"Do you have support from your family? Have you been able to get the care you need?" I ask these questions making sure that I'm in reaching distance of a box of tissues. Ashley, a 25-year-old trans woman, breaks eye contact and stares at the floor. I'm not surprised by what comes next: the wave of pain that washes over her face, the stories of abandonment and abuse. But I'll never get used to the cruelty aimed at my transgender patients.
Now, the attacks are coming from politicians. In Texas, a slate of anti-LGBTQIA bills, including several that would specifically target transgender youth, have been introduced in the Texas Legislature. House Bill 1399 would ban transgender youth from accessing best-practice and age-appropriate medical care. HB 68 and Senate Bill 1646 would criminalize parents and doctors by accusing them of "child abuse" for providing access to transition-related care they need to survive and thrive. Similar anti-trans bills have proliferated across the country.
As an internist who provides gender-affirming care, I know full well how discriminatory legislation negatively impacts health. I see how anti-trans rhetoric increases the bullying, physical attacks, and discrimination aimed at transgender people. When politicians use hate as a political tool, my patients are the ones who suffer.
These bills are based on misconceptions about what care is offered to transgender kids. They follow in the footsteps of a Trump-era HHS rule that sought to strip transgender people of discrimination protections and are rooted in falsehoods. Alarmist language about performing aggressive surgeries are far afield from the careful and considerate care offered at different stages of development. In contrast, legislation that prevents LGBTQIA discrimination, such as the Equality Act, is associated with improved mental and physical outcomes.
I know ignorance doesn't always mean malintent. My brother is a transgender man, and when he first started transitioning, I didn't understand his reasons. I was scared he would be unhealthy or unsafe. But I supported him because I love him, and I educated myself. I later joined the Central Texas Transgender Coalition to educate the medical community on transgender competence and awareness. As I saw the joy that my brother gained in his life, now with a thriving professional career and happy marriage, I became a more caring and patient-centered doctor.
If you've never met a transgender person or a family with a transgender child, I understand that it can be hard to empathize with them. But parents of transgender children, like most parents, simply want to do what is best for their child, and that includes working with medical professionals to ensure that their child has access to necessary and medically recommended care.
Banning best-practice medical care can be a matter of life and death. Transgender teens have staggeringly high rates of suicidal behavior; 1 in 2 transgender boys and 1 in 3 transgender girls have attempted suicide. Studies also show that allowing teens to express their gender identity socially and use hormone blockers around the time of puberty decreases anxiety and suicidality.
That's why medical care for transgender youth is endorsed by the American Academy of Pediatrics, the American Medical Association, the National Academies of Sciences, and all other leading health authorities. Patients, their families, and their health care providers – not politicians – should decide what is in their best interest.
As physicians working during a global pandemic, the last thing we or our patients need is another fight. But we will continue to advocate for our patients, because they deserve respect and care. Back in the clinic, I finish my visit with Ashley and prepare for another patient. I leave the exam room, go to the supply closet, and grab another box of tissues.
Aliza Norwood is an internal medicine physician who provides HIV primary care, HIV prevention, and gender affirming care in Austin, Texas. She also serves as the medical director at Vivent Health in Austin.
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