AAP Voices Blog

The consult request came late in the afternoon.  A young person on inpatient psychiatry was expressing significant gender dysphoria. Could I come now? I co-lead our multidisciplinary gender team, providing medical and mental health care to gender-diverse youth throughout a three-state region, in the deepest of the Deep South. 

The kind, mild-mannered child dressed in oversized scrubs and pacing the room was well known to the care team. This was the third inpatient admission, with countless emergency department visits trailing behind. All for suicidal ideation and depression. This time, she felt comfortable disclosing her deepest fear. She had always known herself to be a girl. Always. She was simply born into a boy’s body.

At 13, her body was beginning to change in ways that horrified her. The guilt of angering and disappointing her mom and siblings was consuming her. Could I help her?

The arrival of Section 1557 of the Affordable Care Act  extended nondiscrimination protections around a person’s inner sense of their gender — even if it did not match the sex the person was assigned at birth — saying transgender people must never receive differential services in health care and cannot be denied equal access to care. Any provider or institution that received even a penny of federal funding through Health and Human Services was obligated to uphold these extended non-discrimination protections.

“As pediatricians, we should honor our duty to our patients and families, all of them.”

I was asked to lead every provider and staff member on that unit and several others at Children’s of Alabama through an understanding of gender dysphoria. Together we problem-solved ways to actively affirm trans-identified youth in their spaces. These discussions were warmly received, as most folks in 2015 Alabama had little prior understanding and contact with transgender people.

Section 1557 accelerated large strides in addressing the provision of culturally responsive care in medicine. Recent demands for racial equity and inclusion can build on these gains. But in June, the Trump administration finalized a rule that removed these nondiscrimination protections for LGBTQ people when it comes to health care and health insurance.

It remains my prayer that this final rule will not derail much needed progress in the provision of care for all marginalized and stigmatized patients. The culture in our profession has come too far. We are embracing the needed heavy lifting to grow further.

Operationally, the final rule does not order health systems and providers to change the care they deliver to LGBTQ-identified people. The HHS ruling does not mandate that physicians be closed-minded. It only affords them to option to do so. As pediatricians, we should honor our duty to our patients and families, all of them.

Before leaving the psychiatry unit, I allowed my new friend one of our transformational interventions: a huge hug. Into my shoulder she sobbed, “You are the first person I’ve met who understands me.” It shouldn’t take 13 years and three suicide attempts for youth to be heard. 

Stay strong. We pediatricians don’t walk back progress.