Kim Hutton was leading a charge to bring gender-affirming care to the Washington University School of Medicine in St. Louis when she agreed to get lunch with a skeptic. She met Dr. Paul Hruz, a pediatric endocrinologist at the university, in October 2013 at a cafe near campus, hoping that if she shared her struggles to find suitable health care for her young trans son, he would change his mind.

But Hruz was not there to listen.

No sooner did she sit down than he launched into a breathless lecture on Gods plan for her son. I cant begin to count the number of times he said, If only you will read the writings of Pope John Paul II on gender, you will understand, she recalled.

Hruz made it clear he would try everything in his power to stop the medical schools new gender clinic. When Hutton pleaded that trans kids were more likely to have suicidal thoughts without affirming care, he replied, Some children are born into this world to suffer and die.

Washington University started the gender clinic despite Hruzs efforts. But as the assault on trans rights intensifies nationwide, he has come to play a pivotal role, and a lucrative one.