When bills to ban gender-affirming care for youth and adults were introduced in Texas last summer, Charley and his partner knew it was time to leave.

His move to Minnesota didn’t feel like moving in the traditional sense. It felt like fleeing. 

“It was pretty clear that if that didn’t pass something else would,” said Charley, who is transgender. “We just needed to get out.”

Even the mere introduction of legislation caused some medical providers in Texas to preemptively cease offering care.

MPR News agreed to identify Charley by first name only because he works as a graduate student at a university in Texas and fears possible workplace repercussions while completing his studies.

The couple put a list together of all the states that had passed protections for LGBTQ+ people. Then they looked at each state’s cost of living and different employment opportunities. Minnesota came out on top. 

Just over a year ago, Minnesota became a legal refuge for transgender people after the Legislature passed a law cementing protections for trans people and those who offer gender-affirming care. 

The move was aimed at countering efforts by dozens of conservative-led states that restricted access to care or banned it all together. 

KFF, an independent health care policy tracking organization, reports that 24 states have limited access to the services for minors and 22 impose penalties for physicians that provide it. In the Midwest, Minnesota became an island for gender-affirming care. Iowa, North Dakota and South Dakota have enacted bans on care for youth. 

The bans have spurred people like Charley to uproot their lives and move to Minnesota. And he’s not alone.

Between July 2023 and March 2024, the pro-LGBTQ+ group called PFund said 231 people filled out a survey indicating that they have moved or are in the process of moving to Minnesota. But PFund notes that the number is likely higher.

Executive Director Aaron Zimmerman said it’s not easy to gather data at a large scale in this space. Some families and people moving to Minnesota for care might not need resources, ask for community support or seek out PFund as a resource. 

Democrats who put forward and passed the legal changes in St. Paul said the numbers show the law has worked in bringing more people to Minnesota. But now, they say, the state needs to do more to offer communities for those who make the move.

Conservatives, meanwhile, said the step went too far and has tarnished the state’s reputation.

Demand for services grows

This increase in trans people and families in the state has caused a strain on the healthcare system and the providers that treat them. Children’s Minnesota saw a 30 percent increase in calls to the Gender Health Program in early 2023 as surrounding states began to ban gender-affirming care. 

Before the Trans Refuge Law was passed, the waiting list for the Gender Health Program was over a year long. Dr. Angela Kade Goepferd, the program’s executive director, has only watched it grow. 

“Our arms are already incredibly full,” Goepferd said earlier this year. “Our team at Children’s Minnesota and our colleagues in the Twin Cities who specialize in this essential health care are outmatched by the demand.”

Children’s Minnesota has hired two new clinicians as a part of the Gender Health Program to keep up with demand. The clinic now has six doctors. While interviewing candidates, at least half of the candidates were medical or mental health professionals looking to relocate to Minnesota from states where gender-affirming care bans for youth were in place.

“With essential health care for trans and gender diverse kids, nothing’s new,” Goepferd said. “We’ve been providing this care for decades, we’ve been using the same medications for decades, we’ve been following international guidelines that are now in their eighth revision and initially came out in the ‘70s. So this is not new care. The only thing that’s new about it is the controversy.”

Goepferd said misinformation surrounding gender-affirming care has been harmful and confusing for families with transgender youth. Transgender youth who are the targets of violence or harassment experience a negative impact on their mental health. The current political landscape has also made it more difficult for doctors like Goepfered to do their jobs. 

“These are kids and families that are coming to us experiencing trauma,” Goepferd said. “We as a health care team are also experiencing trauma because we are personally targeted at times … we are a healthcare team that’s under stress, treating patients and families that are under stress and trauma.”

Gopeferd said the hope is that state lawmakers will pass funding to provide more resources for physicians and providers delivering care to transgender youth and adults.

‘Minnesota Transplants’ takes off

As Charley’s moving truck pulled up to his new home in St. Louis Park last August, he felt instant relief.

“It was really good to pull the Penske up into our neighborhood and already see the progress flags. That’s not something that I saw a lot in Texas, at least not in a suburban area,” he said. “Then just the feeling that winter was coming and the temperature was dropping. I got really excited because it was confirmation that I wasn’t in Texas anymore.”

His second emotion that would plague the next few months in his new home: loneliness.

“It felt like my partner and I were on our own little island,” Charley said. “There’s this whole community around us that we just sort of crash landed into, which was a really weird feeling.”

He began looking on local social media pages to try and find a social group to join. But there wasn’t a group in the Twin Cities dedicated to trans individuals who had moved to Minnesota.

So in January, Charley made his own. The Minnesota Transplants group offers a social network for new Minnesotans who are fleeing states that banned gender-affirming care — members of the group help each other move into their new homes and organize outings to explore their new city. 

In four months, the group has grown to 40 members. They come from all over the country — many from Texas and Florida, Iowa and Wisconsin, even some from Alaska. 

“Part of the goal of the group is to get people some kind of social life when they get here,” he said. “The shared understanding that we all have to be there for each other has been overwhelming, in a positive way.”

A new Capitol push

Rep. Leigh Finke, DFL-St. Paul, is the first openly trans lawmaker in the Minnesota Legislature and drove the trans refuge bill in the 2023 session. She is proud of the strides taken last year.

“So what we have done in Minnesota to make moves towards protection has really resounded,” Finke said. “Many people have come, organizations have built coalition’s around how we are going to support the community that’s already here, and the community that’s coming.”

But, Finke said, lawmakers have work left to do this year. 

She said lawmakers should approve grant funding to help LGBTQ+ people and gender care providers relocate to Minnesota, along with other policy changes.

She’s also backing a constitutional equal rights amendment that guarantees access to gender affirming care and a bill that would mandate that insurance companies cover the cost, as well as a bill that would prohibit school boards or local governments from banning the display of rainbow flags.

“We can’t just pass the trans refuge bill and then think that we’re done,” Finke said. “We need to expand health care options, we need to make our schools safer, we need to do so much work to protect those people.”

While DFL majorities at the Capitol have advanced those proposals, they could be stymied by the arrest of Sen. Nicole Mitchell. Democrats hold a one-vote lead in the Senate and the policies could stall out if she resigns or is somehow barred from voting.

Conservative groups and Republicans at the Capitol have raised concerns about the policy change and the efforts to brand Minnesota a destination state for gender-affirming care. 

“Forcing all insurers to pay for this is misguided and forcing all taxpayers to pay for so-called gender-affirming care is coercion,” said Rebecca Delahunt of Minnesota Family Council. “Children cannot give informed consent on treatment that alters or potentially changes their reproductive health.”

GOP lawmakers said they worry about how people elsewhere would perceive Minnesota after passing the trans refuge law and protections for those seeking abortions.

“I’m very saddened by what has been going on in our state Legislature here as of late turning Minnesota into a destination state for death or mutilation,” Rep. Matt Grossell, R-Clearbrook, said. “That is not the that is not the kind of reputation you want.”

While those comments or concerns permeate the national dialogue around gender-affirming care for transgender and gender diverse people, they don’t square with reality, physicians said.

Major medical associations support gender-affirming care and note it improves mental health outcomes in the short and long term. Providers also note that only in rare instances do transgender people under age 18 qualify for surgical treatments.

Settled in

Charley has lived in Minnesota for less than a year, but he already knows he wants to stay. 

“This is a wonderful place to live. I’ve never felt like I could be more myself,” Charley said.

Charley has been talking with people across the country who want to form Transplants chapters in other states that have enacted laws similar to Minnesota’s trans refuge law. He wants to help create a blueprint for new chapters.

Colorado, Illinois, Maryland and New Mexico have all passed bills designed to shield transgender health care through legal protections, health care coverage and access. 

He hopes one day there will be enough resources available for transgender people moving to Minnesota that the Transplants group does not have to exist. 

Until then, he said the Transplants group will be ready to welcome them with open arms.