In the Pacific Northwest, doctors struggle to meet growing demand for gender-affirming care

In Seattle, just two surgeons perform the full range of gender-affirming surgeries for teenagers and young adults, both at the same hospital. One provider often sees more than 20 patients and performs up to 12 surgeries a week. The pace hasn’t slowed in years. 

In Washington and the Pacific Northwest, some providers who specialize in gender health say access to gender-affirming health care services has struggled to keep up with growing demand. As debates over rights to this type of care gain increasing attention on the national stage, medical experts, mental health professionals and LGBTQ+ advocates wonder what the safest path toward better care looks like.

With support from the Center for Health Journalism 2023 National Fellowship, our reporting will center the wide scope of experiences of trans and gender-diverse youth who have begun to explore gender-affirming health care in the Pacific Northwest. We’ll look at the challenges, joys, fears and support systems that are often part of the process. 

Although we live in a place that continues to protect the right to gender-affirming care, the debate over the future of LGBTQ+ and general reproductive health care is active in Washington. The state has not been unaffected by changing laws in some neighboring states, including in Idaho, where the governor in April signed a bill criminalizing gender-affirming medical care for trans youth. 

More than 400 bills this year seek to limit the rights of trans and nonbinary people — including dozens that explicitly ban affirming medical care for minors. The push has been impossible to ignore for many in the community, particularly kids and teenagers, according to mental health professionals and nationwide surveys. 

In Washington state, 89% of LGBTQ+ youth surveyed by The Trevor Project in 2022 said recent politics sometimes or often negatively impacted their well-being. About 54% said they wanted mental health care but weren’t able to access it. 

Seattle providers say it’s too soon to know if patients from states like Idaho will seek care across the border in Washington but pointed to bumps in patients seeking abortion care in the state last summer after the Supreme Court overturned Roe v. Wade. Providers say they wouldn’t be surprised to see similar trends in the search for trans health care this year. 

Does the region have the capacity to support a potential wave of young patients? What might that look like? How will the region support their mental health? Local gender health providers aren’t sure yet, but we hope to find out.

This project will study recent anti-LGBTQ legislation across the country, particularly laws that affect minors’ access to health care and how their impacts could touch the Pacific Northwest. We’ll also look at the history of gender-affirming care in the region. 

Washington has fairly expansive medical freedoms for youth, especially for trans youth or those at-risk. In fact, the governor recently approved controversial legislation that would further protect trans youth seeking gender-affirming or reproductive care. Licensed shelters will no longer be required to notify parents if their child shows up there, unless a compelling reason applies; instead, shelters will be allowed to contact the state Department of Children, Youth and Families. 

Despite additional protections and an apparent commitment from the state to expand access to care, Seattle providers say it’s not uncommon for some insurance companies to deny coverage of gender-affirming care for those under 18. Families can appeal, but they’re not often successful. 

In many cases, insurance battles are yet another draining obstacle for young people searching for appropriate care.

An inability to access gender-affirming health care can lead to lifelong physical, mental and emotional challenges for anyone who identifies as gender diverse, but teens and young people are particularly vulnerable to anxiety, depression and self-harm, public health officers and youth advocates have testified. At the same time, certain parts of the process can be filled with enormous relief and joy. This was evident in research from Stanford University last year that found gender-affirming care often significantly boosts the mental health and overall well-being of trans and nonbinary youth.

We hope to better understand how this broad range of experiences impacts young people’s ability to feel comfortable in their bodies and navigate conflicting feelings of identity and belonging. We also want to better understand what access to medical and mental health care looks like in different parts of the state. 

Some state data is available to track demand for and access to care. But the lived experiences of health care providers, mental health professionals and trans and gender- diverse youth in the region will sit at the heart of this project.