A Life or Death Crisis: The Safety of Trans Youth in the Healthcare Industry

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Overview of Trans Health:

Transgender individuals have faced a lot of controversy and discrimination in all facets of society, but particularly in the healthcare industry. Many transgender individuals must have a close relationship with the healthcare system because it is a source of treatment to aid in their medical transition. However, some doctors and insurance agencies will refuse to treat or cover trans patients. In other cases, they will make the process difficult and demeaning for the patient. According to a survey of 28,000 transgender people by the National Center for Transgender Equality, 33 percent of respondents had experienced a negative interaction with a healthcare provider because of their gender identity in the past year (Thoreson). Negative experiences with healthcare providers or fear that they will occur often lead trans individuals to avoid seeking care. The same survey also found that 23 percent of respondents did not seek the care they needed because of concern about mistreatment based on gender identity (Thoreson). 

Terms to Know:

Sex: Biological attributes in humans. This includes chromosomes, gene expression, hormone level and function, and reproductive organs (CIHR).

Gender: A performance and expression of socially constructed behaviors and expressions. It is a continuum of fluid identities (CIHR).

Transgender: The identity of someone who does not identify with the gender they were assigned at birth. 

  • MtF: Male to female.
  • FtM: Female to male
  • Nonbinary: an umbrella term for all gender identities that do not fall into the socially constructed ideas of male and female.

Hormone/Puberty Blockers: Medication that stops puberty from occurring. These are often used to give trans youth more time about how they want to medically transition. These can be stopped at any time and puberty will resume. 

Transition: There are many types of transitions. They essentially involve the process of shifting from the person’s gender assigned at birth to their gender identity.

  • Medical transition: This can involve hormone replacement therapy and surgeries
  • Social transition: This is the process of shifting to one’s gender identity in society. This can include (but not always) gender expression, pronouns, name, etc.
  • Transitioning looks different for every person
Diagram explaining the difference between sex, gender, and sexual orientation (Trans Student Educational Resources)
Tips for referring to and interacting with trans patients (Greene, et. al)
Medicaid coverage of care for transgender patients (Ollove).

US Politics and Trans Health:

Currently, many state congresses in the United States are processing bills regarding the protection of trans youth and access to gender-affirming care. 

Arkansas most recently passed a ban on gender-affirming care for people under 20 years old. This marks the first ban to effectively be passed. The governor attempted to veto this ban, but it was overruled by the house and senate of the state (Cunningham and Pereira). There are wide implications with the passing of this ban. Many states have been proposing bills like these for a while, but this is the first one that has passed, which makes the situation much more serious and scary for trans individuals.

In my state, South Carolina, there is a bill currently being processed called South Carolina HB 4047 (Ronan). If passed, this bill will prohibit the prescription of hormone blockers or hormone replacement therapies and any surgeries meant to better align the body with the person’s gender identity. This bill also requires teachers and doctors to out trans students to their guardians, even if it is unsafe to do so (South Carolina General Assembly). Many other states, such as Texas, Tennessee, South Dakota, Alabama, and over 15 other states, are also considering such bills (Deliso).

These bills are very dangerous because these medical treatments can be life-saving for many individuals.

The intersection of Gender-Affirming Care and Mental Health:

In many cases gender-affirming care is lifesaving.

Mental illness and suicide among LGBTQ+ youth, particularly trans youth, are significantly higher than those of heterosexual and cisgender youth. The Trevor Project did a study in 2020 on mental health and discrimination faced by LGBTQ+ youth (The Trevor Project). 

  • 52% of trans youth have considered suicide in the past 12 months, and 1 in 5 have attempted in the past 12 months. This is over twice the rate in cisgender youth.
  • Over 60% of trans youth engaged in self-harm in the past year.
  • More than 3 in 4 trans youth reported symptoms of generalized anxiety disorder and more than 2 in 3 report symptoms of major depressive disorder.
  • Trans youth who reported having their pronouns respected by all or most of the people around them attempted suicide less than half the rate of those who did not have their pronouns respected.
  • 82% of LGBTQ+ youth reported that recent politics have negatively impacted their wellbeing.

These high rates of depression, anxiety, self-harm, and suicide come from oppression and discrimination that is faced every day. In addition, children living in homophobic and transphobic households and communities are often forced to hide who they are (The Trevor Project).

However, gender-affirming care has been proven to lower mental illness and suicide rates in trans youth. In a study done in 2020, it was found that youth who experienced gender dysphoria and received gender-affirming treatment (puberty/ blockers or hormone replacement therapy) saw lower rates of depression and suicidal ideation/attempts than their trans counterparts who did not receive gender-affirming care. Gender dysphoria is the physical and emotional distress from one’s gender assigned at birth not aligning with their gender identity. This study also found that the earlier children received gender-affirming care, the less likely they were to develop mental health issues (Sorbara, et al.).

This shows how crucial access to gender-affirming care is. It is a matter of life or death because early access to gender-affirming care could be the thing that saves a child from suicide.

Infographic of statistics about trans youth (Napoletano).
This diagram compares the age that patients presented with Gender Incongruence and the frequency of mental health issues. (Sorbara, et al.)
YPY: Younger Presenting Youth OPY: Older Presenting Youth

For now response:

  1. Start conversations regarding gender identity and mental health in the schools.
  2. Advocate for legal protections of trans patients in medical facilities.
    1. Call your representatives and urge them to allow trans kids to access gender-affirming care.
  3. Develop training for medical professionals about how to respectfully and effectively treat transgender children, teens, and adults.

What can you do to help?

  1. The most important thing is to educate yourself and others on the topic. Make yourself aware of the impacts in your community and on a larger scale in your country and the world. 
  2. Start conversations about these issues. This can go far to reduce stigma and also let closeted individuals know that you are an ally.
    1. Research policies and bills being passed in your state or country and comment them on this post to further a discussion.
  3. Find resources in your local community that advocate for and support the LGBTQ+ community, and see how you can support their mission.

Bibliography

6 Comments

6 comments

  1. Hi Ella,
    Your project is super relevant in the modern days. It really saddens me how much prejudice we can see all around the world. I really liked how you added a section saying what we can do to help, and I believe that the most effective way of ending this stigma is education.

  2. Hey Ella! Considering the current discriminatory healthcare legislation being considered in many states, this is an extremely important topic. I think the US politics and trans health section of your project did an amazing job at explaining the present-day issue, and the connection you made to your own state of South Carolina is meaningful as well. Although I don’t currently know of any of this legislation in my state of California, I believe the overall message of these harmful policies leave transgender children nationally feeling unsafe and can have negative effects on their mental health by seeing parts of their country that aren’t supporting their rights. Overall, amazing work!!

  3. Hi Ella, you shared some really alarming statistics surrounding this issue and I found your presentation very informative and well developed. The point you make about the importance of establishing a trusting relationship between physicians and transgender individuals is such a key factor in this issue and I found the tips for referring to and interacting with trans patients as a helpful starter. Great work bringing more awareness to this topic!

  4. Hi Ella, your project was really well-done! I enjoyed your detailed research, helpful statistics, and relevant graphics. The Trevor Project statistics provided are staggering. In California, there aren’t notable legal barriers to gender-affirming care, but transphobia and stigma surrounding trans individuals is an issue. I think your action steps are very applicable, and I will take note of some local organizations that support the LGBT community. Great work!

  5. Very impressive research and important advocacy, Ella. The issues you raise are challenging ones in the sense that there is plenty of ignorance and much more research and awareness needed, but simple from the perspective of fostering love, trust, and respect. Your statistics, citations, and graphical representations are compelling. If you want to continue to expand this exploration here locally, I wonder if you might interview local physicians and/or physician-educators at the medical school.

  6. Hey Ella, impressive research! To begin, the definitions you included at the beginning of the presentation set up your following information excellently, wonderful addition! I believe a lot of misunderstanding around the transgender community comes from a lack of education on the sociological aspects of gender. I think you did a great job of taking a current day issue and connecting it to your own community in South Carolina in order to push for action to improve the health care rights for transgender individuals. In regard to your “what you can do to help” section, what are some current legal protections that you suggest we advocate for?

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