Donald Trump's executive order is attacking the health care of transgender youth, unlocking chaos within healthcare institutions across the country, causing threats to careers and clinics as providers fight to serve patients I was forced to face it.
The President's January 28 policy declared that federal funding should be revoked to youth under the age of 19 from centers providing gender maintenance care, including hormone therapy and adolescent blockers. , Colorado, Virginia, California and Washington, DC have announced an immediate suspension on adolescent treatment.
According to Alex Sheldon, GLMA Executive Director, doctors, nurses and other medical staff who specialize in gender-maintaining care suffer conversations with families and have professional and personal consequences for advocacy I'm afraid. An association with approximately 1,000 healthcare providers advocating for LGBTQ+ Health Equity.
“Medical professionals are now in the field to save lives and are now forced to choose between patients and their own livelihood,” Sheldon said.
The GLMA, along with trans young people and their families, is a plaintiff, with Trump's orders being unconstitutional, discriminatory and challenging them as a custody violation. Targeted treatments are part of the established standards of care supported by all major medical associations in the United States. A recent study shows that fewer than 0.1% of minors in the US are trans and receive gender-affirming treatments, but for those who do, they are linked to reduced depression and suicide. It is considered to save lives.
The Guardian spoke with Sheldon about fallout from Trump's order among healthcare professionals and how providers are resisting the order.
This conversation has been edited and condensed for clarity.
What kind of calls did you receive about your order?
My phone wasn't ringing. Providers are scary to patients and can simply lose the ability to practice medical care to provide the same care they have always provided. Hospital administrators are rushing to interpret ambiguous and politically motivated instructions while trying to protect staff and institutions. Many feel the weight of the threat that by providing care to one small population, they could lose funds that could keep the door open to all patients. I heard from my parents who were absolutely in despair and extreme pain and asked where I should go next. And I've been exhausted from trans and non-binary community members from fighting to exist for their fundamental rights and once again say their health and happiness is controversial It is being done. Chaos is relentless, and fear is obvious.
How do patients and staff respond to the institutions that have suspended treatment?
I have connected with many providers who have been forced to cancel patients' long-awaited appointments. They describe those experiences simply as excruciating. There is the unbearable weight of seeing young people suffering, knowing exactly what treatments will alleviate their suffering and providing them is absolutely helpless. One provider said it was like withholding CPR from someone who is struggling to breathe. We know that this treatment is safe, effective and supported by decades of research. Healthcare providers are seeing patients get deeper, knowing that pain is not necessary. They have received so many calls from patients expressing increased amounts of pain and suicide. One provider had to cancel reservations for a young trans girl who had just moved to the state. Her mom said: “If my child doesn't survive this, it's your fault.” Some providers are trying to ease the blow and help patients move their care. However, under some interpretations of this cruel executive order, they are not convinced that they are permitted to refer patients. Therefore, they must adhere to facility interpretation and suspension care and choose whether to risk the health of the patient. Otherwise, you may refuse to comply and lose your livelihood. That is a very impossible decision.
What advice would you give to providers who want to continue this care?
One provider said every care decision they make now feels like a legal and ethical minefield. Similarly, we ask elementary school teachers to serve as armed security guards. It requires medical professionals to act as constitutional scholars who interpret the multi-level policies that govern their work. It's very taxable. The best advice we can provide at this point is to connect with a network of providers facing these challenges and work together to advocate for this care. Thankfully, many providers have chosen to fight and are looking for so many creative ways to continue care. I also always tell members to remember why they entered the profession because their heartbreak is overwhelmed. They didn't enter the field to become activists, they went into the field to save lives. So our advice is to use your voice to advocate for your patients.
How do patients maintain care? I know that in some states where it is prohibited, families have been forced to stockpile drugs – have you heard a similar reaction now?
The LGBTQ+ community has something essential about community care. We provide care to each other if we are not recognized in the face of limitations. Therefore, GLMA was established in the early 1980s in response to the emerging HIV/AIDS crisis and the deliberate elimination and inaction by the federal government. LGBTQ+ experts gathered to make sure their community was caring for them by leveraging their expertise and living experience. I'm now seeing volunteers from the same community appear between patients and providers. But fear is very realistic and I have heard from many patients and families that I am considering leaving the country. Some have already left their homeland due to the ban. Now, moving to a new state will allow you to maintain access to care.
What risks do providers face when they are engaged in advocacy?
Many providers have spent years advocating for trans patients. They say they still feel like their calling, but they explain the new, constant anxiety that they are under extreme scrutiny. There have been litigation, expert complaints and threats of personal harassment that have become part of the lives of many healthcare providers. They have seen their colleagues retreat and the hospitals distance themselves from care, but they are still fighting. Some face potential unemployment. Others are worried about reviewing medical licenses. Last year in Texas, a gender-maintaining care provider was sued by the state attorney general. So there was already this fear and government overreach. But providers know what is at risk – their patients' lives are on the line. Medical professionals are uniquely suited to oppose these attacks as they are experts. Politicians understand this care less well than doctors, nurses, and therapists who have dedicated their careers. Many feel a responsibility to ensure that patients are not used as political scapegoats.
Are providers facing pressure not to advocate for trans patients?
I spoke to a doctor with over 20 years of experience being pressured to step back from his hospital's gender-affirming role in care clinics. Because providers were threatened by the federal administration.
However, it is important to remember that the majority of agencies are standing firm and continue to provide healthcare to trans youth. I am extremely encouraged by managers, legal departments and providers who understand confusion, fear and threats. They know that there are existing legal frameworks that protect access to this care at many state and federal levels. Executive Orders are not law. Therefore, they refuse to let fear decide to care for the patient. There is a true and obvious pride in continuous care. The providers work long hours and are gathering around patients and doing everything they can to ensure that care continues. Others are ready to fight in court because they know they are the lifeline of their patients.
Are there other ways that orders affect the institution?
Some states previously restricted transminers' care, and executive orders are seeking to extend those restrictions to anyone under the age of 19. This means that people as young as 18 may be restricted. One provider in the state with the ban said no one in his department knew about it as his hospital's decision to suspend care for an 18-year-old child came so quickly. His care team didn't understand why they had to cancel their appointments. It's like experiencing whiplash every day. There's a lot of confusion. I also hear that in a few institutions that suspend care, they sometimes move so fast, that the directives from the managers are not even written. They have called their providers individually and say they need to cancel this care. It's like a phone game and the person who has to relay that information, but it can be partial or incomplete directly to the patient.
What should people know about the efforts to challenge this order?
It is very important to remember that this type of care remains perfectly legal for cisgender patients. (Doctors can prescribe testosterone on CIS boys who are late in adolescence, or use testosterone suppression in CIS girls with conditions that cause excessive facial hair, for example.) This is the case for these limitations. He speaks most clearly about his cruel nature. It's not safety. It is not about effectiveness. It's simply discrimination. They target populations of patients rather than a type of care.
And this is not how the drug works. It is not intended to be criminalised by working with standards of care that have been supported by decades of research.
