Gender-affirming care isn’t a political issue for health providers, said Des Moines-based doctor Kaaren Olesen, but it has become debated and legislated by politicians across the country.
Gov. Kim Reynolds signed a bill into law restricting transgender minors from using puberty blockers, hormone therapy or surgery for gender transition in March 2023. Olesen, an OBGYN at Broadlawns Medical Center, said for many people, their family and support systems might be in Iowa, but making moves to other states with less restrictive laws — or even to Canada — has been part of her conversations with patients.
“[I have] minor patients who have been receiving hormone therapy or puberty blockers, who now just can't — it's illegal. So [they are] crossing borders to Illinois and especially Minnesota,” Olesen said. “I've had one family that I've cared for moved to Minnesota, left good paying jobs here in our state, to take their kids to a safer state so they could continue their care.”
She added that the medical community is in agreement about the importance of gender-affirming care.
“This isn't really a political issue for medical professionals. The science is on our side.”
The ban on gender-affirming care for minors is just one of the actions taken by the Iowa Legislature in the last few years that has restricted transgender rights. Under Iowa law, transgender people can no longer use the bathroom that aligns with their gender identity in K-12 schools and transgender women and girls are barred from female sports.
During the current 2025 legislative session, lawmakers passed a bill that will take away protection for transgender people by removing gender identify from the Iowa Civil Rights Act. The bill was signed into law by Gov. Kim Reynolds and goes into effect July 1.
Olesen said this law could have devastating impacts on the medical landscape for transgender patients, who could now face discrimination.
“I foresee that insurance companies would become more able to limit insurance coverage for gender-affirming care, whether that's going to be medications, office visits, surgeries,” she said. “I could see that facilities could then put in some restrictions and say, ‘We're not going to provide these surgeries.’ Although we're doing the same surgeries for cisgender people, but I could see them saying like, ‘Well, if you're coming here for a gender dysphoria, we're not going to take care of you.’ This is a terrible, terrible slippery slope that that we're on.
She added that these laws in the Legislature create more anxiety and depression for a population already at risk. She knows transgender patients who have committed suicide, “even though they were receiving gender-affirming care, the discrimination around them was just too much.”
Max Mowitz, executive director of OneIowa, said the removal of transgender people from civil rights protection could compromise Medicaid’s coverage of gender-affirming care. They added that the talking point that these laws restricting transgender Iowans protect cisgender women is not based in fact.
“We know that by and large, the folks that are causing harm to women are not trans women,” Mowitz said. “In fact, when we look at statistics on violence, from sexual assault, to domestic violence, to harassment, we actually see that trans women are more likely to experience violence than to cause it.”
According to the Williams Institute at the UCLA School of Law, transgender people are over four times more likely than cisgender people to be victims of violent crime. A study from The Trevor Project found that suicide attempts by transgender and gender nonconforming teenagers increased in states that passed anti-transgender laws.
“I have a transgender child, adult child, who lives out of state and will never move back here,” Olesen said. “And fortunately, lives in a state where access to care is much, much easier, much more well-rounded, so that makes me feel good. But it's also sad that they don't feel that they can return here and have a life here in Iowa.”
Olesen said she has considered exiting the state herself, but also feels it’s important to try to improve things for transgender Iowans.
“If we all leave, then there's nobody to stay here and fight. So I can't. I can't leave the people that I'm taking care of — I have a duty to them, and so I'm going to stick around. I'm going to keep speaking up and doing the right thing, and we'll just keep putting one foot in front of the other.”
To hear this conversation, listen to River to River, hosted by Ben Kieffer. Caitlin Troutman produced this episode.
