Recent anti-trans articles miss the point of gender-affirming caring

In this comment, Kaiyti Duffy, MD, MPH, Chief Medical Officer of the Los Angeles LGBT Center, responds to current anti-trans articles and the impact they can have on the community.

In the middle of Transgender Awareness Week and just before a gunman killed five in a shooting at a popular Colorado LGBTQ bar, The New York Times publishes a unfortunate piece about gender-affirming care. The headline asked a question: “You paused puberty, but is there a price?” Transgender people, queer activists, and LGBTQ-affirming medical providers like myself braced themselves immediately for the inevitable: another article addressing transgender health and challenges the community’s seemingly endless quest for equitable medical care.

I understand that journalists have a duty to ask questions and shed new light on controversial issues. As Chief Medical Officer of the world’s largest non-profit LGBT organization, the LGBT center in Los Angeles, I particularly welcome solid research on queer and transgender care, especially because I want our patients to be safe and healthy. Instead, our mainstream media seems to have learned nothing from US activism AIDS crisis, or the powerful queer and trans organizations during the monkeypox outbreak. Article like the one in the Times don’t seem concerned about our security – and this is just the latest in a series of similar articles. Instead, they could further marginalize a population already medically vulnerable and politically beleaguered.

The play’s authors, Megan Twohey and Christina Jewett, spend a significant portion of their article exploring the potential risks involved leuprolide, the primary drug used to stop puberty from developing. However, they fail to meaningfully examine the most compelling reason medical providers are considering puberty blockers in transgender and gender-biased youth: those drugs save lives.

The gist of the article is that puberty blockers may have an impact on bone density in some patients. Medical providers like me were a bit taken aback by the “question” that was asked here Times “Detection.” We have long known the reduced Bone mineral density is a possible risk of this drug. When deciding whether the benefits outweigh the risks of providing puberty blockers, we look at the young person sitting in front of us. What are the risks of deciding against puberty blockers and allowing puberty to progress? In my experience, there is a risk Death.

Importantly, Twohey and Jewett fail to substantially acknowledge the powerful internal and external forces affecting the physical and mental health of our transgender and gender-matched patients. Gender dysphoria, for example, refers to the sense of uneasiness and anxiety a person feels when realizing that the gender assigned at birth does not match their internal gender identity. This can be a deeply personal process and very painful for many. However, this experience is compounded by social stigma and the very real threats of physical violence, harassment and discrimination inflicted on this community by classmates, family members and now public and political figures. Actually the The American Medical Association declared an “epidemic of violence” against trans people, especially women of color, in 2019. Trans youth on the precipice of puberty are having to confront their inner relationship to gender and realize that the world holds little value for people with their experience. No wonder what these young people experience high rates from depression, fearand suicidal thoughts and attempts.

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