(I will speak here specifically about transgender folks, but also affected are those born intersex and those who identify as non-binary.)
We, as physicians, have a duty to do what is right for our patients. Most, if not all of us, entered this profession with the great intention of helping others with scientifically proven treatments in order to limit or relieve illness and suffering.
LGBTQ+ members of our society have long faced barriers to adequate health care due to many socioeconomic reasons, a lower probability of having insurance and high cost of care, fear of acceptance and xenophobia within the health care system, and lack of social supports, such as accepting family.
Transgender children and youth, as well as adults, are facing discrimination in health care even more than before. Transgender people are marginalized, now even demonized, and have much higher rates of suicide and substance abuse. Suicidality and mental health challenges will only increase without options for continuing gender-affirmative treatment.
Those who identify as transgender do not choose to feel incongruous with the gender they were assigned at birth. We all have a deep, innate sense of gender, and for some, it does not align with the physical gender. A simplistic comparison is being made to writing right-handed when you are left-handed, like many were forced to do until well into the 20th century. You follow your innate sense of right- or left-handedness, and going against that innate sense is a struggle.
We are all familiar with the “first, do no harm” tenet of non-maleficence. Not providing gender-affirming care for transgender patients causes them harm. Those who have provided care for transgender youth, depending on state laws, have been forced to decide between doing what is right for patients and being professionally disciplined or ceasing care, and now are being forced again to abandon providing gender-affirming care to youth.
We know from multitudes of studies that the lack of gender-affirming care causes harm and are aware of the high rates of anxiety, depression, and suicide in LGBTQ+ youth, especially those who are transgender. As the mother of a transgender teen, I have seen firsthand the emotional toll being transgender takes on an adolescent, even in a very supportive environment.
Multiple professional societies, such as the AMA and AAP, have supported the necessity of gender-affirming care. Gender-affirming care is life-saving care. We are not taking kids out of school and performing “sex-change operations” on them, and we are not mutilating them, as some have charged. Why are we physicians not standing up for our patients and for ourselves, to be able to do our jobs and care for our patients as they deserve to be cared for?
Over one million licensed physicians live in the U.S. Additionally, other health care workers, including mid-level providers, social workers, and psychologists, provide care to transgender patients. Many work for large academic institutions that conduct research, train our future health care workers, and shape our nation’s health care policy. That adds up to a very large number of powerful and influential voices. So why are we letting those with no medical background, only their own agenda and disinformation, bully us?
Obviously, part of that answer is funding. However, if medical providers, researchers, and institutions unite with one very strong and very loud voice in support of our work and the people we serve, it would be much more difficult for discrimination in health care to exist. All people in this country deserve compassionate, evidence-based, accessible health care. There is already a shortage of doctors, with many more leaving the profession due to increasing restrictions. We owe it to ourselves and to all of our patients to fight for the ability to practice medicine according to the standards we have been taught and value. We owe it to our patients to rethink funding sources and not have to rely so much on federal and state funding.
First, do no harm. That means recognizing that transgender patients need and deserve appropriate care and, above all, affirmation. They need us to advocate for them. Additionally, we should expect our professional societies, to whom we pay hundreds of dollars annually, to advocate for us as physicians so we can better advocate for our patients. Physicians, as a group, are often wary of lawyers, but maybe it is time to team up and work with the ACLU and other legal groups who are fighting for our patients’ ability to receive appropriate, research-supported health care.
Our transgender youth and adults need and deserve our support in the fight for life-saving, gender-affirming health care. Physicians have been bullied enough—being told by others, who have no medical training yet have their own agendas, to whom and how they can provide appropriate medical care. It is time our collective voices speak loudly to protect our patients, continue our research, and preserve our own freedoms and values in order to provide care to all of our patients.
Amy Philipp is a pediatrician.
