CT doctors see referrals spike for gender care. After Trump election, it’s ‘kind of emergency mode’

Hartford Courant – Monday, November 18, 2024
By Kaitlin McCallum

When news that Donald Trump had secured a second term as U.S. president became undeniable, the phones at hospitals and gender clinics across Connecticut began ringing.

On the other end were transgender people, a tiny sliver of the country’s population who, along with immigrants, bore the brunt of Trump’s attacks throughout his campaign. The former and future president railed against “transgender insanity” and spent tens of millions to criticize trans people and Vice President Kamala Harris for her support of them.

On the campaign trail, Trump promised to ban access to gender-affirming health care, cut off funding for institutions such as hospitals that provide the care and schools that affirm gender-expansive young people, and by rolling back antidiscrimination laws that protect them.

Hartford HealthCare, a spokesperson said, saw its largest one-day total of referrals ever on the Wednesday after the election. And the surge has continued since then.

“Since November 5th, there has been a marked increase in referrals to the Center for Gender Health at Hartford Healthcare — at a rate of 2 ½ times what has been typical since we launched two years ago,” a statement from the hospital system said. “Patients are directly expressing worry about possible changes in access to gender affirming services.”

The requests have been specifically for gender-affirming hormone treatment and surgical procedures, the statement said.

Gender-affirming care consists of a range of services, including mental health care and medical and surgical interventions that support alignment of a person’s physical traits with their gender identity. Major medical organizations, including the American Academy of Pediatrics, the American Medical Association and the American Psychiatric Association, support age-appropriate gender-affirming care as standards-based, evidence supported and lifesaving.

In anticipation of Trump’s inauguration, Connecticut gender doctors have seen a spike – in referrals for care and in anxiety, depression and suicidality in their patients.

“There’s widespread concern that there will be a barrier to access,” said Kathryn Tierney, director of the Middlesex Health Center for Gender Medicine. “We’re seeing a significant number of messages from patients making sure that they can get seen before the inauguration.”

Patients are worried that they will lose access to hormone therapy they’ve long depended on and that surgical procedures will no longer be available.

At Middlesex, one of a handful of gender care providers in the state, Tierney said staff have been trying to fit in as many patients as possible.

“Immediately the next day after the election, we did give the front desk who does our scheduling the OK to move patients up and open up times,” Tierney said.

“Surgical services providers are trying to open up times so they can get patients in and moving faster than they would otherwise. … Providers who aren’t doing this care have offered to offload some of my responsibilities so I can do this kind of care and all of us are in kind of emergency mode,” she said.

Anxiety

Even before any policy changes can take place, the election is taking a toll on patients’ mental health, Connecticut providers said.

Dr. Christy Olezeski, director and co-founder of Yale Pediatric Gender Program, said she has seen the impact.

“There has been a precipitous increase in anxiety, both youth and parents. Folks are very concerned about what will happen to medically necessary holistic care that’s being provided,” she said.

People are struggling with the potential loss of care, as well as being fodder for political debate.

“Ever since there has been a highly politicized debate about gender-affirming care and an increase in social media posts and news stories about bans on health care, there has been an increase in anxiety, feelings of despair, suicidality,” Olezeski said.

“Kids are really struggling even if the ban isn’t happening here in Connecticut. They’re worried about their care being taken away and also they have some peers who are engaging in increased incidences of bullying because they’re seeing this on social media,” she said.

Adults are also experiencing increased discrimination, harassment and fear of loss of care.

“We’re getting a lot of patients with changes in their mental health … The general community at large has felt emboldened to use language that’s not tolerant. Patients are reporting that they’re being harassed in public,” Tierney said.

The Trevor Project, a suicide prevention hotline for LGBTQ+ youth, said it saw a huge increase in calls, texts and chats the day after the presidential election, many of which included mention of the election.

An issue of health and safety

Dr. Ayiti Maharaj-Best, medical director at Planned Parenthood of Southern New England, said the irony is that the arguments often made against gender-affirming care are about health and safety.

“A lot of the time in these conversations people who are against access to gender-affirming therapy or against trans rights in general will frame this as trying to keep people safe or keeping people from care that’s harmful and there’s no data to support any of those claims and there’s robust data that shows people who want to be on hormones … consistently report that their lives are better, they are safer when they have access.

“People’s health outcomes do get worse when they’re not allowed to be their authentic selves and, as a doctor, that breaks my heart. That’s not what I want to see for my patients and my community.”

Looking to elected officials

Even before Trump’s victory, proposals of anti-trans legislation in states across the country have soared.

Translegislation.com is tracking 665 bills that limit transgender rights in schools, health care, housing, employment, drag performance, sports, bathroom use and more. Forty-five have passed, it reports.

On Thursday, the 7th U.S. Circuit Court of Appeals ruled an Indiana law banning gender-affirming care for minors is constitutional and may stand. The court referred to Dobbs, the 2022 U.S. Supreme Court decision overturning Roe v. Wade, as foundational to its opinion.

Amid the fear and uncertainty, parents, activists and doctors are looking to Connecticut policymakers for protection.

In addition to access to puberty blockers, hormone therapy and surgery, Connecticut providers are concerned about other ways a new administration might disrupt care and target gender diverse people, including through patients’ electronic medical records and funding for academic programs that train gender care providers.

Each of the providers the Courant spoke to said they would fight to continue to provide gender-affirming care and hoped elected officials would, too.

“I really do believe the state of Connecticut as an institution and government has been incredibly supportive for decades of gender-affirming care and I suspect we will rise to this as well,” Tierney said. “I know we are set up to do the right thing for gender diverse families.”

Olezeski pointed to Connecticut’s shield law, which protects both patients and providers from prosecution for providing either gender-affirming care or reproductive care. While the law was designed following the overturning of Roe v. Wade to establish Connecticut as a sanctuary state for those seeking care, a representative of Attorney General William Tong’s office confirmed that the law would be superseded by a federal ban.

“Right now is the time when we have to, as a state as a sanctuary state, as a state that has shield laws, make sure that our elected officials are doing everything that they can to make sure this continues to be a safe place for trans and nonbinary folks to receive care,” Olezeski said.

“Some people have talked about… Connecticut (as) a destination state for LGBTQ and if it is we need to make sure the state is protecting all of their constituents. We need to do that now. They need to be protecting all of their constituents, even the people who can’t vote yet but will be able to in the future,” she said.

Democratic state leaders, at a press conference following the election, promised to support Connecticut’s trans kids.

“We will stand up strongly for LGBTQ+ rights,” Lt. Gov. Susan Bysiewicz said.

Tong said Connecticut will “continue to fight hard for the LGBTQ+ community and protect and defend them every single day.”

Gov. Ned Lamont at the end of his speech offered his support to trans youth, whom he noted had been the subject of attack ads.

“(They) just spent hundreds of millions of dollars on mocking kids like this over the last, you know, three or four months. And I’d just like to give a message: we love you, we’re all God’s children. Your friends want to see you in school tomorrow, and that’s what it means to be in Connecticut,” Lamont said.

Lindsey Pasquale, co-president of Hartford PFLAG, said “being trans is not constantly thinking about getting gender-affirming care but when you’re looking at taking it away, that becomes the focus.”

The current political situation, she said, has the potential to rob people of what should be a joyous time.

“The saddest thing for me is that pursuing GAC can be scary to take the first steps for, but afterwards is generally a joyous and self-affirming process. It should be something people get to celebrate as they pursue it,” she said. “At the moment it has taken on a sense of urgency of timing and anxiety as to whether they will be able to go all the way through the process before the path is potentially taken away from them. It is my hope that people do what they need to do, and that they don’t forget to take moments for themselves along the way to feel that joy.”

PFLAG and organizations like Q Plus that serves queer youth are available to provide support.

“It is our vision at PFLAG that someday we will have an equitable, inclusive world where every LGBTQ+ person is safe, celebrated, empowered, and loved. In the meantime, at PFLAG we will do everything in our power to join with others and preserve access to GAC. GAC saves lives,” she said.

Hartford Healthcare also noted that there has been misinformation concerning parental consent. “Minors cannot received any procedures or medical care without the consent of their parents,” the spokesperson said. “There isn’t any medical intervention for gender dysphoria for pre-pubertal children.

“We want patients to know that we are there for them.”

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