Trans and gender diverse youth across the country are scared, struggling and dying, and it’s our duty to address this crisis.
We know that gender-affirming health care improves the health and well-being of transgender and gender diverse youth. Despite this, several states, including Texas, Florida and Alabama, are going out of their way to make life-saving gender-affirming care illegal.
At the same time, the COVID pandemic has shown us that healthcare is not limited by geography; many health systems have strengthened their telehealth offerings. As clinicians in Massachusetts, where gender-affirming care remains more accessible than elsewhere, we believe there are many ways clinicians can use telehealth to address growing gaps in vital services, particularly mental health services, to provide the care that young, gender – different people need and deserve.
At Transhealth Northampton, where one of us (Ducar) is the Chief Executive Officer, we have been able to provide life support to over 100 trans and gender diverse people in the last few months through a community health worker and a community engagement specialist. Through in-person and telehealth services, our limited but growing primary care and mental health providers provided vital care to more than 1,000 people across New England in our first year, including rural areas where gender-affirming care has historically been limited. Now that Massachusetts is expanding protections for gender-affirming care, we’re poised to extend this social support and care to gender-diverse youth, regardless of zip code.
Gender-affirming care is more than hormones and surgery, and there are concrete steps that hospitals, academic medical centers, ambulatory care networks, and health insurers everywhere can take to support youth and families in states with bans on gender-affirming medical and surgical care. Helping these young people, at the very least, is our responsibility to ensure that they grow up safe and secure in who they are. And unfortunately, our ability to help can be a matter of life and death, primarily as transphobic laws make their way through the court system, and these children and their families are needlessly stigmatized or even criminalized.
First, health systems should invest in supporting social and mental health. Recent data show that more than half of transgender and gender non-conforming youth have attempted suicide. This is about three times the national average. In the age of telehealth, institutions can offer vital, gender-affirming online care for youth and families by establishing telehealth services and online support groups (like ours). These services can be a lifeline for families in care-free states and for people in more isolated, rural regions of the country. For hospital administrators who question the value of providing these services, we remind you that providing health care that prevents suicide is far less expensive than attempting to treat it.
Support groups that do not explicitly provide clinical care, such as Transhealth, are inexpensive. They are different from clinic visits that provide primary care or therapy and are billed through insurance. They can be led by trained facilitators who do not need a license in every state where care is provided and who may themselves be transgender. This is especially true because the barriers to becoming a peer supporter are much lower than obtaining a medical or nursing degree. Creating virtual peer support groups also provides meaningful work for transgender and gender diverse facilitators and gives young people the opportunity to see people like them thriving. Although such support groups are not a substitute for clinical care, insurers are increasingly willing to reimburse them. They can be offered in places where gender-affirming clinical care is prohibited, and they can be offered to people regardless of geography. The cost of expanding them to reach underserved youth and families would be small.
Second, hospitals in states with bans on gender-affirming care should expand the scope of support services beyond their walls. Transgender youth and families with financial means may travel out of state to receive the care they need, leaving lower-income families disproportionately vulnerable to the consequences of being denied treatment. Many hospital systems recognize that by supporting the so-called social determinants of health—housing, income, food, education, and employment—they improve the health of their neighbors. Well-resourced hospitals and insurers could provide funds to families affected by bans on gender-affirming care, including covering the cost of travel to health facilities in states where the full range of gender-affirming care is available. Many employer health plans have already begun to do this for other types of medical care that are politicized, such as abortion.
Third, health systems should offer legal aid through medico-legal partnerships. Families in states that have tried to ban gender-affirming care have already begun to face legal challenges. They will need support specific to these new laws, but individual legal aid is expensive. Health care facilities already work with attorneys to offer guidance on nondiscrimination, employment, criminal law, and child welfare, and could expand these services across state lines. Advocates can help address privacy concerns by informing patients and families that they do not have to answer questions from law enforcement in health care settings and that health information cannot be provided without consent.
Fourth, health researchers must study and document the consequences of withholding treatment. Health systems, particularly medical schools and academic hospitals, routinely collect data and monitor adverse outcomes, including those resulting from state policies related to LGBTQ. In a recent survey, nearly seven out of every eight transgender and gender-nonconforming teenagers said that anti-LGBTQ legislation across the US has worsened their mental health. By collecting data securely, sharing it widely but appropriately, and using these studies to channel the real stories of youth and families, academics have a powerful platform for policy change.
As an administrator or health care provider, you may not feel that it is your responsibility to help trans or gender diverse youth, especially if they are out of state. We disagree. Geography doesn’t matter; an obligation to help a child in one’s community is an obligation to help children everywhere. The cost of inaction is well documented: gender diverse youth whose needs go unaddressed struggle with mental health. They attempt and complete suicide.
When governments restrict access to gender-affirming health care, it contradicts scientific evidence and puts lives at risk. As health care providers, we are obligated to provide care in accordance with evidence-based guidelines, regardless of geographic area. When we expand our view of gender-affirming care to include telehealth support beyond hormones and surgery, many more clinicians and health systems can help transgender and gender diverse youth and their families.
ABOUT THE AUTHOR(S)
Dallas Ducar is a registered nurse and chief executive officer of Transhealth Northampton. Follow her on Twitter @DallasDucar
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