Access to gender-affirming care in the U.S. often comes down to where you live and the laws in place there. That patchwork can have serious consequences. In today’s episode of Translucent, host Lee Wade talks with a physician about what happens when care is interrupted or denied, and why starting and stopping treatment can do real harm.
Wade: Across the country, laws and policies governing medical care for transgender youth vary state by state and can change quickly, leaving families, doctors, and young people navigating uncertainty, alongside deeply personal decisions. Meredithe McNamara is a physician at the Yale School of Medicine who specializes in adolescent medicine and teaches pediatrics. She is also a prominent advocate for on-demand access to medical gender transition services for youth in the United States.
McNamara: We know that when people who experience gender incongruence, the difference between their physical bodies and their sense of self, achieve physical attributes that help them feel like themselves and feel better about their bodies, that other mental health benefits ensue. Gender is a really important, deeply held sense of who we are, whether we're male or female or something else. So medications like estrogen and testosterone and other types of medications along those lines can be really helpful to trans and gender diverse people for achieving those physical characteristics that they desire.
Wade: While some lawmakers label gender-affirming care experimental, McNamara says, the real question is what happens when people are prevented from accessing it.
McNamara: The real experimental care that's going on for trans and gender diverse people right now is the systematic deprivation of their care in settings where institutions, clinics are suddenly deciding to stop. We're talking about people who will suffer and do suffer when their care is forcibly withdrawn. We don't know how to take care of somebody who desires and qualifies for gender-affirming medications, is actively receiving them, and then must be stopped, right? That is experimental.
Wade: At the center of it all are young trans people. McNamara shared one story that stayed with her.
McNamara: I had a patient a couple of years ago who was able to receive testosterone because he was in the foster care system. And finally, after all of these appeals and all of this kind of like medical reviews of his case, the state consented to care on his behalf. And it was the first time he ever felt, seen, heard and valid. And that spilled over into school and to future orientation. He's like, well, maybe I can go to college now because I feel like I know what my life could be like in five years' time. Everybody benefits from that sort of perspective, but when that perspective unfolds and blooms in adolescence, it's just so extraordinary to see.
Wade: But some lawmakers are pushing to restrict this care, and McNamara says many of them don't fully understand what the treatment actually involves.
McNamara: From top down, and I really mean starting at the top, recognize that this is medically necessary care, that it cannot be safely stopped. And if you would not safely stop any other type of healthcare that you offer, don't do it for this. What I would say to policymakers is, I don't think you really belong in this space if you don't understand this care. What's real is that trans identity exists, that people benefit when they receive affirming medical care, should they desire it, should they qualify for it, and that this is care that people continue and incorporate into their lives.
Wade: Thank you, Meredith McNamara, for the amazing work that you're doing to advance understanding of gender-affirming care.
McNamara: A big thank you to producing an informationally sound medium for people to obtain information. That's a really brave and important thing to do right now. And I know that this takes time. So you're doing amazing work too.
Wade: I'm Lee Wade, and thank you for listening to Translucent.
This story was produced at the Eichelberger Center for Community Voices at WYSO. Translucent is made possible with support from The Rubi Girls Foundation and Square One Salon.
