Let Texas doctors treat their trans patients
I carried with me a deep sense of responsibility as I flew to Texas — my birthplace — this month.
I was on my way to attend the SXSW festival and participate in a panel discussion about transgender health care. Landing in the middle of a political firestorm of anti-transgender legislation in Texas (and other states, too, including Florida, Arizona and Tennessee), I also felt fortunate. I don’t face these political obstacles in New York.
At the center I direct, we’ve treated more than 1,300 transgender patients. But my colleagues on the SXSW discussion panel, who hail from Oklahoma and Ohio, field calls from transgender people who are asking where they should move to receive gender-affirming medical care. Sometimes those calls are from parents, worried about where and how they might find care for their children.
The conversations I had after the panel also struck me.
A man who looked to be in his 50s approached me and shared that his transgender brother had taken his own life about 10 years ago. I wish there were no statistics behind that story, but a 2017 Youth Risk Behavior Survey found that 44 percent of transgender students reported “seriously considering attempting suicide” and 34 percent reported a suicide attempt.
A couple in their 80s told me about their adult transgender son. I saw their concern. And they understood that, despite political storms, I am not in the business of withholding medical care.
My job is to provide safe, evidencebased medical care to my patients who represent every color on the rainbow flag. It’s a severely at-risk population that I, my team and like-minded colleagues throughout the country are committed to treating and educating — when we’re allowed to do so. Our work has become unsafe in several states.
Elected officials have mistakenly declared that medical treatments and procedures to treat transgender children “constitute child abuse” and should be illegal. They’re encouraging people to report cases where young people are receiving gender-affirming treatments so they might be investigated for child abuse. Thankfully a judge stalled that effort.
A Human Rights Campaign report has found that state legislatures introduced 268 anti-equality bills in 2021, 27 of which were passed. These bills are having a harmful effect on the young LGBTQ community.
In the Trevor Project’s 2021 National Survey on LGBTQ Youth Mental Health, 94 percent reported that “recent politics negatively impacted their mental health.”
President Joe Biden, on the other hand, supported transgender folks in his State of the Union address: “The onslaught of state laws targeting transgender Americans and their families is wrong. As I said last year, especially to our younger transgender Americans, I will always have your back as your president, so you can be yourself and reach your God-given potential.”
Providers like me need to be able to treat our patients compassionately, but are being met with hostile protests at work.
A lot of the conversation about gender affirming care centers on the use of GnRHa agonists — the most common form of puberty blocker — to inhibit the release of sex hormones such as estrogen or testosterone. A strong body of research indicates that well-timed interventions for gender dysphoria “result in favorable mental health outcomes.” In fact, delays in prescribing hormones and puberty blockers, “may worsen mental health symptoms for trans youth.” Yet there is some confusion regarding the long-term effects of puberty blockers. While some lawmakers, including Gov. Greg Abbott, have associated puberty blockers with lifelong sterilization, there is no substantiated evidence that GnRHa treatment impairs reproductive function or reduces fertility in girls. If GnRH agonists are stopped, girls can develop subsequent onset of menses and regular menstrual cycles.
We’re committed to safe outcomes. That’s why we carefully evaluate patients to plan their gender journey in stages that address developmental, physical and psychological needs, both when they first see us, and as they grow.
When we’re allowed to do our jobs, those of us who care for LGBTQ patients help them accomplish incredible things. It’s a team effort: Transgender patients and their families need a hand navigating medical, physical and emotional questions.
When we’re not being intimidated into withholding medical care, we can have a meaningful impact on our patients’ overall health and public health, like understanding why transgender patients face increased rates of certain types of cancer, substance abuse, mental health disorders, infections and chronic diseases. We can play a leading role in preventing HIV and AIDS.
My colleagues and I help patients and their families improve their lives in more sensitive, informed ways. Of course, there’s always room for our work to evolve; we always seek more research and data.
Our transgender patients need us, just as they need and deserve a healthy, safe future anywhere they live. Beyond SXSW, we will continue to highlight this urgent responsibility as the country watches Texas — and too many other states — grapple with how to meet the health and medical needs of all its citizens.