Trans and gender-diverse youth across the country are scared, struggling and dying, and our duty is 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 doing their best to make lifesaving gender-affirming care illegal.
At the same time, the COVID pandemic has shown us that health care isn’t 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 that clinicians can use telehealth to address growing gaps in vital services, particularly in mental health services, to provide the care that young, gender-diverse people need and deserve.
At Transhealth Northampton, where one of us (Ducar) is the chief executive officer, we have been able to provide lifesaving support to more than 100 trans and gender-diverse individuals in the past several months through a community health worker and a community engagement specialist. Via in-person and telehealth services, our limited but growing primary care and mental health care providers have provided vital care to more than 1,000 people across New England within our first year, including in rural areas where gender-affirming care has historically been limited. Now with Massachusetts expanding protections for gender-affirming care, we are poised to expand 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, outpatient care networks and health care insurers everywhere can take to support youth and families in states with bans on medical and surgical gender-affirming care. Helping these youth is, at a bare minimum, our responsibility to ensure they grow up secure and confident in who they are. And sadly, our ability to help can be a matter of life and death, primarily as transphobic laws work their way through the court system, and these children and their families are needlessly stigmatized or even criminalized.
First, health systems should invest in social and mental health support. Recent data show that more than half of transgender and gender-diverse youth have attempted suicide. This is about triple the national average. In the age of telehealth, institutions can offer vital online gender-affirming care for youth and families, establishing telehealth services and online support groups (like ours). These services could be a lifeline for families in states with bans on care and for people in more isolated, rural regions of the country. For hospital administrators questioning the value of providing these services, we remind you that providing health care that prevents suicide is far less costly than treating attempts.
Support groups that do not explicitly provide clinical care, like Transhealth, are inexpensive. These are different from clinical visits that provide primary care or therapy and are billed through insurance. These can be led by trained moderators who do not require licensing in every state where care is being delivered and who might themselves be transgender. This is especially true because the barriers to becoming someone providing peer support are vastly fewer than attaining medical or nursing education. Creating virtual peer-support groups also provides meaningful work for transgender and gender-diverse facilitators and gives youth opportunities to see people like them thriving. Although such support groups are not replacements for clinical care, insurers are increasingly willing to reimburse for them. They can be offered in places where gender-affirming clinical care has been outlawed, and they can be offered to people without regard to geography. The costs of expanding them to reach underserved youth and families would be low.
Second, hospitals in states with bans on gender-affirming care should widen the scope of support services beyond their walls. Transgender youth and families with financial resources can travel out of state to receive needed care, leaving lower-income families disproportionately vulnerable to the consequences of treatment bans. Many hospital systems recognize that by supporting 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 allocate funds to families affected by bans on gender-affirming care, including covering the costs of traveling to health care facilities in states where the full spectrum of gender-affirming care is available. Many employers’ health plans have already begun to do this for other types of medical care that have been politicized, like abortion.
Third, health systems should offer legal aid through medical-legal partnerships. Families in states that have attempted to ban gender-affirming care have already begun to face legal problems. They will need support specific to these new laws, but individual legal help is expensive. Health institutions already work with lawyers to offer guidance on nondiscrimination, employment, criminal law and child welfare, and they could expand these services across state lines. Lawyers can help address privacy concerns, informing patients and families that they do not need 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 fallout of treatment bans. Health systems, especially medical schools and academic hospitals, routinely collect data and monitor adverse outcomes, including those resulting from LGBTQ-related state policies. In a recent survey, nearly seven out of every eight transgender and gender-diverse teens indicated that anti-LGBTQ legislation across the U.S. had worsened their mental health. By collecting data securely, sharing it widely but appropriately, and using these studies to channel the real-world stories of youth and families, academics have a powerful platform for political change.
As a health care administrator or provider, you may not think it’s 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 goes against scientific evidence and risks lives. As health care providers, we have a duty to provide care according to evidence-based guidelines, regardless of geography. When we widen our view of gender-affirming care to include telehealth support beyond hormones and surgeries, many more clinicians and health care systems can help transgender and gender-diverse youth and their families.