It was a difficult Pride Month. Instead of being a month to celebrate, it was a month on defense. This is nothing new. In 1969, Pride started with a riot. It continues to be a time when LGBTQ+ individuals have to fight for their right to exist — and their right to basic health care. This year, we have seen an unprecedented increase in state legislatures condemning, and even making a felony of gender-affirming care, which is simply good health care.
Gender-affirming care consists of listening to patients’ needs, providing options and clinical expertise. It removes judgment and barriers to accessing trained medical providers. While much of the dialogue has been focused on GnRH agonists (puberty blockers), hormones, or surgery, gender-affirming care is so much more. Gender-affirming care provides a framework of better health care for all, in a country whose overall health care system is badly in need of improvement.
In 2020, we at Transhealth Northampton chose to provide comprehensive primary care and mental health care to people of all ages. We do this because trans people, like all people, have everyday health needs that change across their lifespans. We know this because we are trans-led and have lived these experiences in the absence of basic care. We provide community support and engagement because we know social support is one of the biggest ways to reduce rates of suicide attempts, because of the way society has chosen to stigmatize and discriminate against us. In many ways, the national debates about access to gender-affirming care feel entirely divorced from what we experience with patients in our clinic.
Medicine continues to harm and fail trans people. Puberty blockers and hormones have been used to treat cisgender populations for decades, but for purely political reasons, trans people are now required to prove their needs. Within the history of medicine, trans people have had to consistently prove their identity. Medical and governmental establishments have often made it within their jurisdiction to determine someone’s identity. This form of care results in dehumanizing trans people at every step and can result in serious medical mistreatment. In contrast, gender-affirming care re-centers the individual’s authority in understanding and representing their own identity and corresponding health care needs.
Many of these politicized approaches are rooted in the false idea that trans youth are something new. We know from anthropological data that gender diversity has been a part of the human experience since at least the Neolithic period. Some argue that there are large numbers of youth transitioning without clinical guidance. This is false and unsupported by any data. These claims attempt to give legitimacy to the harmful idea that it is permissible to stop trans people from being trans prior to helping them.
There’s no debate on receiving access to diabetes care or any other form of lifesaving care, so why target other forms of health care? Just as high blood pressure, high cholesterol, or back pain do not require specialty clinics, neither does gender-affirming care. It should simply be the standard of care that every clinic provides, to affirm every individual who walks through the clinic doors. Gender-affirming care has been shown to be lifesaving care.
Only a small but tyrannical minority oppose it. A large majority of providers support providing gender-affirming care, and American youth overwhelmingly support trans rights.
Some may feel that gender-affirming care is too accessible, but studies show that the barriers are rampant for youth and adults in states where care is still legal. The problem isn’t a divided clinical community or too much access but, rather, the political framing of a private health care issue.
Some media outlets frame gender-affirming care as a debate. It is not. Instead, news outlets should hire trans reporters, consult the Trans Journalists Association (including its style guide), and primarily interview and center stories around people from the trans community. When this is not done, the media fail our community, framing this as a culture war rather than what it is: a continued attempt to make it more difficult or stop trans people from existing. This has the very real effect of encouraging the anti-LGBTQ+ violence we have seen last month.
Society must stop treating gender-affirming care as something special. It is comprehensive care that affirms the individual and meets them where they are. This is something everyone within health care should be able to deliver: basic clinical competency.
Pigeonholing gender-affirming care as a specialty care treats it as a talking point in a culture war. In reality, gender-affirming care is quality health care that does not discriminate against transgender and gender-diverse people. Who could argue against that?