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Standing up for our transgender patients and our right to treat them

Marwan Haddad, MD, MPH
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“Gender-affirming care is life-saving therapy,” a colleague of mine reminded our care team recently. “Denial of this care is a medical emergency.”

My physician colleague was far from overstating the risk of denying care and perpetuating the stigma and discrimination experienced by transgender individuals whose sex given at birth does not match their gender identity. An alarming 52% of transgender and nonbinary youth in the U.S. considered suicide in 2020, according to a survey conducted by the Trevor Project.  

National Transgender HIV Testing Day on April 18 is a time to recognize the disproportionate impact of HIV on transgender people and promote access to HIV prevention services. One study conducted in seven cities in the U.S. found that 42% of transgender women were living with HIV. Tragically this year, as a number of states advance anti-trans legislation, we must focus our attention on urging politicians not to interfere with our ability as clinicians to provide comprehensive, evidenced-based health care, including gender-affirming care to one of the most vulnerable populations of this country’s young, our trans youth.

States banning gender-affirming care for youth  

Arkansas and more recently Arizona have passed laws banning gender-affirming care for trans youth. Most recently, Alabama’s governor signed into law a bill that makes it a felony for medical providers to administer gender-affirming care to trans youth. More than a dozen other states are considering similar legislation banning gender-affirming care for youth.

After failing to advance legislation in Texas, that state’s governor, Greg Abbott, issued a directive requiring the state’s child protective services department to investigate for child abuse parents who help their children access gender-affirming care. The directive also designates medical providers and teachers as mandatory reporters and making them subject to penalties for a failure to report.

These harmful and potentially deadly laws and policies are advancing despite the widespread consensus among the medical community of the importance of supporting access to gender-affirming care. The list of supporters includes the Endocrine Society, American Medical Association, American College of Physicians, American Academy of Pediatrics, American Psychiatric Association and 26 other organizations, including IDSA and HIVMA.  

The impact on patient care

Hearing directly from providers at clinics that have been affected by these policies is chilling. One trans care program at a large academic medical center in Texas that was created more than a decade ago and had grown as a multidisciplinary medical home to serve more than 1,000 trans youth from all over the state was forced late last year to go underground and to stop accepting new patients.

They were allowed to continue seeing their current patients so as not to risk medical abandonment claims but were forced to remove signage, take down their website and turn off their phone lines. These providers report that the parents of trans children are taking steps such as home schooling and relocating to other states to protect their kids and provide them access to the health care services that they need.

What health care professionals can do  

At the federal level, the Department of Justice sent a letter last month to state attorneys general reminding them that transgender youth have a right to access gender-affirming care and that they are protected by the Affordable Care Act’s nondiscrimination provision, referred to as Section 1557. As medical providers, we can help by reporting cases of discrimination to the Department of Health and Human Services’ Office of Civil Rights and encouraging our colleagues and parents and family members of trans youth to do the same when they encounter barriers to access health care services, including gender-affirming care.  

I am saddened, disheartened and angry that dangerous and spiteful politics are creating harmful, life- threatening situations for trans youth, their parents, and their families and are interfering with medical providers and their health care teams from providing them lifesaving care. As medical providers, it is critical for us to stand by our patients and protect our rights as providers to be able to offer them the evidenced-based health care services that they need and deserve to stay healthy and to thrive.


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