In 2021 alone, 34 states introduced 147 anti-transgender bills, focusing on discriminatory anti-equality measures. And more legislation is on track to be filed in 2022. 

We talked with Jessica Halem, award-winning educator, advocate, consultant on LGBTQ+ issues, and Violet partner educator, to talk more about what’s happening and what providers can do right now in the face of mounting backlash against transgender health care for young people. 

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VIOLET: Why are we seeing so many headlines about officials in places like Texas, Alabama, and Tennessee attacking medical care for transgender youth?

JESSICA: Throughout history, politicians have created problems that seemingly only they can save us from. They then stoke fears in their constituents to raise money and notoriety for themselves. Wading into the waters of our culture’s changing relationship to — and understanding of — gender identity seems to be an easy fear to stoke. 

In the past, children who expressed their gender in a way that may have gone against societal norms were bullied to stop. Many of us live with the scars of being shamed and forced to change. Today’s transgender youth are what the world looks like when we get out of their way and help every child to flourish.

There is such a wonderful increase in visibility of beautiful, happy, transgender kids and adults with an infectious joy of living life to the fullest. Politicians are using transgender youth as their latest target because we are actually make great strides in the care we are able to offer more families in more places. Plus, medical schools and residency programs in every corner of the US are teaching the next generation of doctors the very best in evidence-based medical care for gender-diverse and transgender youth. This change will become cemented at every level of our health care system very soon. Frankly, it’s a momentum stronger than any politician can stop. 

VIOLET: Can you tell us why someone would consider this kind of medical care to be “child abuse”? 

JESSICA: Most people do not know that doctors have been practicing transgender medicine for nearly 100 years. So I imagine some of the anxiety over “child abuse” comes from the fear that this is new or untested and children are going to suffer terrible side effects. We could combat that fear by listening to the doctors and researchers in this field who have been working on this for decades. 

Also, would anyone want to see their child suffer ridicule and discrimination? Of course not. Many adults think that letting a child live outside of dominant cultural norms will bring stigma and shame and we should steer them away from any hardship. But we know the opposite is true. Being supported for who we are at an early age helps bolster us against whatever may come. 

"Today’s transgender youth are what the world looks like when we get out of their way and help every child to flourish."

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VIOLET: Why are these gender-affirming procedures and medications so important? 

JESSICA: The bottom line is that providing the medical care that transgender young people need is a must. We know their mental health, their physical health, their ability to fully participate in school activities, their future life as a fully formed adult – all of it is predicated on providing gender-affirming care and support. In fact, a recent AMA study found that receiving gender-affirming care in transgender youth is associated with 60% lower odds of moderate or severe depression and 73% lower odds of suicidality. 

VIOLET: Can’t these kids and families just go to other states to get care? 

JESSICA: Every transgender kid’s story is unique which is why we want to keep them with their current pediatrician and not referred out to specialists far away from home. The relationship between a doctor and patient should be protected and private. We trust doctors to know their patients best so finding the time to start puberty blockers or start hormone therapy isn’t a one size fits all. Remember, these drugs have been around for a long time and prescribed for all sorts of reasons. Every doctor carefully weighs risks and benefits and knows their patient best.

Additionally, not every family has the ability or access to go out-of-state for care. Which is all the more reason that we need to ensure every transgender child has the ability to receive the care they need, with as minimal barriers to entry. 

VIOLET: What can health care providers reading this article do right now? 

JESSICA: We know that many pediatric clinicians are already providing high quality, gender-affirming care. Many of you did not learn this in your medical training. But because you want to make sure your patients get the care they need – you read the protocols, you take webinars, you ask colleagues for consults and you learn transgender medicine. Keep doing what you do!

For those who want to do more for pediatric patients, learn how to provide the care transgender kids need. You know about puberty blockers and hormone therapy. These are drugs that have been around for a long time. You already know the power of plastic surgery to make us feel better in our bodies. So keep listening to your patients and asking them how you can provide medical care to create more peace between their internal sense of self and their physical bodies. 

Providers can also be important advocates for all the non-medical ways transgender kids need to be supported. Providers can take a lead in speaking with school officials to get a patient’s name and pronoun respected, bathroom safety ensured, or speaking with coaches about the importance of sports. If documents need to be updated like passports, health insurance, or birth certificates – get out your pens! Doctors and everyone in a pediatrician’s office are so vital to every aspect of ensuring transgender youth can grow into transgender adults.

VIOLET: What else can we do?

JESSICA: Gender is changing. Right before our eyes. And for many of us, it can’t change fast enough. We have all suffered too long under the restraints of what boys and girls should look like and what they can do and not do, how men and women should act, dress, work, and even speak. The gender binary is collapsing under the weight of our unleashed inner selves, imaginations, and best lives! So let’s celebrate transgender kids and their families for shining the light so bright onto a better world.

Further reading

• AAMC Statement on Gender-affirming Health Care for Transgender Youth
• AAP, Texas Pediatric Society Oppose Actions in Texas Threatening Health of Transgender Youth
• Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People
• The World Professional Association for Transgender Health (WPATH)
• Gender Spectrum
• The Family Acceptance Project
• Histories of the Transgender Child
• Transgender History, second edition: The Roots of Today's Revolution

Jessica Halem is an award-winning educator, advocate, and consultant with accolades from GLMA, Harvard, Howard Brown, and The Advocate magazine. She works with Fortune 500 companies, medical centers, and public officials on LGBTQ+ issues, workplace inclusion, and health equity. She serves on the Board of Directors for the Tegan and Sara Foundation.

Violet is building the first-ever infrastructure for inclusive health care, through benchmarking, upskilling, and recognizing cultural competence in health care providers. They envision a world where every human receives equitable health care, no matter their race, sexual orientation, gender, ability, language, citizenship, or more. 

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