The health care system is at the center of a wave of anti-transgender politics that is restricting access to certain gender-affirming treatments, criminalizing providers and ostracizing patients.
Clinics specializing in gender-affirmation services have historically been a major source of support for LGBTQ patients amid changing legislation and public opinion. As demand for health services for LGBTQ people has increased in recent years, large organizations have expanded the care they provide to this population.
Now, many smaller providers are looking to those large organizations and industry organizations to push back limits on gender-affirming care and lead the healthcare system towards to LGBTQ inclusion standards.
Ana Marson, medical and wellness director at the LGBTQ Center, Orange County in Santa Ana, California, said: “Large hospitals downsizing this care will send the opposite message while depriving them, she said. of the patient.
“It would be detrimental if hospitals came back and said, ‘We can’t provide the services you need, whether it’s hormone replacement therapy, surgical advice or even care,’ Marson said. mental health care’.
Jessica Halem, Senior Director of the Eidos LGBTQ+ Health Initiative at the University of Pennsylvania, said: “Continuing complacency or turning away from the issue will also put hospitals and service providers on the edge. Others have difficulty recruiting doctors who specialize in gender-affirming care.
“I have watched politicians use transgender, non-binary and LGBTQ people to gain political favor. I watched it all my life, coming and going,” she said. “What concerns me most is that medical institutions dedicated to the public interest ignore the science, ignore the evidence, ignore the faculty and staff they have preferentially recruited and trained, and turn your back on them.”
Hospitals and other providers that provide sex-affirmed care to minors have been subject to new laws and threats of violence that have prompted them to temporarily close their rooms check, cut service and increase security.
Clinicians are being criminalized and targeted with death threats, sometimes restricting patients and their families to virtual care. Besides health care, LGBTQ people are also following a series of laws that regulate where they can use the bathroom and which sports teams they can join, which has negative health consequences. their mental health.
“We recognize these threats to LGBTQ access to social facilities and health care at the local level, and it has created an impact,” said Lindsey Dawson, deputy director of HIV policy. patchwork of both tolerance and access to care at the local level. and director of LGBTQ health policy at the Kaiser Family Foundation. “The providers who want to provide these services are stuck between a rock and a hard place.”
Boston Children’s Hospital has faced harassment, including bomb threats, for weeks. The hospital had to begin locking doors and significantly increase security for patients and clinicians when death threats were received, which disrupted care. This comes after the conservative Twitter account “Libs of TikTok” posted a video of a doctor talking about sexist prolapse. “Libs of TikTok,” which has 1.4 million followers, claims the hospital is performing these surgeries on minors — a claim Boston Children’s Hospital denies.
To avoid being the target of similar online campaigns, hospitals have removed or modified information about gender-affirming care, provider records and patient testimonies, Dawson said. from their website.
Akron Children’s Hospital in Ohio has removed patient testimony and provider information, and Vanderbilt University Medical Center in Nashville, Tennessee, has temporarily removed its transgender health clinic website after being targeted. social media goals.
Others, including the Milton S. Hershey Children’s Medical Center Boston and Penn State Health in Hershey, Pennsylvania, have updated their websites to provide more details about their services. them and the science that supports them. But a small number of hospitals have responded to the new law or political pressure by scaling back their transgender care services.
Texas Children’s Hospital in Houston, the largest pediatric hospital in the United States, halted hormone therapy after Texas Governor Greg Abbott (R) issued a directive classifying certain sex-affirming care services as “child abuse” and calls for punishments for parents and clinicians assisting minors in seeking certain medications or procedures.
Vanderbilt University Medical Center has suspended gender-affirming surgeries after Tennessee Governor Bill Lee (R) called for an investigation kicked off by a conservative media campaign claiming the clinic Vanderbilt’s LGBTQ “mutilates” children and punishes providers who oppose gender-affirmation surgeries and other types of transgenderism.
Oklahoma City’s OU Health, one of the largest health systems in the Early State, stopped offering hormone therapy and sex-affirming surgery after Governor Kevin Stitt (R) threatened to withhold segregation. distributes federal COVID-19 relief funding because it provides gender-affirming treatments for youth.
Vanderbilt University Medical Center, Penn State Health, and Akron Children’s Hospital declined requests for interviews. Children’s Hospital Boston, Texas Children’s Hospital, and OU Health did not respond to requests for interviews.
According to the Department of Health and Human Services, in adolescents, sex-identifying treatment reduces rates of mental health problems among transgender and gender-diverse youth and improves quality of life. Sex-affirming surgeries are rare in adolescents.
Recently enacted state laws will jeopardize access to care for an estimated 58,000 transgender minors in 15 states, as reported by the University of California, Los Angeles Law School. Republican officials in various states have tried to ban certain sex-affirmative care services for minors, including puberty-blocking drugs, hormone therapy and surgery, and criminal the delivery of these treatments.
For example, this year, Alabama enacted a law making it a felony to give minors puberty-blocking drugs, hormone therapy, or sex-affirmation surgery. In Arkansas, providers are prohibited from referring to clinicians in other states who provide sex-affirming care.
The laws, which face judicial scrutiny to determine their legitimacy under federal non-discrimination regulations, cut off services that are already hard to access due to a lack of providers. Insufficient provision and insurance.
In response, the American Academy of Pediatrics, the American Medical Association and the Children’s Hospital Association sent a joint letter to Attorney General Merrick Garland this month requesting an investigation into the growing number of threats to hospitals, doctors and patients.
Meeting the need for gender-affirming care is a task that often falls to LGBTQ clinics because patients feel more comfortable with it, says Dr. Katherine Williams, physician at Summa Health’s Pride Clinic in Akron, Ohio. service providers are publicly acknowledged and poorly experienced elsewhere. . But as demand soars, laws restricting access to sex care will overwhelm these clinics.
“We’re exploding at the seams,” Williams said. “At the moment our patient census is approaching 1,500 people, and it keeps getting bigger, because as we are growing, the patient population is also growing with us. .”
In Colorado, Denver Health LGBTQ + Health Services had 850 new LGBTQ patients access its services in 2021, according to the health system. This year, the health system’s clinic is scheduled to treat more than 1,000 patients.
Tracy Scott, administrative director of LGBTQ+ Health Services at Denver Health. This allows smaller facilities to support each other and continue to provide care.
These service providers are also increasingly reaching out to LGBTQ-focused clinics to train cultural competencies and remove misinformation about the medical needs of the LGBTQ community, Marson said.
In addition, more than 1,100 clinicians providing sex-affirming care, including some in states where certain services are illegal or in jeopardy, have released a Directory LGBTQ+ healthcare through the Tegan and Sara Foundation, LGBTQ health organizations GLMA and Cigna to help patients receive care such as voice and hormone therapy, mental health, and sex determination surgery.
“We make sure our services remain available and [we’re] It’s clear to patients and the community that ‘We’re here. We’ll stay here,” Scott said. “Gender affirmation services and access to healthcare for the LGBTQ+ community are lifesavers, so we’re not going anywhere.”
