Medicine news

Anti-trans laws will chill medical news and research

On this year’s Transgender Visibility Day, we should be celebrating accomplishments, honoring resilience, and loudly advocating for the rights of trans people. Yet the growing onslaught of anti-trans legislation targeting the healthcare decisions families make with their doctors threatens to cast a shadow over this day.

About a year ago I lost a family member to the mental trauma of transgender discrimination, so I’m talking about a place of watching someone I love suffer from a lack of support. These recent and proposed laws, none of which is based on evidence-based medicine, will affect the mental and physical health of adults and children and the families that support them.

I’m in medical school and considering majoring in psychiatry in hopes of working with transgender or non-binary people. Instead of feeling empowered to serve, the intent behind these laws makes me fear for my future patients. The directive in Texas calling health care claiming the kind “child abuse” scares me to practice and outraged that any state can insert itself into the clinical decision-making that we spend thousands of hours refining for several years. There are so few doctors who treat transgender people, let alone specialize in physical and mental medicine specific to their needs. These laws could deter clinicians from entering this profession.

Instead of enacting laws that deny the basic health rights of the trans community – and signal to trans people that they are not safe, accepted or supported – policymakers, clinicians and advocates must work together to create laws that thwart and prevent the health disparities which are exacerbated by the persistent discrimination of this community.

One of the biggest points of misinformation in lobbying for these laws is what constitutes gender-affirming health care. gender-affirming care is defined as treatments that delay the onset of physical changes associated with puberty and those that create physiological and physical changes that affirm gender identity (eg, hormone therapy or surgery). It’s important to note that transitioning is a spectrum – not all transgender people choose hormone therapy, and not everyone chooses surgery. Yet all options are in play with some of the laws that have been passed or proposed.

Doctors don’t offer gender-affirming therapy in a rush, and they only prescribe puberty blockers after working with a younger transgender person considering transitioning for a long time. Access to puberty blockers is essential because the effects of puberty on certain parts of the body cannot be easily reversed by hormone therapy later in life (eg, effects of testosterone on voice). Overall, the process requires coordinated advice and medical oversight from a multidisciplinary clinical team that may include psychiatrists, endocrinologists, and urologists, among others.

About 25% of transgender and non-binary people choose gender-affirming surgery. Medical guidelines do not recommend surgery (such as facial reconstruction, mastectomy or phalloplasty) before a person is 18, a point deliberately misrepresented by politicians who incorrectly say doctors operate on young children.

More … than 58,000 transgender teenagers who are in transition are at risk of losing access to their medical care, according to a report from the University of California, Los Angeles, School of Law’s Williams Institute. The effects of these bills and laws would be devastating. An extensive survey published in Pediatrics in 2018 found that 30-50% of trans and non-binary youth said they had attempted suicidecompared to less than 9 percent of all teenagers. Experts hypothesize that this higher risk among trans youth is linked to internalized rejection and shame. In contrast, transgender youth who are supported by their families and receive gender-affirming care have significantly lower rates of depression: gender-affirming care has been associated with an almost 40% reduction in depression and suicide attempts over the past year. Additionally, trans youth who have access to puberty suppressants have a much lower lifetime risk of suicide as adults.

As the Texas legislature debated anti-trans bills last year, the Project Trevoran organization focused on LGBTQIA+ youth suicide prevention, received over 10,800 crisis contacts in total. Transgender or non-binary youth made up more than 3,900 of these crisis contacts, and many of them reported feeling stressed, turning to self-harm and contemplating suicide as a result of anti-LGBTQIA+ laws proposed by their state politicians. Between 2020 and 2021, the Trevor Project recorded a 150 percent increase among LGBTQIA+ youth in Texas contacting the organization in crisis and asking for help. As a future psychiatrist, I find it incomprehensible that state lawmakers deliberately harm the mental health of so many young people.

All of this legislation is in direct conflict with medical advice from the American Psychiatric Association, the American Medical Association (AMA), and the American Academy of Pediatrics (AAP). These medical organizations recommend these medications and procedures for transgender people because there is a body of scientific literature claiming their benefits when medically indicated. These treatments are far from new and untested: puberty blockers have been used in medical care since the 1990s.

Calling me a child molester will not prevent my future patients from seeking treatment. Similar to efforts to stop abortion, transgender people and their families are likely to turn to unregulated black market products not under Food and Drug Administration oversight safety and quality of hormonal products. I cannot fulfill the Hippocratic oath knowing that my failure to provide gender-affirming care could force patients into dangerous situations.

Many bills then propose criminalize doctors if they provide hormone therapy to patients. In medical school, we had lectures on the importance of providing gender-affirming care, as well as panels specifically on the healthcare experiences of transgender patients. The Texas Shutdown only multidisciplinary clinic for transgender youthGENECIS, in response to pressure from the Governor is proof of the suffocating effect these laws are already having on healthcare professionals.

As the pandemic has highlighted, a dangerous risk factor for physician burnout is when they cannot control the health outcomes of their patients. Yet these bills go even further by creating preventable negative health effects and would introduce a new level of helplessness and moral loss among providers. WADA and AAP have both statements issued oppose recent anti-trans bills.

Speaking against an anti-trans bill in Arkansas last year, Michele Hutchinsona pediatrician at Arkansas Children’s Hospital said, “I guarantee you that if this bill passes, the children will die. And I’ll call you guys whenever we do. In April 2021 that anti-trans bill passed.

The day the police came to my house to tell my family that my uncle had been found dead of an overdose after years of struggling with his identity, it felt like a nightmare.

In the painful days that followed, I pledged to work in partnership with transgender communities to provide medical care and advocacy. Yet as lawmakers continue to signal that they would rather see people like my uncle dead than happy, alive and thriving, my grief has not abated. Reading Texas Governor Greg Abbott’s letter declaring gender-specific care to be “child abuse” and understanding that a growing number of lawmakers are seeking to ban me and other physicians from providing life-saving care, I know my family’s nightmare is not over.

Despite these legal battles highlighting the perseverance of the transgender community in the face of harrowing challenges, suffering is not what Transgender Awareness Day is all about. Sadly, brazen and medically ill-informed politicians who deny basic human rights in favor of gender binary ideas have left us with no choice but to come together and keep fighting. My uncle, who was a transgender woman but liked to be called “uncle”, deserved better in life. That’s what I can do for her in death.

IF YOU NEED HELP

If you or someone you know is struggling or having suicidal thoughts, help is available. Call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK), use lifeline cat or contact the Crisis Text Line by texting TALK to 741741.