How gender-affirming care is affected when clinics that offer abortions close: NPR

Supporters stand in front of a pile of burnt-out wreckage at Planned Parenthood in Knoxville on January 6.

Brianna Paciorka/News Sentinel/USA Today Network via Reuters


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Brianna Paciorka/News Sentinel/USA Today Network via Reuters


Supporters stand in front of a pile of burnt-out wreckage at Planned Parenthood in Knoxville on January 6.

Brianna Paciorka/News Sentinel/USA Today Network via Reuters

When someone burned down the only Planned Parenthood health clinic in Knoxville, Tennessee, earlier this year, the center was immediately inundated with patients. questions about what will happen to their care – but it wasn’t just about abortion services.

“We have been inundated with calls more from our gender-affirming hormonal patients than from any other type of patient because we are an ongoing source of care for gender-affirming patients,” Ashley Coffield, executive director of Planned Parenthood of Tennessee and North Mississippi, NPR told.

“It was very upsetting and scary for them when we were suddenly gone.”

When reproductive health clinics close, it’s not just access to abortions that is lost, but also a range of services – such as birth control, sex education and gender affirmation treatments – that can disappear.

And some of these services, like hormone replacement therapy, require patients to see their doctor more regularly than usual. patients visiting abortion or birth control services, says Coffield.

That’s why she and other providers are particularly concerned about the impact that future clinic closures could have on transgender and non-binary patients, who already face many barriers to health care. The threat of losing access also comes as some states step up legal efforts to restrict such care, especially for transgender youth.

Gender affirming care includes medical, social and psychological support to help a person understand and appreciate their gender identity. This care could be useful for anyone, but it is especially vital for transgender and non-binary people.

Dr. Bhavik Kumar, medical director of primary and trans care at Planned Parenthood Gulf Coast, told NPR the community is facing a crisis.

“With trans care, it’s not a drill,” he said. “As much as people are concerned about abortion care and access to abortion – which is very important – we should also be concerned about trans people and the preservation of their humanity and dignity.”

Gender-affirming treatments and abortions are essential but stigmatized health care, providers say

Before the fire, more than 700 of the Knoxville clinic’s 4,000 patients sought hormone replacement therapy in 2021, according to Coffield.

This makes sense, she added, because clinics that perform abortions are often well placed to provide gender-affirming care.

“Gender-affirming hormone care and abortions are essential health care services not offered by most providers, and both are stigmatized services,” she said. “So the same values ​​we use in abortion care — like self-determination, respect, and a non-judgmental approach to health care — very easily translate into serving our patients in hormone-affirming gender-affirming care.”

Kumar said that’s why more than half of all Planned Parenthood health centers offer gender-affirming care, including hormone replacement therapy, mental health services and support for legal processes like changes. name.

More than 35,000 of Planned Parenthood’s patients nationwide sought gender-affirming hormone replacement therapy in 2021, and that number doesn’t include trans and non-binary people who relied on other services, according to Kumar.

After the fire, transgender and non-binary patients rushed to find new providers

When Jake Gutridge learned that his Planned Parenthood health clinic had burned down, his immediate thought was, “Oh my God, what am I going to do?”

Gutridge told NPR that he has relied on the clinic to receive hormone replacement therapy for nearly two years. At the time, Planned Parenthood was the only provider he knew of nearby that didn’t need insurance.

For weeks, he tried to refill his meds at Planned Parenthood centers in North Carolina and Georgia, both more than four hours away. But appointments have been booked for up to a month, he said. Gutridge quickly fell into withdrawal, suffering from mood swings and anxiety.

Eventually, he was connected with a gender-affirming doctor in East Tennessee, but Gutridge attributed it largely to luck. Eight months later, people seeking hormone replacement therapy are still in shock and asking Gutridge for help.

Since Roe’s overthrow, Gutridge said he wouldn’t be surprised if other communities experience similar fallout.

“There are a lot of people who think gender-affirming care is more of a privilege, but it’s necessary health care,” Gutridge said. “Before, I felt like I was trapped in my body, like I was constantly fighting against myself. When I started taking testosterone, I finally felt like I was in control. save the life.”

Providers also braced for a rush of new patients

After the fire, the Planned Parenthood branch continued to offer services via telehealth. But even then, Coffield said only a fraction of their transgender and non-binary patients can be served due to capacity constraints.

That’s when local doctors started seeing a surge of gender-affirming care inquiries.

“We had an extremely large influx of people who had been displaced,” Dr. Annie Kolarik told NPR. She is a primary care physician whose office is located a few miles from Planned Parenthood’s former location.

At Cherokee Health Systems, Kolarik estimated that she now cares for more than 150 patients who had relied on gender-affirming care from Planned Parenthood — many of whom travel at least an hour to receive services. Before the fire, she had around 30 patients seeking this type of care.

To meet demand, Kolarik said Cherokee Health Systems implemented an online appointment system to expedite scheduling and began using telehealth services. Physicians and other practitioners meet with patients during their lunch breaks.

“People should expect similar increases if places where Planned Parenthoods or abortion clinics that provide gender-affirming care end up closing,” she said.

Choice Health Network, a provider in the area that exclusively serves HIV-positive patients and those at risk of contracting the virus, has also seen a higher volume of calls about gender-affirming treatments. He plans to expand those services, a nurse practitioner with the Choice Health Network told NPR.

“The fire seemed designed to send a message to all of us who support Planned Parenthood or use its services – that we are not safe,” said Meg Gill. “We must continue to offer these services and, as much as possible, expand them.”

Even in states where abortions are banned, clinics struggle to provide gender-affirming care

In areas where gender-affirming care is rare, clinics like Planned Parenthood are often the only place transgender and non-binary people access any type of health care, said Kumar, who is on the Gulf Coast.

“When that’s taken away from them, sometimes they find themselves with no options,” he added.

So far, no family planning clinics have closed since the Supreme Court’s decision in June to overturn Roe vs. Wade. Even in states with abortion bans, a spokesperson for the national Planned Parenthood organization told NPR that their clinics are determined to stay open to continue offering services such as gender-affirming care. .

In that vein, the Planned Parenthood Health Clinic in Knoxville, Tennessee, plans to rebuild its office and launch a mobile health unit in the fall to continue providing support. This is despite the state planning to ban all abortions at the end of August.

“It’s no surprise to anyone who knows us in Knoxville that we’re reopening whether or not abortion is banned because they rely on us for so many other services,” Coffield said.

Independent providers, who tend to be more financially dependent on abortion services, are also struggling to keep their doors open.

In West Virginia, the Women’s Health Center recently expanded its services to provide hormone replacement therapy — even though she could lose nearly half of her income if lawmakers enact an abortion ban, the clinic’s executive director told NPR.

“We believe in patient-centered healthcare that honors the autonomy and dignity of our clients. Expanding our range of services to include gender-affirming hormone therapy is very much in line with this vision,” said Katie Quinonez.

“No matter what happens to legal abortion in our state, we will continue to do everything in our power to expand and meet the health care needs of our community.”

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