HONOLULU — Facing closure, Hawai‘i’s largest gender-affirming care provider has successfully raised more than $150,000 to continue providing lifesaving services for the state’s LGBTQ residents.
Located in Honolulu, The Lavender Clinic is a nonprofit health care center with the stated goal of providing inclusive, quality health care for all communities.
“Our tagline is, ‘Everybody deserves a little TLC,’ and we truly mean everybody,” said Stephanie Mikhail, chief operating officer and secretary of the board of directors at The Lavender Clinic.
“Anybody who wants a strong relationship with their provider is going to get a lot more time with their provider and not be passed off from person to person, as is common in larger practices. You’re more than welcome in our doors.”
On top of primary care services, the clinic provides gender-affirming health care, ancillary medical consultations, telehealth services, sexually transmitted infections management and testing, and voice and speech therapy.
The Lavender Clinic is also one of only two facilities in the state to provide gender-affirming care for trans and gender-nonconforming youths.
Several major medical organizations — including the American Medical Association, American Psychological Association, American Psychiatric Association, the Endocrine Society, the American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry — have found age-appropriate, gender-affirming care to be both evidence-based and medically necessary.
Additionally, more than a dozen studies of more than 30,000 transgender youths have shown that access to such care is associated with increased mental health concerns for patients. Conversely, these studies have shown that a lack of access is associated with higher rates of suicidality, depression and acts of self-harm.
“When we talk about distress, that means that this can interrupt childrens’ ability to leave the house, or to form friendships and relationships, or to be able to concentrate in school,” said Matthew Houck, lead prevention educator at the YWCA of Kaua‘i. “Really basic developmental things can be challenging when someone does have that significant distress, categorized as gender dysphoria.”
During a child’s early youth — up to around age 10 — The Lavender Clinic does not offer any gender-affirming medical interventions, although it will provide social support for the family.
“We’ll talk to parents who are often really scared and don’t know what to do when their young child begins to question their gender,” Mikhail said. “They can come in and talk to us, and learn what the options are as things get more age-appropriate.”
Around the onset of puberty, the clinic can begin to provide puberty blockers to patients, delaying the onset of puberty and allowing the child more time to explore their gender identity.
“Puberty is really bad for everyone,” Mikhail said. “It’s not fun for anyone, but it is devastating for people who do not identify with what their body is going to start doing to them against their consent.”
Beginning around age 16, the clinic may provide cross-sex hormone therapy to patients, allowing their hormonal makeup to better match their gender.
Mikhail adds that for patients who utilize puberty blockers or hormone therapy, the effects can typically be undone.
“If you stop the cross-hormone therapy, if you stop the puberty blockers, then unless breast tissue has grown if we’re going in that direction, or unless the voice has started to deepen, for the most part, the results are going to be reversible,” she said.
Mikhail also notes that in very rare cases, the clinic will recommend top surgery for patients between the ages of 16 and 18, so long as surgeons, parental guardians and the patient all agree such action to be necessary. The Lavender Clinic has only ever endorsed one 16-year-old patient for top surgery, according to Mikhail.
Mikhail also stressed that before beginning any medical interventions, the clinic looks for clear, direct and consistent messaging from the patient to ensure that treatment is right for them.
“Children will naturally play make-believe — that’s how they learn about the world,” she said. “So, having a male-assigned child who likes to pretend he’s a princess, or having a female-assigned child who dresses up like George Washington, is not in and of itself an indication that there’s gender dysphoria. But children who have gender dysphoria tend to be very loud and consistent and clear, because they learn about the different treatment of gender before they can even articulate it, because it’s just so ingrained in culture and society.”
Following a series of financial losses, the clinic started a GoFundMe campaign in late January in an attempt to keep the facility afloat. The campaign was initially successful, quickly raising about $10,000, but stagnated in the following weeks.
“We had all but written ourselves off as dead,” Mikhail said. “We were in the process of printing and distributing massive amounts of patient records back to the patients so that they could attempt to seek other care, and we’d already lost a number of our staff.”
As the clinic has the largest patient base for gender-affirming care in Hawai‘i, Mikhail notes how the facility’s closure would have been catastrophic.
“In any given year, we see about 400-500 unique gender minority patients,” she said. “Our next biggest competition — their organization sees around 100. If they were to suddenly have to absorb all of our patient load, it would be a disaster for the system.”
However, after a series of news reports on the clinic aired in mid-February, the fundraiser exceeded $150,000 within five days.
“That was just overwhelming and amazing,” Mikhail said.
Still, even with the fundraiser’s success, the impact of the clinic’s financial woes lingers.
“Our services are in a bit of a state of flux now,” Mikhail said. “Some of the damage from telling the world and your own staff that you’re in imminent danger of closing is that you lose patients and staff, so our services right now are more limited than they have been in the past.”
Currently, The Lavender Clinic operates with a fraction of its former staff. The clinic had to suspend its behavioral health services until it can hire a new clinician, and Mikhail — the clinic’s chief operating officer — now also works the front desk.
To rebuild their operations, The Lavender Clinic intends to use the GoFundMe money to add new staff, as well as pay off remaining debts and upgrade out-of-date equipment.
Additionally, the clinic has continued fundraising efforts, and plans to introduce more cost-effective supplementary services to ensure that it can continue providing core services.
“One of the really unfortunate things about nonprofit work is that if you put the mission before the money, you will die — as we almost did, and as we still could,” Mikhail said.
Despite these hurdles, Mikhail is optimistic about the clinic’s future.
“I hope that we will build it up better and stronger, on more sound foundations, and really have something that we in the community deserve and can be proud of,” she said.
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Jackson Healy, reporter, can be reached at 808-245-0427 or jhealy@thegardenisland.com.
