Lifesaving healthcare for children is at-risk in 26 states

When Jack Teter got top surgery ten years ago, they had to fly from Colorado to Florida of all places. That’s because, at the time, there weren’t providers in-state.

“For a long time, it was like, if you wanted chest surgery, you had to go to Florida. If you were a trans woman who wanted gender-confirming surgery, you would go to Trinidad, Colorado, and then Marci Bowers in California,” said Teter. “And so for a while, it was like, there’s three doctors and wherever they go, it’s where you have to go. It’s just not like that anymore.”

In the years since, many more providers have popped up in additional states including Colorado. But, by no means is it easy to access gender-affirming care in 2024. Barriers like insurance coverage, travel expenses, wait lists, and working around current legal challenges to accessing that care can all stand in the way.

“This all continues to be a challenge, and so trans people have to be adept at navigating health systems,” Teter explained.

Colorado is the only state as of 2023 that explicitly includes gender-affirming care services in its benchmark health insurance plan for essential health benefits. There’s also laws in Colorado that require certain buildings to have restrooms with amenities that are not gender specific, as well as anti-discrimination laws that extend to schools, legal bans on conversion therapy for minors … the list goes on.

All of this and more has led Colorado to develop a reputation as one of the safest, most inclusive states in the country. But, at the end of June, the Colorado Supreme Court had to reject a proposed ballot measure that would have broadly banned gender-affirming care and surgery for minors. It wasn’t approved because the supporters of the initiative didn’t quickly enough appeal a state administrative board’s rejection of the proposal, but still stands as a legitimate attempt to challenge gender-affirming care in the state. 

Colorado has seen a similar pattern when it comes to abortion care. People travel across the country to access abortion services, just as they do for gender-affirming care. And, abortion is far from unanimously agreed upon at the state level.

Jack Teter is the director of government affairs for Planned Parenthood of the Rocky Mountains. He’s spoken on KGNU’s airwaves before, about the significant increase in individuals coming to Colorado for abortions.

Teter drafted shield laws that protect both abortion care and gender-affirming care in Colorado. They said that as a trans person who works in health policy, they’ve thought a lot about these topics, and are always eager to opine on the similarities and differences between these forms of care and the need to protect them both.

Listen:

“Colorado is a safe haven for patients of all types who are traveling from areas of the country where the kind of health care that they need to be well, that their family supports them in receiving, is now a felony,” said Teter. “And that applies both to patients who are seeking abortion care and to patients who are seeking gender-affirming care.”

Teter acknowledged that unlike abortion care, gender-affirming care usually requires more than a one-time trip. Patients using hormones are often on those medications for years, and may need several consultations. This form of care can also involve intensive surgeries and support services. As a result, Planned Parenthood of the Rocky Mountains has seen both an increase in out-of-state patients traveling to Colorado for gender-affirming care, and those same patients moving to Colorado for continued care.

“When patients are traveling for gender-affirming care, some of them might travel a couple of times, but ultimately a lot of patients are relocating. And then that patient becomes an in-state local Colorado patient. I think too, it’s really important to recognize that traveling is not a solution, right? I don’t want to live in a country where trans people can only live in 24 or 26 states, right? I don’t think that is sustainable and I don’t think that’s right. And there are trans people who are living and thriving and having kiddos and going to work and just living their lives in these states that have passed these gender-affirming care bans. And so I would never suggest that people ought to, right?”

Moral arguments around gender identity and gender-affirming care are alive and well. A 2024 Gallup poll found that 51% of Americans think changing one’s gender is morally wrong. Judgment, or downright disapproval, of one’s gender identity feeds into stigma against gender-affirming care.

Teter said many people believe both abortion and gender-affirming care are specialized and uncommon, and cited stigma and political intervention – “all the way from our legislatures into med schools and training programs” – as the fuel of these inaccurate perceptions.

“These are not highly specialized, rare diseases where there’s one expert in the country and you really have to travel. This is primary care. This is just normal, basic family medicine services. And people should be able to access abortion care with any primary care provider, any OBGYN that they see. They should be able to access hormone services through their family medicine doctor,” Teter explained. “Many of us access hormones from our primary care providers in the form of oral birth control pills. That is very, very common, normal health care that no one would suggest you would need to see a specialist for. And yet, I think around gender-affirming care, there’s sort of an artificially created scarcity that makes it quite a bit harder to access the care that patients need.”

Teter brought up the simplicity of hormone-replacement therapy as one of many reasons why gender-affirming care would fit seamlessly into primary care. He told me that estrogen and testosterone – the two drugs most commonly prescribed to transgender and gender nonconforming individuals to achieve a more aligned gender identity – are some of the simplest medications. You can pick them up at Walgreens, Teter pointed out. They don’t need to be refrigerated, and the dosages are often simpler to identify for a patient than for common selective serotonin reuptake inhibitors (SSRIs) like Zoloft or Prozac.

“The medications that trans people use are not complex medications,” Teter explained. “I think one thing that’s very important to recognize is that the national political effort to ban gender-affirming care is the exact same thing as the national political effort to ban abortion. These are being run by the same people and the same organizations. The same human beings are drafting the bills. This is part of the same concentrated effort to use the lives and health care of a marginalized group of people as a political cudgel in order to win elections and do horrible things with the power that they might obtain.”

26 states have passed bans on gender-affirming care for youth. In Florida, Arkansas, and Montana those bans are currently blocked from enforcement through court orders as they enter litigation proceedings. Meanwhile, 14 states have total abortion bans.

From Teter’s point of view, the cause for abortion access goes hand-in-hand with the cause for gender-affirming care.

“And so if you are outraged by the attempt to ban abortion, making it a felony in half of the country that threatens women and their doctors with jail time, then you should also be outraged and you should oppose efforts to ban gender-affirming care. You gotta support trans people’s ability to access their health care because the attempts to ban them are the same. Neither of these restrictions come from a place of medical best practice or interest. They are being run by anti-trans, anti-abortion politicians and think tanks that do not care about people’s healthcare, but just want to control them. Your family and your healthcare provider might all agree that this is the absolute thing that you need for your health and well-being. And yet, a politician who does not care about you or your wellness wants to make that care, not only inaccessible, but illegal, a felony. And I think it’s just so important to draw that connection that this is the same effort pursuing these.”

Teter’s perspective that abortion bans and gender-affirming care bans are part of the same concerted effort to put care out of reach for patients is not new. Back in 2023, Mother Jones magazine reported on the ties between anti-abortion activists and the campaign against trans youth. They found that many of the groups supporting anti-abortion legislation are the same ones authoring and advocating for gender-affirming care bans.

Another potential correlation to note: there was a significant increase in anti-LGBTQ+ hate crimes the year Roe v. Wade was overturned. That’s according to the Federal Bureau of Investigation (FBI)’s 2022 Hate Crime Statistics Report, which made it clear that 2022 saw the highest number of hate crimes against the LGBTQ+ population since 2017. Additionally, anti-trans incidents alone increased 40% from 2021 to 2022.

“LGBT people are in every state, every country on earth, and we have to recognize the impact, both on medical access and also on our psyches, that the health care that we need to live [may become] a felony in half of the country, and that’s not acceptable, it’s not sustainable, but that’s the reality of where we are right now.”

Receiving adequate healthcare can make or break someone’s quality of life – and ability to stay alive. The presence of supportive adults and access to healthcare can reduce suicidality by 75% in trans youth.

“Being denied access to that care increases the risk of suicide. And that’s not because trans people are mentally ill. It’s because trans people who can’t access the healthcare that they need are put into a terrible, untenable situation where we feel awful all the time. And so I think that that’s crucial…People’s ability to access the health care that they need is often a matter of life and death, and it’s also a matter of whether people can thrive or whether they’re miserable, and forcing people to live miserably when we could instead support them to thrive by accessing really basic health care is certainly not what I think the government ought to be doing with their time.”

Planned Parenthood provides estrogen and testosterone, as well as primary care services, for trans folks. That’s because, Teter told me, gender-affirming experiences around all kinds of care are important – from pap smears to yearly checkups. Planned Parenthood doesn’t do surgeries, but will help connect patients with doctors that do. They do not provide gender-affirming care to anyone under the age of 18, as this care tends to be more specialized; however, they will provide referrals to those folks.

“I think it feels important to reassure patients that even though the need is so high, our patient assistance funds are approaching $13 million. We will never turn patients away. And so if patients need help, if patients need help paying for an appointment, they should still contact us. We are not out of money. They should come and see us.”

Fawn Bolak, the Regional Director of Communications & Marketing for Planned Parenthood of the Rocky Mountains, sent over this statement to further clarify the services they provide:

“Planned Parenthood of the Rocky Mountains currently provides gender-affirming hormone therapy (GAHT) to patients 18 and over in four Colorado locations and via telehealth services. These four locations are Salida, Colorado Springs, Denver Central and Littleton. We began offering GAHT in Salida (January) and Colorado Springs (April 15) just this year; Our team is projecting to see 4,500 GAHT patients by the end of the year; and approximate 25% from last year. The majority of patients we see traveling to Colorado for gender-affirming care are coming from Wyoming, Texas, and Arizona.”

Although there won’t be any challenges to gender-affirming care on the upcoming November ballot, Teter stressed the importance of voting to protect abortion access.

“I know that it is reassuring for many of us to know that we live in a safe haven state. And if we think it can’t happen here, we’re wrong. It’s happening in states all over the country and lots of people in those states thought, ‘It’ll never happen here.’ And so it’s so important that we protect access to abortion care in our state constitution so that people inside the state of Colorado are protected and able to access the care that we need.”

For more information on Planned Parenthood of the Rocky Mountain’s gender-affirming care services, visit their website here.

Correction:

• 25 states have successfully passed bans on GAC for trans youth. 20 of those are currently in effect. 
• Almost all of the proposed or enacted bans on GAC for youth carry penalties for the providers including loss of a medical license or referral to medical licensing boards for further action and/or criminal penalties that rise to the level of felony charges. 
• Some laws carry penalties for parents: For example, Florida’s law, modifies state custody laws to permit the state to take physical custody of the child, if they are “at risk of or is being subject to” gender affirming care. In Texas, some types of youth GAC are defined as child abuse, which could carry penalties not only for parents, but for teachers, school counselors, etc. who are mandated reporters.

Transcript:

Jackie Sedley: It’s 8:35 on listener-supported KGNU. This is A Public Affair. Colorado is the only state as of 2023 that explicitly includes gender affirming care services in its benchmark health insurance plan for essential health benefits.  We also have laws in Colorado that require certain buildings to have restrooms with amenities that are not gender specific, anti discrimination laws that extend to schools, bans on conversion therapy.

So, Colorado really, at least in a forward-facing way, is a very inclusive place. But, at the end of June, the Colorado Supreme Court had to reject a proposed ballot measure that would have broadly banned gender-affirming care and surgery for minors.  It wasn’t approved because the supporters of the initiative didn’t quickly enough appeal a state administrative board’s rejection of the proposal, but that was still a challenge to gender-affirming care in this state. 

Colorado has seen a similar pattern when it comes to abortion care. People travel across the country to access abortion services, just as they do for gender-affirming care.

I’m Jackie Sedley, and I reached out to Jack Teter, the director of government affairs for Planned Parenthood of the Rocky Mountains. We’d spoken before, about abortion on KGNU’s airwaves back in December, and back then they told me about a significant increase in individuals coming to Colorado for abortions. I was curious if they had made any connections or correlations between abortion care and gender-affirming care as I’d observed.

Shortly after we hopped on Zoom, Teter told me they drafted Colorado’s SHIELD law, which protects both abortion care and gender-affirming care. Seems like I came to the right place for this kind of conversation. They smiled and told me that as a trans person who works in health policy, they’ve thought a lot about these topics, and were very eager to opine on the similarities between these forms of care, and the need to protect them both.

***

Sedley: Jack, the last time we spoke, we talked mostly about abortion access and how Colorado has become this sort of sanctuary state for those living in states around it. After the overturning of Roe v. Wade, a lot of these surrounding states have put bans or attempted to put bans in place to restrict access to abortion.

Colorado doesn’t have any bans like that in place. However, on the upcoming November ballot, there is a measure looking at abortion and health insurance coverage. If that ballot measure passes, there will be a right to abortion created in the state constitution and public funds will be allowed to be used for abortions.

That access to public funds could be a game changer for Colorado as the demand for abortion care in this state from those out of state increases. Just a couple weeks ago on KGNU, we talked about Cobalt, a huge abortion provider in the country based in Colorado, having to restrict funding because of that demand.

So, all of this really has brought me back to this idea of gender-affirming care. The reason being that Colorado is also a sanctuary state for those services. So that was lots of information that I just said, but I kind of wanted to start us off in this conversation by asking you your perspective, Jack, on the current status, both in terms of demand and ability, to provide gender-affirming care in the state of Colorado – both from a Planned Parenthood perspective and from the perspective of someone that has accessed to those services in the past yourself.

Jack Teter: Colorado is a safe haven for patients of all types who are traveling from areas of the country where the kind of health care that they need to be well, that their family supports them in receiving, is now a felony. And that applies both to patients who are seeking abortion care and to patients who are, who are seeking gender-affirming care.

I think gender-affirming care is a little different in that it’s usually not a one-time travel, right? For patients who are using hormones, um, those are medications that many of us are on for years and years and years, if not for, you know, large portions of our lives. And so traveling, you know, kind of every month doesn’t feel possible and doesn’t really make sense in the same way that someone might travel once to have an abortion and then go home.

I think when we think about the patients who we’re seeing traveling for abortion care, the needs of those patients are extraordinarily high, and the patients who we are seeing are undergoing just extraordinary journeys, patients who are driving a thousand miles one-way from east Texas. The majority of patients who have abortions are already parents, and so people are driving with their kiddos asleep in the back seat, uh, because they couldn’t get childcare, because they got time off of work.

And patients are arriving, they need help with hotels, dinner, and somewhere to send their kiddos during their appointment. I mean, the, the needs of patients show the lengths that people are willing to go to access the care that they need, and no one should have to do that, right? People shouldn’t have to leave their homes and their support systems and their families behind to travel across the country to access care.

For trans people who are accessing gender-affirming care, those conversations look a lot more like moving, and I’m – I’m personally in touch with families who are relocating to Colorado, especially to support their trans kiddos who are looking for new school districts, looking for a house, and mom and dad need to get different jobs. And that kind of permanent relocation, I think, is different, certainly no less outrageous, right?

People should not have to do that, but it’s certainly happening. I think too that for gender-affirming care, like abortion care, stigma makes care harder to access, right? Gender-affirming care, abortion care, these are not highly specialized, rare diseases where there’s one expert in the country and you really have to travel.

This is primary care. This is just normal, basic family medicine services. And people should be able to access abortion care with any primary care provider, any OBGYN that they see. They should be able to access hormone services through their family medicine doctor, right? It’s only because of stigma and political intervention, all the way from our legislatures into med schools and training programs, that makes this care seem so specialized and rare, and it’s not. It’s not super complicated. Many of us access hormones from our primary care providers in the form of oral birth control pills. That is very, very common, normal health care that no one would suggest you would need to see a specialist for.

And yet, I think around gender-affirming care, there’s sort of an artificially created scarcity that makes it quite a bit harder to access the care that patients need.

Sedley: And I think that that stigma is seen in so many ways on personal levels, of course, and also on governmental levels. There’s 26 states that have passed bans on gender-affirming care. Many are currently in litigation proceedings with challenges to those bans, or they’re on hold. Like in Florida, Arkansas, and Montana, the bans are on hold or blocked from enforcement through court orders.

This idea you just brought up of gender-affirming care as primary care, that it should be seen as considered and integrated into primary care systems, is really interesting. And I would love to hear more about your thoughts on that, and how to fill that gap so that people can see gender affirming care as primary care – bridging that gap of knowledge and information and understanding of just how important gender affirming care is.

Teter: The medications that trans people use are not complex medications. Estrogen and testosterone, you pick them up at Walgreens. It’s not a big deal from a specialty pharmacy. It doesn’t even need to be refrigerated. It’s like, it’s not a big deal.

But because of stigma and now because this care is a felony in half of the country, the opportunity for providers to get trained in providing that care has been pushed out of reach.

I think one thing that’s very important to recognize is that the national political effort to ban gender-affirming care is the exact same thing as the national political effort to ban abortion. These are being run by the same people and the same organizations. The same human beings are drafting the bills. This is part of the same concentrated effort to use the lives and health care of a marginalized group of people as a political cudgel in order to win elections and do horrible things with the power that they might obtain.

And so I just think it’s so important to reiterate that you can’t support one without the other.

And so if you are outraged by the attempt to ban abortion, making it a felony in half of the country that threatens women and their doctors with jail time, then you should also be outraged and you should oppose efforts to ban gender-affirming care. You gotta support trans people’s ability to access their health care because the attempts to ban them are the same. Neither of these restrictions come from a place of medical best practice or interest. They are being run by anti-trans, anti-abortion politicians and think tanks that do not care about people’s healthcare, but just want to control them. Your family and your healthcare provider might all agree that this is the absolute thing that you need for your health and well-being. And yet, a politician who does not care about you or your wellness wants to make that care, not only inaccessible, but illegal, a felony. And I think it’s just so important to draw that connection that this is the same effort pursuing these.

Um, it is not a surprise to me. I think that the abortion movement was very clear with people that they would not stop at abortion. Next, they went to gender-affirming care. Now we see them going after IVF. We look at things like Project 2025 and know that they want to go after contraception. And so, if you are someone who cares about abortion bans, and you look at this and think it doesn’t impact you, it does, right? This is, this is all part of the same concerted effort to put care out of reach for patients.

Sedley: And those correlations, I feel like I’ve seen a trend of them just through observation in my personal life, with my friends, and the discrimination they face, specifically with regard to medical needs – in both the realms of abortion and of gender-affirming care. It’s hard to outline direct correlations or causations of discrimination, especially discrimination that has been long-standing, but the FBI released a report last year, the 2022 Hate Crime Statistics Report. And in that report, they made it clear that the highest number of anti-LGBTQ hate crimes over the past five years was in the same year that Roe v. Wade was overturned, in 2022. Anti-trans incidents alone increased 40% from 2021 to 2022.

And so that’s not a direct causation, I can’t go that far, but it’s something to look at, right?

That those assigned female at birth and those with uteruses, who are viewed as an othered or marginalized group, lose rights to abortion, which is a form of health care. Queer people [are] facing this discrimination, another marginalized group that can often include those same folks that are trying to access abortion care.

So moving it back locally to Planned Parenthood of the Rocky Mountains, have you seen an increase in gender-affirming care take place here in the same way that you were reporting seeing the need for abortion services increase as a result of other states around Colorado restricting access back in December?

Teter: We have seen an increase in gender-affirming care patients and again, I think it’s a little, it’s a little different when patients travel for abortion care. It’s usually a one-time thing, right? When patients are traveling for gender-affirming care, some of them might travel a couple of times, but ultimately a lot of patients are relocating.

And then that patient becomes an in-state local Colorado patient. I think too, it’s really important to recognize that traveling is not a solution, right? I don’t want to live in a country where trans people can only live in 24 of 26 states, right? I don’t think that is sustainable and I don’t think that’s right. And there are trans people who are living and thriving and having kiddos and going to work and just living their lives in these states that have passed these gender-affirming care bans. And so I would never suggest that people ought to, right?

LGBT people are in every state, every country on earth, and we have to recognize the impact, both on medical access and also on our psyches, that the health care that we need to live is a felony in half of the country, and that’s not acceptable, it’s not sustainable, but that’s the reality where we are right now.

I’ll be curious to see where these legal challenges on gender-affirming care land. I think that the legal argument for banning gender-affirming care, it’s very different than the Supreme Court’s new status quo on the ability of states to ban abortion care. Obviously I disagree with the legal rationale that allows for abortion to be banned, and I think it’s a horrific miscarriage of justice and one of the worst decisions the courts ever made.

Banning gender-affirming care legally feels like a very basic up-and-down matter of sex discrimination. If the court believes that I am not actually a trans man, I’m actually a woman, and I shouldn’t be allowed to access testosterone, then they’re saying that men can access testosterone, but women can’t.

If the court believes that the surgeries that trans people need are just cosmetic surgeries, then the court is arguing that some people can access those same cosmetic surgeries and others can’t, based on their legal interpretation of their sex. That doesn’t make any sense, right? And so, even though I obviously disagree with those premises, even if that’s how the court wanted to rule, it doesn’t make sense.

And so I do think there’s an interesting legal distinction there that makes me question whether or not gender-affirming care bans can truly stand as a matter of the law. And so even if you don’t know someone who’s trans, you certainly know someone who’s had an abortion. And it’s really important to draw that connection as we extend empathy to people whose experience might not be like our own, but who need to access healthcare and do it under the expert supervision of their healthcare providers and their medical teams and be able to access the care that they need without having to travel thousands of miles or move their family across the country.

Sedley: Those connections can be so crucial to leading people to realize how much these causes impact them and their loved ones. Oftentimes, I think, people don’t realize they know a trans person, either because that trans person hasn’t been comfortable enough to come out to them, or because they just assume that gender-affirming care challenges don’t affect them and their loved ones.

They do, a lot of the time, especially when you put it in the way that you just did, bringing together these two fights. So I wanted to ask, what kinds of consequences you’ve seen for those that can’t access gender-affirming care? Obviously the consequences can look different for someone not being able to get an abortion versus someone not being able to get gender-affirming care, but physical and mental implications of not being able to get basic care in either of these realms exist.

Teter: Yeah, it’s interesting, right? There’s both a physical and a mental impact, of course. Um, we know that access to gender-affirming resources, whether that’s healthcare or being able to change your name and being supported, we know that the presence of supportive adults and supportive access to healthcare reduces suicidality by 75% in trans young people. And so being denied access to that care increases the risk of suicide.

And that’s not because trans people are mentally ill. It’s because trans people who can’t access the healthcare that they need are put into a terrible, untenable situation where we feel awful all the time. And so I think that that’s crucial.

I think that as we see increased political attacks on trans people, there’ve also become just bureaucratic hurdles that make life more difficult. And so Texas recently announced that they’re not going to allow trans people to update their driver’s licenses. That means if you change your name, but you can’t update your driver’s license, you now have a driver’s license that doesn’t reflect your legal identity anymore. And then what are you supposed to do? Or that you might be able to update your passport, but not your driver’s license. Now you have identity documents that don’t match. That helps no one. That’s just a miserable situation to put somebody in.

Uh, anyone who’s ever changed their name, maybe because they got married or got divorced, knows it’s a pain in the butt, right?

This is not, um, a pleasant kind of task for anyone to undergo anyway and to make it impossible for people to have identity documents that match their current name or their gender presentation is, is just sort of a situation that puts people in a risk. People’s ability to access the health care that they need is often a matter of life and death, and it’s also a matter of whether people can thrive or whether they’re miserable, and forcing people to live miserably when we could instead support them to thrive by accessing really basic health care is certainly not what I think the government ought to be doing with their time. But in some states – in 26 states – that care is now a felony, and that’s the reality for people who live there.

Sedley: So I know you said that in Colorado, there’s somewhat of a trend, not just people traveling here for gender-affirming care, but moving here for gender-affirming care. Can you speak to any potential strain on groups like Planned Parenthood that are providing gender-affirming care, as a direct result of this demand, as a result of the fact that so many other states cannot and will not provide that care?

Teter: The waiting lists for gender-affirming care across medical systems broadly, often, and have always sort of been quite long. Planned Parenthood has done an incredible job of expanding access to care. And so our wait, our wait lists are pretty accessible. But especially for families with adolescents who might be seeking care, those wait lists can just be very long. And I think that that’s mostly a result of the stigma and the political restrictions around that care, and wait times for primary care broadly across systems as our providers continue to grapple with the ongoing COVID-19 pandemic. As providers continue to deal with the burnout that comes from that, as states just grapple with their infrastructure, the wait times for primary care are long.

And so even when gender-affirming care is successfully integrated into primary care, there can still just be a long wait list. And so I think it depends on the type of gender-affirming care, right? Basic care, like access to hormones, that can be handled in a primary care visit for a lot of patients. And those waitlists might be several weeks sometimes, but the waitlists for, uh, you know, gender-affirming top surgeries, depending on the provider, can be months-long. And that’s just been the case for a long time, and it’s because there aren’t as many providers who provide those services.

It has certainly increased in access since I had chest surgery almost 10 years ago. I remember I had to go to Florida because there weren’t providers in the state that I lived in at the time. There are way more providers now in additional states, and so that has certainly, you know, reduced those barriers, and finding a provider who takes your insurance, right, this all continues to be a challenge, and so trans people have to be adept at navigating health systems. And anyone who’s ever had to sort of, you know, find the right provider for something that they need or try to find a specialist and what is the wait time and what does that look like? And do you need your prior auth and that kind of thing for any aspect of care, right? Knows what that experience is like, and I think it’s imperative that health care systems and primary care providers get additional continuing education and figure out how to better integrate gender-affirming care into the primary care space so that people aren’t facing those barriers.

And that’s true of abortion care too, right? The fact that the vast majority of OBGYNs in lots of states don’t provide abortion care at all, or that medical schools are graduating OBGYNs who didn’t receive training in abortion care, that’s a political problem, right? That’s a problem of state politicians creating restrictions on the ability of providers to get the training that they need, a restriction on the infrastructure, being able to provide fellowships and residencies that are able to provide that training. That’s a political problem. It’s not a provider problem. It’s not because of lack of interest or lack of support on the side of providers. It’s because of political restrictions on care.

Sedley: What a moment of whiplash to hear that you had to go to Florida for your top surgery, considering the state of Florida now. I’m assuming you weren’t coming from Colorado?

Teter: I was. Yeah.

Sedley: Oh, you were. Okay. Wow.

Teter: That was like. Yeah, that was back in, how many years was that? There’s a very well-known plastic surgeon in Florida who does a ton, he, all he does are like top surgeries, it’s all he does. And he has been doing it for a long time. I think for a while he was maybe like one of three surgeons in the country. It was him and then it was the guy in Plano, Texas. Because now there’s providers in Colorado, there’s private practice providers, and you can have chest surgery at the university, you can have it at Denver Health, it’s covered by Medicaid, right? It’s just really different now.

There, for a long time, it was like, if you wanted chest surgery, you had to go to Florida. If you were a trans woman who wanted gender-confirming surgery, you would go to Trinidad, Colorado, and then Marci Bowers in California. And so for a while, it was like, there’s three doctors and wherever they go, it’s where you have to go.

It’s just not like that anymore, but, um, yeah, it was Florida and Texas. Those were options for a long time.

Sedley: Right. It’s so interesting how the landscape of these things can change, but also stay the same in a lot of ways. And I wonder if the conversations around this have at the very least increased the number of folks that are going into these fields of medicine.

I’d be curious to know if more folks are specializing in gender-affirming care or anything like it as a result of the knowledge that it may be harder to get to it for a lot of people.

Teter: I think that medical systems and medical schools and safe haven states are increasingly devoting resources to training providers. And in some cases we’re seeing sort of cross state reciprocal agreements. where medical students in states with bans are intentionally seeking out that training because they know that if they don’t and they graduate from a medical school in a state like Texas, they might graduate without having ever obtained training in abortion provision and they don’t want to be a doctor who doesn’t know how to provide that care.

Sedley: And Jack, what services does Planned Parenthood provide with regard to gender-affirming care?

Teter: We provide estrogen and testosterone, as well as primary care services for trans folks. A gender-affirming experience around a pap smear is also incredibly important, even if it’s not an appointment around hormones, for example.

Planned Parenthood doesn’t do surgeries. And so if patients need access to, you know, chest surgery, that kind of thing, then that would be a referral out.

Sedley: Jack, is there anything else that you want to bring up that we didn’t touch on? I know I asked you a lot of questions and we covered a lot of ground, but there’s always more to talk about when it comes to healthcare.

Teter: I think it feels important to reassure patients that even though the need is so high, our patient assistance funds are approaching $13 million. We will never turn patients away. And so if patients need help, if patients need help paying for an appointment, they should still contact us. We are not out of money. They should come and see us.

I think it’s also important to uplift the incredible importance of the ballot measure to protect access to abortion in the state constitution this November. That feels like an imperative part of protecting this care for patients who are traveling from across the country, patients who are based here.

I know that it is reassuring for many of us to know that we live in a safe haven state. And if we think it can’t happen here, we’re wrong. It’s happening in states all over the country and lots of people in those states thought, “It’ll never happen here.” And so it’s so important that we protect access to abortion care in our state constitution so that people inside the state of Colorado are protected and able to access the care that we need.

***

Jackie Sedley: That was my conversation with Jack Teter, the director of government affairs for Planned Parenthood of the Rocky Mountains.

If you or your loved one are seeking out gender affirming care, you can head to the organization’s landing page for that care. Go to https://www.plannedparenthood.org/planned-parenthood-rocky-mountains/learn/gender-affirming-care. That full link will also be posted to kgnu.org, so no worries if you didn’t catch that.