Let’s get this out of the way. There’s a lot of misinformation swirling around about gender-affirming care. Rainey Fraser is ready to clear things up.
“The biggest misrepresentation right now is that trans people don’t know what we need,” said Fraser, virtual services administrator for Kind Clinic. “It’s the complete opposite, and frankly, nobody can tell us otherwise.”
Founded in 2015, Kind Clinic provides Texans with gender-affirming and intersex care in a sex-positive, judgement-free environment. It also offers vital access to the HIV prevention medications known as PrEP (pre-exposure prophylaxis) and PEP (post-exposure prophylaxis), as well as testing and treatment for HIV and other STIs. The doors are open to clients of every identity and financial status, with services offered at little or no cost.
To help mark Kind Clinic’s 10th anniversary, Texas Health Action gave The Barbed Wire an exclusive look at how its gender-affirming care model brings lifesaving hope to patients in every corner of the state.
First, it helps to understand what gender-affirming care for trans and nonbinary people actually means. According to Fraser, the term refers to a wide spectrum of medical treatments, mental health services and resources. People tend to equate the term with hormone replacement therapy, or HRT. That encompasses a wide variety of treatments, including those benefiting cisgender people.
Kind Clinic offers a subset of care called gender-affirming hormone therapy, or GAHT. This treatment involves prescribing hormones like estrogen or testosterone to adult patients who seek physical characteristics that align with their gender identity.
The clinic practices an informed consent model. Clients are not required to have a letter from a therapist clearing them to start treatment. Medical providers thoroughly explain the benefits and risks of treatment to patients, who then make the decision that’s best for them.
“In healthcare, you have to trust your patient to tell you who they are and what they have going on,” Fraser said. “When people don’t feel safe to do that, you’re not going to get an accurate understanding of their needs.”
Kind Clinic clients first meet with a patient advocate, who connects them with necessary resources, including financial assistance. Then, they see a provider.
“Kind is so great at making patients feel validated, affirmed, seen, heard and safe,” said Cynthia Stewart, a nurse practitioner at the clinic. “That’s the key word—feeling safe in a space that does not see what the world sees you as, does not judge you for who you are or what you look like, what gender you are or what you call yourself.”
Barring any medical concerns, most people seeking GAHT receive their prescription the same day.
Hormone therapy is just one piece of a bigger pie. The clinic’s HIV testing, prevention and treatment services are integral. While HIV affects everyone, it disproportionately impacts the trans community, especially Black and brown people. Patient advocates connect people to mental health providers, too. Texas Health Action operates Waterloo Counseling Center, a longstanding Austin-based organization that now serves clients statewide.
Kind Clinic’s model seems even more revolutionary considering the obstacles in its way. There’s a persistent lack of healthcare resources for trans and gender expansive folks, Fraser said. That’s compounded by constant attacks from lawmakers.
None of it can change the facts: Gender-affirming care leads to reductions in anxiety, depression, suicidality and substance use. “Overwhelming statistical evidence supports the benefit to quality of life for the people who seek this care,” Fraser said.
Kind Clinic operates four physical locations across Austin, Dallas, and San Antonio, but its reach extends statewide thanks to virtual care. Without that, many patients would have to drive hours to receive services.
“A common theme from a lot of our rural trans patients is, ‘I haven’t had anyone.’ We can—at least in our little pocket of cyberspace—foster a little more connection,” Fraser said. “In whatever small measure, we’re making people feel less alone.”
Fraser sees the lifesaving effects of gender-affirming care every day at work. Over the years, patients have shared their success stories with her. Relationships with loved ones improving. Progress at work. Making a big move to somewhere special.
“We’re here in Texas,” Fraser said. “We aren’t going anywhere. We’re going to flourish, no matter what anybody else says.”
