The Anti-Trans Memo — Abandoning Doctors and Patients

The New England Journal of Medicine 
by Jocelyn Samuels and Mara Keisling
January 10, 2019


In October 2018, the New York Times reported on an effort under way by the Department of Health and Human Services (HHS) to redefine gender as a “biological, immutable condition determined by a person’s genitalia at birth.”1 If that effort succeeds, it will, at a minimum, restrict federal nondiscrimination protections for transgender people seeking necessary medical care. Indeed, it will have damaging repercussions for both transgender and intersex Americans — vulnerable communities that have faced persistent and pervasive discrimination from health care providers, hospitals, and insurers, among others.

Consider the case of a transgender teenager from southern California who was battling severe depression, including suicidal ideation and self-harming behaviors.2 In 2015, the young man was admitted for inpatient care at a hospital’s adolescent psychiatric center, where his mother made clear to hospital staff that he was a transgender boy who needed to be treated as a boy. In fact, his medical records reflected his legal name and gender change. Nevertheless, staff at the hospital repeatedly harassed and humiliated him, including by using feminine pronouns and telling him that he was “such a pretty girl.” Soon, other patients followed suit, referring to the boy as “she.”

Such treatment is distressing for many patients, but it’s particularly harmful to a young person already in crisis. Beyond that treatment, moreover, the hospital took other damaging actions. For example, hospital personnel blocked the boy’s mother’s phone number when she called to share her son’s reports of harassment and remind the staff to refer to the boy as male. In addition, far from protecting him, the boy’s doctors discharged him early because of the staff’s conduct. Five weeks later, the boy died by suicide.

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