States that declared themselves refugees for transgender people have essentially issued an invitation: Get your gender-affirming health care here without fearing prosecution at home! Now that bans on such care for minors are taking effect around the country – Texas could be next, depending on the outcome of a court hearing this week – patients and their families are testing clinics' capacity. Already long waiting lists are growing, yet there are only so many providers of gender-affirming care and only so many patients they can see in a day. For those refuge states – so far, California, Connecticut, Colorado, Illinois, Massachusetts, Maryland, Minnesota, New Jersey, New Mexico, Washington and Vermont, plus Washington, D.C. – the question is how to move beyond promises of legal protection and build a network to serve more patients. Dr. Angela Kade Goepferd, medical director of the gender health program at Children's Minnesota hospital in the Twin Cities said that the appointment requests are flooding into Children's from all over the country – including Texas, Montana, and Florida, which all have bans. Requests have grown in a year from about 100 a month to 140-150. Initial sanctuary laws or executive orders were an emergency step to protect transgender people and their families from the threat of prosecution by more than 20 states that have restricted or banned such health care, advocates say. They generally do not contain provisions to shore up health systems, but advocates say that needs to be the next step. #Queer Up Health