Transgender Visibility Saves Lives in the Clinic, Too

COMMENTARY

The overwhelming evidence and consensus among global health organizations is that gender-affirming care saves lives. Yet many transgender, nonbinary and gender non-conforming people lack access to the care they need. Some must wait up to a year to talk to a medical professional about gender-affirming care. Or they may have to drive hundreds of miles to find a single clinician they can trust. Lack of access is one of the main reasons I co-founded Plume.

But now, on Trans Day of Visibility, we’re facing serious threats to this lifesaving care. Normally a time to celebrate trans joy, this year’s TDOV is a hard one for me — for all of us. At a time when anti-trans hate has made so many of us feel unsafe in public, we are about to abandon policies that for the first time made it possible for many TGNC folks to safely access care from home.

During the COVID-19 pandemic, the Public Health Emergency lowered barriers to care for all Americans, but transgender and nonbinary patients benefited significantly. People who need testosterone as gender-affirming medication have been able to obtain their prescriptions via telehealth: a private conversation with a licensed clinician, who follows the same standards of informed consent recommended by the World Professional Association for Transgender Health and practiced in brick-and-mortar clinics. Now that access is under attack.

As the PHE expires on May 11, the proposed rule regarding the remote prescription of controlled substances could leave thousands of people struggling to find reasonable care options. I’ve heard countless stories from patients terrified at the thought of having to find a physical clinic where they live in order to continue their care. Others will be forced out of the medical system and into black-market pharmacies, where there are no protections in place to ensure their safety. Even those who can secure an appointment with a clinician risk being outed in conventional practices, asked humiliating questions or having to educate their doctor on trans health because they haven’t had any training on this topic. The ways our community will be harmed go on — even as we ask for nothing more than the right to gender-affirming health care and the freedom to live our authentic lives.

This year, state legislatures across the country are breaking new records in the number of bills threatening our community’s health care access. This comes with a surge in anti-trans rhetoric, especially on social media platforms. Put simply, people who rely on access to gender-affirming medical care are caught in the crossfire.

Meanwhile, laws targeting clinicians and aimed at restricting access continue to pour in. Florida banned the use of public funds for gender-affirming care, eliminating equal access for people on Medicaid. South Dakota, Utah and Mississippi all signed bills this year to penalize doctors who provide gender-affirming care to young people. Other states’ legislation rewrites gender-affirming surgery guidelines, making procedures unobtainable for the average person.

These laws put our already-vulnerable population at higher risk and will further increase incidents of self-harm: 40% of our community has attempted suicide at least once, and gender-affirming care decreases this risk substantially.

Understanding the unique needs of the TGNC community should inform how gender-affirming medications are regulated, prescribed and dispensed — not an adherence to outdated war on drugs policies. It comes down to trusting patients to work with clinicians who can determine the appropriate course of treatment, based on science and circumstances.

And this is where I find signs of hope. Care providers around the country are stepping up, learning more and working to fill long-overlooked gaps in the system. Activists and health care workers are defending access to care, including the most essential aspects of the PHE now open for public comment. Over 150 pro-LGBTQ+ bills have been proposed since the beginning of 2023. For example, Minnesota and Michigan have implemented executive orders to protect equal access to health care. HHS’ proposal to update Section 1557 of the Affordable Care Act to improve nondiscrimination protections based on gender identity (including in health care settings) is also a step in the right direction.

As we observe TDOV this year, we demand that politicians stop treating our health care as a bargaining chip or a topic up for debate. It’s our lives, and we deserve the full protection of the law, in and out of the physician’s office. And we remain steadfast in our commitment to fight for that right until every member of our community has access to the care they need and deserve.

Jerrica Kirkley, M.D., is a board certified family physician, trans woman, and co-founder/chief medical officer of Plume, a virtual medical provider for the transgender, nonbinary and gender nonconforming community. Kirkley’s pronouns are she/her. Plume can be reached on Twitter.