Providers concerned about safety, liability with providing transgender care for youths
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Key takeaways:
- Most pediatric endocrinologists expressed concerns about proposed or enacted laws to ban transgender care for youths.
- Providers said more research and better mental health support for youths are needed.
State legislation prohibiting gender-confirming medical care for children and adolescents may lead to decreased access as pediatric endocrinology providers expressed concerns about their ability to practice in a survey.
“Our study found that pediatric endocrinology providers were significantly less likely to report providing gender-affirming medical care in states where legislation aiming to ban such care were proposed and/or passed between January 2021 and June 2022,” Stephanie A. Roberts, MD, attending physician in the division of endocrinology at Boston Children’s Hospital and instructor of pediatrics at Harvard Medical School, told Healio. “Our data supports that these pediatric endocrinology providers experienced adverse effects and barriers to providing medically necessary care in states where gender-affirming medical bans were proposed or passed during this time. We also found that the effects of such legislation negatively affected pediatric endocrine providers delivering gender-affirming medical care in states unaffected by this type of legislation.”
Roberts and colleagues invited Pediatric Endocrine Society members to participate in a survey in May and June 2022. The survey included three sections, with the first asking questions regarding the provider’s role and time in practice, their practice environment and the state of primary practice. The second section asked whether the respondent cared for transgender youths. Participants who did provide transgender care were asked questions about pressures, concerns and barriers connected to transgender health. The final section asked about institutional engagement in advocacy for transgender youths and institutional response to legislation aimed at banning gender-confirming medical care.
The findings were published in The Journal of the Endocrine Society.
Providers concerned about safety, ability to provide transgender care
There were 223 providers included in the study, of whom 46.2% practiced in states where legislation aiming to ban gender-confirming care for transgender youths was proposed or banned. Of the respondents, 56% reported providing gender-confirming care for transgender youths and 10.8% said they did not provide care currently, but had future interest in gender-confirming care. Of the participants providing gender-confirming care, 37.6% practiced in states that passed or proposed bans.
Of respondents who provided gender-confirming care, 12% said they experienced pressure from their institution that would limit their ability to provide care and 14.4% were concerned that providing transgender care may negatively impact their career. Of those providing transgender care, 59.2% were concerned about the risk of facing legal action and 16.8% said they expressed concerns in the past or were currently concerned for their personal safety at work or home. Providers practicing in states that proposed or passed legislation expressed more concerns in all four questions than those practicing in nonaffected states.
“Our data suggests that gender-affirming medical care bans may limit access to pediatric endocrinology providers more generally, which risks negatively impacting child health,” Roberts said.
Of the full study group, 39.9% said their institution participates in advocacy efforts for transgender youths. However, 17% of respondents said their institution reported concerns about them engaging with the media.
More research, better mental health resources needed
Several themes were identified in open-ended responses of the survey. Participants said they felt that ongoing research in care for transgender youths was crucial to allow providers to make informed decision about care. The respondents also said better mental health support was needed for transgender youths.
For providers in states that proposed or passed legislation to ban gender-confirming care, one common theme was a need to better understand how the laws would affect medical practice. Several providers also expressed concern about their own safety and the safety of their patients. For those practicing in states unaffected by legislation, respondents said they felt that better legislation was needed to maintain access to care for youths and their families. Participants also said they felt that there was a need to explore what other types of medical providers may be able to assist with providing transgender care for youths.
“Additional research is needed to explore the impact on all types of gender-affirming providers, as this care is multidisciplinary,” Roberts said. “Further research is also needed to continue to assess the impacts of health care bans on transgender and gender-diverse youth and their families.”
For more information:
Stephanie A. Roberts, MD, can be reached at stephanie.roberts@childrens.harvard.edu.
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