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DULUTH — Instead of listening to another person misgender them last fall on a bonding tour across the state, Duluth Rep. Liish Kozlowski simply told the driver of a bus full of lawmakers to pull over.

"I had told them over and over and over again to stop calling me she/her," said Kozlowski, who is nonbinary and uses they/them pronouns. "So I chose to get off the bus instead of driving back two hours with them." (A friend picked Kozlowski up.)

Kozlowski is undergoing hormone therapy, and being misgendered "was really brutal," they said, especially with "the backdrop of a national attack on trans and queer folks" with hundreds of bills across the country "seeking to literally relegate us to the coffin or to the closets."

Kozlowski shared this story with more than 100 people at a gender-affirming care event at Duluth's Peace United Church of Christ on Thursday. Organized by medical students and others, it's a response to a growing rift within the Duluth campus of the University of Minnesota Medical School, where some of its students formed a Catholic group that opposes gender-affirming care for minors. Such care includes medications to suppress puberty and hormones for older teens, according to the group's website.

The Duluth campus, where most students stay for two years before moving on to the Twin Cities or a rural town for training, focuses on family medicine in rural areas and Native American communities. The rural focus has some fellow students worrying how those beliefs — contrary to their curriculum — will affect future patient care, especially when it involves gender and in areas where provider choices are slim.

Kozlowski is among the Duluth legislators who sent a letter to U and University of Minnesota Duluth leaders following a Star Tribune story about the group. It cited an off-campus seminar some Duluth medical students attended where a discredited pediatric endocrinologist advised the audience to ignore patients' preferred pronouns and called gender-affirming care "nonsense."

"Unfortunately, reports we have received indicate that this egregious incident did not happen in isolation, and rather, that it reflects a larger environment of anti-[LGBTQ+] sentiment and systemic racism that exist in the pharmacy and medical school programs, impacting students, faculty and future patients," reads the letter signed by Sen. Jen McEwen, Rep. Liz Olson and Kozlowski, among others.

In a statement Friday, Duluth medical school campus dean Kevin Diebel said its curriculum teaches students to care for patients of all backgrounds.

"This includes education and training to care for the [LGBTQ+] community, including gender-affirming care," he wrote. "We support the right and opportunity for all members of our University community to engage in open and respectful dialogue around aspects of health care for which they are passionate."

Diebel's response to the lawmakers sought to distance the student group from the local Catholic medical group that invited the speaker, and said it has no oversight over the group's events. The letter also minimized the number of students who allegedly attended.

The student section of the Catholic Medical Association, which also includes students from UMD's College of Pharmacy, formed in 2021. It received $180 both of the past two years from the U's Medical Student Council, funded by the university.

Nomi Ostrander is a UMD social work faculty member and part of Trans Northland, a Duluth transgender advocacy nonprofit. She said she offered to partner with the Duluth medical school on trainings, but its leaders didn't appear receptive.

First-year medical student Sophie Wang said students seem guarded this year, careful not to "reveal their cards," and the school doesn't seem equipped to have difficult conversations in "a safe way that doesn't dysregulate everyone."

Disappointed in how the situation was handled by school leaders, students galvanized to make something positive of it.

On Thursday, a crowd of medical providers, high school and college students, families and educators ate pizza, held group discussions and heard from a panel that included Kozlowski, local physicians and a transgender high school student. How to support those seeking care and where to seek it in an under-served region were central to the conversation, along with educating people on the wide range of gender-affirming care; how it can be as simple as using a patient's correct pronouns and as complicated as surgery. The crowd was surrounded by tables of resources from Essentia Health, Trans Northland, PFLAG and the We Health Clinic.

Dr. Jamie Conniff has practiced gender-affirming care for a decade. He reminded medical students that listening to their patients is of critical importance, and told patients who encounter health care gatekeeping that they should rethink where they're seeking care. You want a provider who is helping you "tear down those gates" instead of putting them up, he said.

Not having appropriate care hurts young people, but so much more is at stake, said Juniper Kelly-Swing, an East High School student and leader of the school's Gender & Sexuality Alliance.

"It's access to identity," they said, "because gender-affirming care is a huge step in figuring out who you are."

Kozlowski plans to introduce legislation soon that would require more LGBTQ+ inclusion in curriculum and in student recruiting and retention efforts with the awarding of any state money for the Duluth medical school expanding its footprint downtown.

With Minnesota as a trans refuge state, Kozlowski said, it's more important than ever to have enough medical providers trained in gender-affirming care, "especially out here in Greater Minnesota, where we are really feeling the strain."