted policies restricting health care for transgender youth, and the loss of gender-affirming care clinics in those states has dramatically increased the average travel time to a provider, according to a new study.
About half of adolescents now live more than an hour away from the nearest clinic providing gender care, nearly double the share before the restrictions were put in place. And more than a quarter of children live more than a full day’s drive away from the nearest operating clinic, at least 8-hours roundtrip.
Overall, the average travel time to a gender-affirming care clinic doubled from about 30 minutes to an hour, the researchers found, with the largest increases for those living in Florida, Texas and Utah.
“What would happen if the average person’s travel time to their primary care physician increased by an hour? People would find that to be outrageous,” said Mike Parent, principal researcher at Hopelab, an investment company focused on youth mental health and technology. “It’s going to have an immediate and detrimental impact on the well-being of these youth.”
Major medical associations – including the American Medical Association, the American Psychiatric Association, the American Academy of Pediatrics and the American Academy of Child & Adolescent Psychiatry – agree that gender-affirming care is clinically appropriate for children and adults, and access to this care can have significant mental health benefits.
“For transgender and nonbinary children and adolescents, early gender-affirming care is crucial to overall health and well-being,” the US Health and Human Services Department Office of Population Affairs says. Delaying care can exacerbate stressors and health problems for kids.
But the state-level restrictions exacerbate challenges for a system that was already straining to meet the needs of patients, experts say.
For this study, researchers from the University of Michigan compiled a directory of clinics that publicly advertised that they provide medical gender-affirming care for patients younger than 18, including puberty-suppressing medications and hormones.
They identified a total of 271 gender clinics to serve an estimated 300,000 transgender youth ages 13 to 17 nationwide. But more than a quarter of those clinics – and more than 89,000 transgender youth – are in states with restrictions on gender-affirming care.
“It’s a small but growing number of medical and surgical and mental health experts who have been providing this care. And so there have always been waitlists. I’ve watched as waitlists have grown by months to, in some cases, even more than a year to get in to see a specialist,” said Dr. Scott Hadland, chief of adolescent medicine at Mass General for Children.
“The pressure is mounting on the clinicians and clinics that are left now.”
Increased travel time to gender-affirming care has ripple effects that multiply quickly. Children having to miss more time at school, or for the adults they’re with to miss work, in order travel these longer distances creates new challenges – and each trip poses a new risk for care to be interrupted.
“What’s unique here is that gender-affirming care of young people involves the young person and their whole family. When we think about these barriers to access, they’re disrupting not just a young person’s access to care but the entire family’s access to care,” Hadland said.
And gender-affirming care involves a multidisciplinary approach in which regular, consistent appointments are key.
“These distances aren’t being magnified just for one appointment, but rather for many appointments when gender-affirming care is done well,” he said.
Telehealth can help in some ways, Parent said – but there are still limitations. If a patient needs to check their hormones, for example, it’s not as simple as sending data over to a health care provider from a finger prick at home.
For the thousands that will need to make those longer, in-person trips, the negative effects will be tangible, experts say.
“This means that (transgender youth) don’t get access to services that can be life-changing,” Hadland said.
CNN’s Jen Christensen contributed to this report
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