Erin Reed knew she was transgender by age 12, yet because of limited access to medical care for transitioning, it would take an additional 17 years until medical intervention enabled her to feel at home in her body.
Reed, 34 years old transgender activist and now 34, suffered long periods of trauma related to hiding who she is, which resulted in crippling anxiety and panic attacks that finally ended after she transitioned. Since her transition, however, Reed has been overjoyed, healthy, and satisfied; everything that she wanted from this process came true and more!
Now, Reed lives in Maryland – recently declared by its governor as an oasis for transgender people – where she has access to healthcare providers (HCPs) who understand her as a trans woman and can provide gender-affirming healthcare – something many in the LGBTQ community do not enjoy.
What Is Gender Affirming Care? Gender affirming care encompasses various services designed to assist with gender transitioning – that is, shifting away from their birth gender towards one that better represents their identity and gender expression.
Gender-affirming care includes hormone therapy or surgery; it also refers to healthcare that is provided in an accepting manner regardless of how a patient identifies. That may range from HCPs asking and using preferred pronouns for each patient to becoming knowledgeable in treating transgender people.
Read Embracing Hope: The Transformative Power of Gender-Affirming Care
“Transgender patients who have historically and continuously experienced discrimination within healthcare are in need of gender-affirming care that respects and honors who they are,” according to Sarah Pickle, M.D., associate professor of clinical family and community medicine at University of Cincinnati College of Medicine. This may mean taking hormone therapy or having other medical or surgical interventions done on them so their bodies become aligned more accurately, according to Pickle.
Pickle was instrumental in developing UC’s transgender medicine curriculum, which is fully integrated within its general medical curriculum. “Just as our cisgender patients [those whose gender identity matches that assigned at birth] are represented through patient stories and clinical vignettes in teaching medical students about transgender care]”, Pickle says.
Gender Affirming Care Receiving gender affirming care may make the difference between life and death for transgender youth, according to research. Studies indicate that 8 out of 10 transgender youth have considered suicide — with 4 making an attempt. Gender dysphoria — when your gender identity does not match your assigned sex — can cause great emotional distress; when individuals’ physical bodies match who they know they are, depression and anxiety tend to lessen, while self-esteem, self-acceptance, and confidence may increase.
2022 study shows that gender-affirming care – including puberty blockers and hormone therapy – can make an enormous impactful change on trans people’s mental wellbeing. Gender affirming care reduces depression risk by 60% while increasing survival risk by 73%.
“[If someone] experiences chronic social stigma and discrimination and lack access to medical care that could improve other aspects of their health, they may put their body under chronic strain,” Pickle explained. This stress will ultimately result in poorer mental and physical health outcomes.
One survey found that nearly one quarter of transgender people reported not seeking healthcare when needed (even unrelated to transitioning) due to fears they would be mistreated by healthcare providers (HCPs).
Read: Access to Healthcare for Transgender Women
Reed found going to her first six doctor visits after transitioning “very intimidating”, she says, due to being worried about how healthcare providers would perceive and treat her.
Fear is understandable: One third of transgender people who visited healthcare practitioners reported experiencing negative interactions due to their gender identity; these included harassment and being denied treatment because of it.
Pickle noted, “it can be very clear when people are being mistreated because of being transgender,” noting inappropriate questions or examinations may arise due to providers lacking cultural competency in this area and transphobia. Furthermore, more subtle forms of discrimination often result due to inadequate knowledge, training or experience within healthcare fields.
Threats to Gender Affirming Care
More than 146,000 young people across the U.S. have already lost or are at risk of losing access to gender affirming care, according to surveys by Pew.
Since January 2019, over 125 bills have been introduced in over 30 states to ban or limit gender-affirming care, such as one introduced in Ohio where Pickle practices. Nineteen states have already passed legislation restricting such care; even jail time for health providers treating minors; in response, 11 states and D.C. have either passed laws or signed executive orders protecting access to gender-affirming care.
Read: Transgender Children Are Under Attack
Critics of gender-affirming care claim that supporting minors in transition is child abuse and that children should wait until they are adults to undergo transition before making any decisions about transitioning. Yet according to a 2021 review of studies only 1% of teens who transitioned regretted their decision afterwards.
Reed stated, “Gender affirming care is medical care in every sense of the word,” adding, “it is led by teams of doctors, psychologists and parents… restricting access prevents parents from providing their kids with necessary treatment.
Pickle noted that laws that ban gender-affirming care can have devastating repercussions for healthcare providers (HCPs). He highlighted how they impact how they interact with patients.
“Generally speaking, laws that prevent medically necessary and evidence-based care from taking place can cause irreparable damage to patient-physician relationships,” explained her.
Pickle has witnessed many of her students and patients become fearful as a result of state bans limiting where their students can practice – eventually leading to less HCPs who possess knowledge about trans issues in more conservative states. According to Pickle, this issue should matter for people beyond just transgender communities.
Imagine someone you care for who is receiving excellent medical treatment, yet is still flourishing, only for something to change and they no longer have access to that care based on solid scientific research – it would be devastating for them – without proper access. It can happen so fast.
Reed makes an interesting argument: states which prohibit gender-affirming care for transgender individuals also restrict reproductive rights of women by passing restrictive abortion bans – with striking parallels between both policies.
Reed noted that laws restricting essential healthcare for trans people aren’t separate from laws criminalizing other forms of healthcare provision – abortion being criminalized being just one example, while trans people also find themselves leaving their states to find care because their essential healthcare is also criminalized. “So there are ‘abortion refugees’ leaving to find care whereas trans people flee those same states as well due to basic healthcare being criminalized.”
She stated that laws prohibiting abortion and gender-affirming care were violating human rights and would have serious repercussions for communities and individuals alike.
“This whole movement is anti-science and anti-bodily autonomy,” she stated.