States that declared themselves refuges 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.

“We’re trying our best to make sure we can get those kids in so that they don’t experience an interruption in their care,” said Dr. Angela Kade Goepferd, medical director of the gender health program at Children’s Minnesota hospital in the Twin Cities. “For patients who have not yet been seen and would be added to a general waiting list, it is daunting to think that it’s going to be a year or more before you’re going to be seen by somebody.”

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. The program hopes to hire more staff to meet demand, but it will take time, Goepferd said.

More than 89,000 transgender people ages 13 to 17 live in states that limit their access to gender-affirming care, according to a research letter published in late July in the Journal of the American Medical Association, though not all trans people choose or can afford gender-affirming care.

Rhys Perez, a transmasculine and nonbinary 17-year-old, is preparing to move this month from Houston to Los Angeles to start college. The teen, who said they’re “escaping Texas in the nick of time,” said California’s protection for gender-affirming care was one of the main factors in their decision on where to go for college.

Perez has just begun their search for a provider in Southern California but already has encountered several clinics with waits for an initial consultation between nine and 14 months. They were disappointed to learn they likely could not begin hormone replacement therapy until their sophomore year.