Following recent state-level restrictions on gender-affirming care for transgender youth, several Harvard Medical School affiliates and medical professionals expressed concerns that such laws could have potentially harmful ramifications for patients.
In recent months, an increasing number of states have either considered or passed restrictions on providing gender-affirming care for minors. More than a dozen state legislatures have approved such restrictions to date. Massachusetts passed a bill in July 2022 protecting the legality of gender-affirming care.
The Office of the Assistant Secretary for Health’s Office of Population Affairs — which falls under the U.S. Department of Health and Human Services — defines gender-affirming care as a “supportive form of healthcare” that is “crucial to health and well-being” and supported by medical research.
The restrictions on gender-affirming care vary in degree, ranging from bans on gender-affirming care for minors that contain exemptions for minors considered at risk for self-harm to bans that could lead to prison time for medical professionals who provide gender-affirming care.
Casey Orozco-Poore, a recent Medical School graduate, said they were worried about the polarization this legislation is causing.
“They are creating a situation in which some physicians will be put in jail for offering the highest standard of care and other physicians are protected because of antiquated views of sex and gender,” they said.
Harvard Medical School associate professor Michael S. Irwig denounced the restrictions on gender-affirming care, referring to them as “political maneuvers by some conservatives to rally their base.”
“They don’t really care about transgender care. They don’t care about understanding them or researching this or trying to help members of their community who are gender-diverse,” Irwig added. “They’re just interested in getting people to rally around a group that’s being marginalized and bullied and doing this for political gain.”
Irwig, an expert in trans healthcare, said that “if people can’t access therapists to talk to, if they can’t get on hormones, if they can’t get surgeries,” they could suffer from “depression, anxiety, suicidal thoughts, to suicidal attempts, poor quality of life,” and more — a list that Irwig said goes “on and on and on.”
Alex S. Keuroghlian — an associate professor of psychiatry at Harvard Medical School — said he is “very concerned about the adverse impact” that gender-affirming care restrictions are “going to have on the health of very marginalized communities.”
“Becoming more mainstream as a field has been somewhat of a double-edged sword because now there’s more awareness of the health needs of transgender and gender-diverse communities, there’s also been — as we’ve seen abroad — violence and organized backlash and efforts to really cause harm to transgender and gender-diverse people,” he said.
Keuroghlian said this is a time for the medical community to “speak up.”
“It’s been heartening to see the mainstream medical community unified in advocating for the health rights of transgender and gender-diverse people across the lifespan,” he said. “This is not the time to be quiet and stand by the sidelines.”
To individuals living in states with gender-affirming care restrictions, Keuroghlian recommended “working with medical legal services to figure out what you’re safely able to do in the face of restrictions that are emerging in your state” and finding support both within and outside of their states.
A number of Boston-area gender-affirming healthcare providers have faced backlash and received violent threats. In August 2022, Boston Children’s Hospital received a bomb threat and harassment via social media. In the same month, the National LGBTQIA+ Health Education Center — which Keuroghlian directs — received a voicemail death threat toward a pediatrician working at the center.
Keuroghlian — who teaches an elective course at Harvard Medical School titled “Caring for Patients with Diverse Sexual Orientations, Gender Identities, and Sex Development” — faced backlash in January when a fringe conservative media outlet and the Daily Mail wrote pieces claiming that his class teaches about “trans infants” when one aspect of the course discusses “intersex health for infants who are born with variations in sex development.”
“I don’t really worry about myself. I’m worried about all the communities of marginalized people who don't have the platform I do being intimidated by this,” Keuroghlian said. “And I worry for clinicians and educators in parts of the country where there are aggressive restrictions on medically necessary gender-affirming care or on teaching about it and talking about it.”
Vincent C. Smith, Division Chief of Newborn Medicine at Boston Medical Center and a Professor of Pediatrics at Boston University’s medical school, discussed the importance of building trust with trans patients in the current political climate.
“We’re talking about people who are going to have a heightened sensitivity because right now is not a great time,” he said. “To overcome that and have people feel comfortable coming in to get the care that they need, they have to know that the place that they’re going is one they can trust.”
Smith suggested that medical professionals can build trust by asking patients’ preferred name and pronouns, making sure their office is visibly welcoming with signage, and ensuring that all staff are trained properly.
Regarding recent restrictions on gender-affirming care, Smith criticized lawmakers involved in furthering the bills for not realizing “this is actually a human being that we’re talking about.”
“They’re basically using people as pawns, but these are human beings and these are lives that we’re talking about here and it’s not a game,” he added.
This piece is part of The Crimson’s 2023 Pride Month special issue.