Connect with us

Opinions

Opinion | The case for informed consent in trans healthcare

Combatting the toxic influence of medical gatekeeping

Published

on

stillbirth, gay news, Washington Blade

Transgender and nonbinary folk face a whole host of issues when trying to get medical treatment. One of those issues is gatekeeping, in which trans folk have to convince doctors and mental health professionals that they are the right fit and “trans enough” for hormones and surgery. 

Medical gatekeeping occurs among trans women, transmen, and nonbinary folk (people who feel neither male nor female). 

Currently, most medical guidelines for transgender folk are set out by the World Professional Association for Transgender Health, also known as WPATH. 

WPATH is a nonprofit that was founded by a mix of medical professionals set out on a mission to regulate trans healthcare. WPATH is not a government institution, and has no connection to any state or federal legislative body. It also is not directly connected to a hospital institution. It is essentially a bunch of people who just came together to embark on a “savior mission” to presumably make sure that trans people are tended to medically. 

The medical field has come to embody WPATH as the norm, and doctors adopt WPATH protocol when prescribing surgeries and hormones to us. 

Unfortunately, WPATH mandates that trans folk have to receive letters from mental health caretakers before receiving testosterone or estrogen. During these visits with mental health professionals, transmen have to sit down on a couch and convince the therapist that they are sane enough, and “trans enough”, to go on testosterone. 

While coming from a supposed place of “care,” WPATH standards are actually antiquated and harmful to trans folk, and especially nonbinary people, who have a hard time convincing mental health professionals that they are “manly” enough or “feminine” enough to receive care. 

The truth is that all sorts of gender nonconforming folk—some not presenting as strictly masculine or feminine—have the right to receive affirming surgeries and hormones. 

However, doctors often block nonbinary people from seeking these medical treatments. They do so out of an obsolete and bigoted notion that transgender people must conform to being either male (transman) or female (transwomen). 

At Yale University, where I attended college, a doctor within Yale Health denied a nonbinary peer top surgery because they deemed them “not male enough.”

In addition to these horror stories, visits with mental health professionals are both costly and potentially traumatizing for trans folk. Many trans folk lack adequate money to pay hundreds of dollars to see a therapist, oftentimes out of pocket from insurance. 

Additionally, we feel the need to conform to these therapists’ views of what is trans and what is not trans. In the process of doing so, we are marginalizing our own experiences of gender fluidity. 

The solution to this issue of gatekeeping is something called the informed consent model. In the informed consent model, doctors and other medical professionals do not write letters for recipients of surgery and hormones. Instead, they read patients their rights, and inform them of the risks, liabilities, side effects, and benefits of hormone treatment and surgery. Doctors make a reasonable assessment, without mandating a letter, that the patient is fit for treatment. 

Many trans positive clinics across the United States have adopted the informed consent model, mainly because they understand the toxic influence that gatekeeping has had on trans people already. These clinics are usually partly run by trans and queer folk. Whitman-Walker Health in D.C. and Callen Lorde Community Health Center in New York City practice informed consent. 

The informed consent model will birth a new generation of trans patients who are not forced to prove their masculinity or femininity just to get testosterone, estrogen, or surgeries. 

Already, doctors don’t require breast augmentation or reduction patients to get a letter from a mental health professional—so why should trans people? 

It’s time for the medical establishment to reconsider WPATH standards in favor of informed consent. Doing so will greatly enrich the trans experience.

Isaac Amend (he/him/his) is a transgender man and young professional in the D.C. area. He was featured on National Geographic’s ‘Gender Revolution’ in 2017 as a student at Yale University. Isaac is also on the board of the LGBT Democrats of Virginia. Find him on Instagram @isaacamend.

Advertisement
FUND LGBTQ JOURNALISM
SIGN UP FOR E-BLAST

Opinions

A confused Biden and a deranged Trump

Sad state of affairs after first presidential debate

Published

on

Former President Donald Trump and President Joe Biden debate on CNN on Jun 27, 2024. (Screen captures via CNN)

Joe Biden was clearly ready with some facts for this debate, the sad part is he couldn’t articulate them. He sounded raspy, and lost track of what he was saying in the first few minutes of the debate. He did get better as the debate progressed but came off sounding and looking like an old man. For those of us hoping he would sound like he did at the State of the Union, or the speech he gave on anti-Semitism, it was a huge disappointment. 

So, where his campaign goes from here is anyone’s guess. Behind the scenes some Democrats are calling for him to step down as the candidate. But that is much more difficult than it seems at this time. And then, will there be a fight for who the candidate will be. Will it automatically be Kamala Harris, or will it be someone else?  So many unanswered questions over the next couple of weeks.

The only positive take-away for Democrats from the debate was how deranged Donald Trump sounded. He refused to deal with any issue, refused to say he would accept the results of this election, refused to acknowledge climate change, or Jan. 6, and kept saying how the states should control the issue of abortion, and women’s health. Every one of these things should be frightening to so many people. It is clear if Trump is elected, we will have a dictator in the White House, who believes Hitler did good things. His election is scary for women, young people, Black Americans, and the LGBTQ community. If states control issues related to any of these groups, they are screwed. 

One of the very few good lines Biden got across was when he said 40 high-level Trump appointees, members of the Cabinet, and his vice president, have refused to endorse him as they know him best. People need to take their word for how bad he will be should he be reelected. Trump kept talking nonsense and it was hard to keep up with the lies. The moderators didn’t call him on any of it, but CNN has said before the debate they wouldn’t. But then Biden missed so many chances to call him on the garbage he was spouting. I kept hoping he would turn to him and say clearly, “You can’t believe all the BS you are spouting. You sound like a deranged six-year-old and someone who would take our country down the tubes.”

Now I accept the fact Biden speaks more slowly and softly. Though after the debate they said he had a cold. He could have said that at the beginning of the debate, if it was true, and explained his voice to the audience. And while we know he has a stutter, it seemed so much worse during the debate than it normally does. Was it nerves, maybe, but difficult nonetheless for him, and for those listening. We must have compassion for anyone with any kind of a disability. Then one had to ask, was he over-prepared for this debate? Was he so scripted he didn’t dare say anything off script. When he did, they got into this thing about golf handicaps and both sounded so childish. 

Biden did manage to talk about the things he has done, and the successes of his first administration. There have been many. First bringing the country successfully out of the pandemic. He spoke about unemployment being the lowest it has been in decades, and the more than 15 million jobs created since he took office. He was honest about inflation and the fact that not all the economic successes the country is having are trickling down to every American. He understands that rents are high, and grocery bills are still too high. He made clear he wants to raise taxes on the rich and Trump wants to lower them. He had a plan to ensure Social Security would stay solvent, Trump had nothing as usual. 

Finally, I was surprised that in his two-minute closing, Biden didn’t go back to the issues of abortion, climate change, and saving democracy. Did his debate prep team tell him not to? If so, they were wrong. Whether it remains Joe Biden on the ticket, or is someone else, I am 1,000% committed to do everything I can to see Democrats are elected across the board. It is clear to me, and should be to all decent people, electing Donald Trump and his MAGA Republicans, will be the end of our country as we know it today. 

Peter Rosenstein is a longtime LGBTQ rights and Democratic Party activist. He writes regularly for the Blade.

Continue Reading

Opinions

As fewer anti-LGBTQ bills pass, the fight gets harder

A growing indifference to suffering that is baked into the legal system

Published

on

(Photo by Proxima Studio/Bigstock)

In recent years, advocates have faced an unprecedented avalanche of anti-LGBTQ legislation each spring. In 2024, however, the onslaught seems to have faltered somewhat. While hundreds of anti-LGBTQ bills were once again introduced, as many state legislative sessions draw to a close, fewer bills have been enacted into law.

While that may seem like cause for celebration, it’s also cause for concern.

To be sure, the slowdown in anti-LGBTQ legislation is welcome. Beginning in 2020, legislation targeting transgender rights in particular had sailed through state legislatures, with the number and scope of hostile bills increasing each year. Unlike earlier years when one or two prominent anti-LGBTQ bills triggered a national pushback that often chastened lawmakers, hundreds of bills have been introduced during legislative sessions in the last four years, often with little debate or scrutiny, and dozens of them zealously passed into law.

Those bills do real damage when they are enacted, cutting LGBTQ people off from material benefits like health care and domestic violence sheltersrecognition by the state, and equal participation in public life. Even when they fail to become law, they have devastating effects on the mental health of LGBTQ people, throwing their lives into disarray and sapping valuable time and energy from LGBTQ communities. This especially affects children, with more than 90 percent of LGBTQ young people in a recent Trevor Project survey reporting that politics had negatively affected their personal well-being.

But the recent slowdown, far from being a positive signal, may well reflect a growing indifference to the suffering of LGBTQ people that is now baked into the political and legal system. Opponents of LGBTQ rights have normalized hostile rhetoric and enacted draconian laws that seemed unthinkable just a couple of years ago, and even ardent supporters of equality find themselves unsure how they might reverse state laws that unapologetically strip away LGBTQ rights.

If anything, it has become apparent that the damage that has been done since 2020 will most likely reverberate for a generation, and the past year shows that restoring and advancing LGBTQ rights will be a painstaking endeavor.

And one sobering reason for the slowing pace of anti-LGBTQ legislation is that, at this point, many conservative states have already stripped away important rights, particularly for transgender children. As of 2024, half of the states in the U.S. prohibit transgender girls from playing school sports, and half have banned or criminalized at least some forms of medically indicated healthcare.

Put differently, lawmakers aren’t targeting some rights this year because they’ve already eviscerated them.

Yet even as the pace of legislation slows, critical rights continue to be stripped away. According to the ACLU, more than 30 anti-LGBTQ bills have been enacted in 2024 — fewer than the 84 enacted in 2023, but still far too many. Among them, Utah and Mississippi restricted transgender people from accessing bathrooms and locker rooms in public schools and other government buildings.

Lawmakers in Ohio overrode the governor’s veto to ban transgender children from receiving gender-affirming care or playing sports consistent with their gender identity. South Carolina and Wyoming similarly enacted blanket bans preventing transgender children from accessing gender-affirming care.

Many of the bills that have been introduced this year sought to expand existing anti-LGBTQ legislation in new ways. Alabama, for example, successfully expanded its bathroom ban from K-12 schools to colleges and universities. Even those that didn’t pass are in many cases likely to be reintroduced after the 2024 election, particularly if anti-LGBTQ lawmakers increase their showing in state legislatures or if governors who are supportive of LGBTQ rights are no longer positioned to veto hostile legislation.

In many states with anti-LGBTQ legislation, administrative and regulatory agencies are being used to curtail LGBTQ rights even further. Florida offers an instructive example. Even after years of anti-LGBTQ legislation, the Florida Department of Highway Safety and Motor Vehicles took things a step further within its mandate, and decided in 2024 that transgender people could no longer update the gender marker on their driver’s licenses. This echoes recent regulatory crackdowns elsewhere in the United States, from the Texas Department of Family and Protective Services investigating parental support for transgender children as child abuse to school boards across the country stripping away lifesaving resources in schools.

And while many believed that courts would provide a bulwark against discriminatory legislation and regulations, in part because of strong Supreme Court precedent to suggest that anti-transgender discrimination is a form of sex discrimination, that has not consistently been the case. Trial courts have largely found in favor of transgender litigants, criticizing the insufficient justification and discriminatory purpose of anti-transgender laws, but some appellate courts have nevertheless allowed the laws to take effect.

Perhaps most alarming, there are advocates and lawmakers who, if in a position to do so, are eager to carry out an even harsher attack on LGBTQ rights. Project 2025, which a group of conservative organizations has drafted as a roadmap for a second Trump administration, promises an even more draconian attack on LGBTQ rights. This would include rolling back existing nondiscrimination protections for LGBTQ people, reinstating the transgender military ban, and codifying state restrictions on transgender rights at the federal level, in addition to limiting recognition of same-sex relationships.

The anti-LGBTQ backlash may be waning in certain respects — but in other ways, it has only just begun. As we celebrate Pride, LGBTQ people and their allies should be mindful of the need to support those communities whose rights are being eroded, invest in transgender rights organizing, demand that lawmakers prioritize LGBTQ rights, and fight for the independent institutions and protections for basic freedoms that are essential to hold power to account.

Ryan Thoreson is a specialist on LGBTQ rights at Human Rights Watch and teaches at the University of Cincinnati College of Law.

Continue Reading

Commentary

LGBTQ people deserve freedom, a sense of home, and belonging

Latoya Nugent found refuge in Canada after fleeing Jamaica

Published

on

Latoya Nugent, center, at the March for LGBTQ+ Rights in Toronto on May 16, 2024. (Photo courtesy of Rainbow Railroad)

Seven years ago, my fight for queer liberation in notoriously homophobic Jamaica culminated in a violent and brutal unlawful arrest and detention. This was the peak of decades of persecution due to my sexual orientation and work as a queer human rights defender and activist. It completely broke me and silenced me. I suffered severe emotional trauma, from which I am still recovering years later. 

Following that life-threatening arrest, I became a shell of who I once was. I cut off communication with my community for several years, unable to face my fear of the police and the hostility of the world around me. 

In 2022, I was one of the 9,591 at-risk LGBTQI+ people who reached out to Rainbow Railroad for help. Through the organization’s Emergency Travel Support (ETS) program, which relocates at-risk LGBTQI+ people and helps them make asylum claims in countries like the U.S., I resettled in Canada where I’ve been living safely with dignity and pride. 

This Pride Month, I’m reflecting on what it means to be safe. Who has access to safety and why others are excluded from it. What is our collective role and responsibility in expanding safety for our queer and trans communities, especially those in the over 60 countries that criminalize LGBTQI+ people? 

Safety means different things to different people depending on our experiences and journeys. For me, it’s the difference between suffering and thriving, feeling worthless and worthy, and feeling hopeless and hopeful. It is the difference between displacement and belonging. 

Rainbow Railroad recently released a report that examines the state of global LGBTQI+ persecution, drawing on data from 15,352 help requests spanning 100+ countries. This report is significant for several reasons, chief among them is the reality that no other organization or government captures the breadth and depth of data on LGBTQI+ forced displacement, perpetuating the invisibility of queer individuals in humanitarian responses. The report is an important contribution to the discourse on the intersection of queer identity, LGBTQI+ persecution, forced displacement, and humanitarian protection systems. 

Of all the data and insights uncovered in the report, I was most struck by one statistic — 91 percent of at-risk LGBTQI+ individuals relocated through the ETS program reported an improved sense of personal safety. This statistic is particularly personal to me because ETS was the only relocation option accessible to me in 2022 when I reached out to Rainbow Railroad for help. 

I am in that 91 percent because I am now thriving. I feel worthy. I am hopeful about life. And I belong. 

Today, among the 120 million forcibly displaced people around the world, queer and trans individuals face compounded complications from homophobia and transphobia while trying to access protection and safety. And while the anti-gender movement continues to swell in some states, I firmly believe that the U.S. remains a global leader in refugee resettlement — which is why the U.S. government must uphold its international obligations and reverse its recent executive order that imposes severe restrictions on the right to seek asylum. 

Queer and trans individuals deserve freedom, a sense of home, and belonging — realities that flourish only when rooted in the bedrock of safety. 

There is a lot more work to be done. It’s challenging. It’s complex. It’s costly. But I have experienced firsthand what the transformative impact of Rainbow Railroad’s work has on someone’s life — that ability to lift people out of danger into safety is something worth celebrating this Pride. 

Latoya Nugent is the head of engagement for Rainbow Railroad.

Continue Reading
Advertisement
Advertisement

Sign Up for Weekly E-Blast

Follow Us @washblade

Advertisement

Popular