Cruelty is the point in attacks on transgender teens

President Donald Trump spent much of his first month in office attacking the rights of transgender Americans, including stripping away teens’ access to health care.

Although two separate federal judges have temporarily blocked the president’s executive order banning gender-affirming care for minors, parents’ relief is tempered by uncertainty for their children’s futures. Anti-transgender rhetoric was a big part of Trump’s campaign, and he now seems determined to erase the very existence of transgender people.

His cruel and dehumanizing actions are having a particularly profound effect on the physical and mental health of transgender young people.

“It’s just been hard feeling like I’m less of a person every day,” said an 18-year-old transgender college student who initially lost access to care. “Less of somebody who has dreams and aspirations — and more of a statistic.”

(Like other teens and parents I spoke with, the student asked not to be named out of fear for her safety.)

The hostility directed at trans youth is even harder to understand when you consider their small numbers. Just 300,000 teens ages 13-to-17 identify as transgender or gender diverse in the U.S., according to UCLA’s Williams Institute. That’s about 1.4% of all 13-to-17-year-olds.

And not all trans youth choose to undergo a medical transition — and among those who do, very few have access to that kind of care. A recent study in JAMA Pediatrics found that among adolescents with private insurance, less than 0.1% are transgender and also prescribed puberty blockers or hormones.

These teens struggled to obtain care even before Trump’s executive order. Nearly 40% of transgender youth live in states that have barred access to gender-affirming surgeries, therapies or both. (The Supreme Court is considering the legality of the bans.) As I’ve written in the past, these bans have sent some youth and their families across state lines to seek care while others have gone without.

Now, everyone’s access is at risk. An executive order is not law, but children’s hospitals around the country — including those in places whose attorneys general are committed to supporting state laws on gender-affirming care — immediately reacted to it. Patients seeing specialists in Denver, Los Angeles, Washington, DC, Chicago, New York and Virginia were initially told some or all forms of care would be paused. (Some hospitals restored care for some patients after federal judges paused the bans.)

“What if you were that kid who had been waiting five or six months for an appointment?” says Morissa Ladinsky, a pediatrician who helped found the University of Alabama’s youth gender team. “That’s when you take away hope.”

Ladinsky said that just days after Trump’s order was issued, a colleague in New York had a patient attempt suicide. “And I’m afraid there will be more.”

Parents whose kids are already taking puberty blockers or hormones spent the last month scrambling to come up with backup plans. The mother of an 11-year-old transgender girl, who recently started puberty blockers (shots typically given once every three months), managed to get her daughter an appointment for an implant that will deliver the medicine for the next year.

Her goal was to give her daughter space to explore her identity. “It’s a soft cushion to figure out what we want to do,” she says. “Let’s buy some time … and really just meet our kid’s health needs as they come.”

Trump signaled his intentions throughout his presidential campaign, perpetuating dangerous falsehoods such as claiming children were undergoing surgeries at public schools. His campaign spent tens of millions of dollars on ads meant to reinforce the hysteria he was fomenting about transgender people. His attacks were built off four years of Republican efforts to pass laws targeting transgender kids’ ability to access health care, participate in sports, use public restrooms and be called by their correct pronouns at school.

Once in office, Trump unleashed a barrage of directives targeting transgender Americans — orders one judge called “unadulterated animus” toward the group. Federal health agencies stripped away any mention of transgender people and their care from their websites and literature. When the courts ordered it be restored, the agencies appended pages with a warning that the information “does not reflect biological reality and therefore the Administration and this Department rejects it.”

Taken together, Trump’s actions have created a dangerous climate for transgender Americans. Several parents and teens I spoke with told me they are considering extreme measures, such as leaving the country for someplace safer.

The college student, who also has been affected by a separate executive order preventing transgender people from updating the gender marker on their passport, described a life in limbo. “There are things that I want to do in my life. I want to be able to pursue a career, to learn and flourish,” she said. “The fact that those things are now coming second to just my basic well-being? That is really hard.”

She reminds us that these are just teens trying to lead normal teenage lives, and parents and medical providers are doing their best to support them.

This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners. Lisa Jarvis is a Bloomberg Opinion columnist covering biotech, health care and the pharmaceutical industry. Previously, she was executive editor of Chemical & Engineering News.