This article first appeared on Pittsburgh’s Public Source.
There are no medical providers in Pittsburgh openly offering gender-affirming care to individuals under 19, in a shift since President Donald Trump directed federal agencies to withhold funding early last year. Legal advocates argue the underlying executive order is unlawful and discriminatory, yet many institutions have preemptively complied. This compliance overrides the autonomy of parents and keeps healthcare providers from following best practices. In Pittsburgh, we need institutions to practice courageous advocacy.
The issue is about more than federal accounting; for some it could be a matter of life and death. Transgender youth experience higher rates of depression and suicidality than cisgender peers. Gender-affirming care, meanwhile, can improve well-being. In one study, puberty blockers or hormone therapy were associated with 60% lower odds of depression and 73% lower odds of suicidality for transgender youth. Another study followed 55 transgender people over several years of gender-affirming care, and found they reported relief from gender dysphoria and similar or improved well-being compared to cisgender peers.
Most bills proposing gender-affirming care bans cite concerns about detransition and regret, given the potentially lasting effects on health and fertility. However, data on detransition rates are limited, with small sample sizes and inconsistent definitions of detransition. Reasons for detransition also add important context. A study of over 17,000 transgender adults found a detransition rate of 13%. Of those, 83% reported external reasons for detransitioning, including social stigma. Medical interventions such as puberty blockers are time sensitive, and young transgender people are often desperate to avoid the development of secondary sex characteristics misaligned with their gender identity.
The public is not invested in banning care for transgender youth. A nationally representative survey found the majority opposed denying care to transgender people. In a survey about gender-affirming surgery, 80% of respondents believed that being transgender was a natural occurrence, just below the 85% who supported the right to surgery for adults and 62% who supported it for children. Parents of transgender youth have called for lawmakers to accept that transgender youth health is not a political issue.
Medical systems should follow brave examples by speaking out in support of transgender patients. When providers challenge executive orders in court, they slow enforcement, buying valuable time for families scrambling to meet their children’s health care needs. Medical systems should also empower staff to speak out by designating time for clinicians to pursue advocacy and public education on transgender issues. Institutional legal counsel should stay informed about the changing legislative landscape and assist clinicians and hospital staff in interpreting treatment implications. Medical associations and societies should continue to engage in media advocacy for providers’ autonomy in following evidence-based best practice.
Not all local organizations and providers are silently backing down. TransYOUniting and ACT UP Pittsburgh are organizing and assembling, with protests such as a “die in and funeral event to protect trans youth” staged outside UPMC’s headquarters to call out its compliance with Trump’s order. More than 100 UPMC employees signed an open letter urging the organization to resume all gender-affirming services. At the national level, several major health care organizations made statements recognizing gender-affirming treatment as medically necessary. A coalition including the ACLU and PFLAG and a group of 16 states and the District of Columbia are each suing the Trump administration.
In some states, providers face loss of licensure or felony charges for providing gender-affirming care for transgender youth. This is not yet the case in Pennsylvania. Pittsburgh’s medical systems should exercise bravery by supporting their staff and patients and resisting unconstitutional bans while they still can.
Ansel Bloom is a first year student at Point Park University’s Clinical Psychology Doctoral Program and can be reached at ansel.bloom@pointpark.edu.
This article first appeared on Pittsburgh’s Public Source and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.