Access to Care Is a Way to Save Transgender Youth's Lives Today

Rainbow flag isolated on white
Rainbow flag isolated on white

So far this year, the transgender community has seen a mind-boggling amount of violence and loss.

Whether it is Penny Proud in New Orleans, Louisiana, or Bri Golec in Akron, Ohio, in each case the circumstances are eerily similar: Trans women losing their lives unnecessarily as victims of brutal, violent crimes. Other high profile cases of suicides among transgender individuals, or cases of discrimination suffered by transgender people in either housing or the workplace have captured the nation's attention by sharing the challenges that transgender people face by being marginalized, othered, harassed, hurt and misunderstood. Collectively these cases have created a rise in social media posts with a poignant and all-too-familiar hash tag, #translivesmatter.

Among all of this loss, it is the Leelah Alcorn case, and others like hers, that I cannot seem to shake from my head as a pediatrician. You may recall that Leelah was the 17-year-old transgender woman who chose to, or was driven to, end her own life. At the time, the case garnered national headlines with the main focus on Leelah's public social media posts in the weeks preceding her death. These haunting posts discussed her negative experiences with conversion therapy to supposedly "cure" her of her transgender identity.

However, the undiscussed aspect of the Leelah Alcorn case is that access to healthcare, particularly for gender-affirming medical therapies may have saved her life.

Re-read some of her social media posts before she took her life, "I can't wait until I am 18 to begin transitioning," and "I can't wait one more day." These posts point to her inability to access appropriate healthcare as a potential immediate precipitating factor in her death; one that may have been 100 percent preventable.

I suspect this aspect of the story was not pursued with vigor out of respect to Leelah's grieving parents, who the media chose to, understandably, not challenge with respect to the rationale behind the decisions they may have made or not made for their child. And it certainly is not my intention to unnecessarily stir the pot, create drama or inflict more pain for on the Alcorn family.

However, there is a larger educational point that needs to be said loud and clear for the benefit of other families and for transgender or gender nonconforming youth. That message is simple: For transgender youth, access to health care services saves lives.

Truth is that in many centers, including the Gender and Sex Development Program that I co-direct at Ann and Robert H. Lurie Children's Hospital of Chicago, adolescents like Leelah shouldn't have to wait until the age of 18 to begin engaging in gender-affirming care. Youth should and do have the opportunity to begin the process of transitioning in a way that allows them to live life as their authentic self.

Our Gender Program's multidisciplinary team and other programs models across the country are complete with pediatricians, nurses, child development specialists, mental health providers and endocrinologists all committed to working with youth and families who are seeking advice or guidance in confronting the challenges of raising a gender non-conforming or transgender child. In many instances these individuals are not familiar with sources of support in the community or options related to medical therapies and interventions.

The Endocrine Society and World Professional Association of Transgender Health Professionals (WPATH) have what are now considered widely-used clinical care guidelines that support the use of pubertal blocking medications in certain gender non-conforming children or early adolescents based upon pubertal and developmental age. They also support the initiation of cross sex hormones in transgender young people as young as 16 years of age (and in some case and some centers even younger).

It is not unusual for teams such as ours to encounter parents or families of children that do not initially support these medical interventions -- often due to a denial about the child's authentic gender identity, a lack of education about the safety of potential medical interventions or a deeply rooted personal, religious or cultural objection. In the overwhelming majority of these cases (but certainly not all), we can work effectively with families and individuals to find a common path moving forward, or at the very least finding a path that ensures the safety and well-being of the child or adolescent.

Centers like ours strive to dispel myths that label being transgender as an affectation or pathology as opposed to the stable identity it represents for most individuals. We also work with families to see their children through a broader and more realistic lens than the spectrum of dysfunction that is too often the focus of negative media attention.

For, while it remains true that too many transgender youth are the victims of hate crimes, and too many become homeless or contemplate suicide, this spectrum of dysfunction does not capture the strength, perseverance, pride and resilience that in my professional opinion more accurately captures the spirit of the young transgender people I see each and every day.

Alongside educating families, it is important to educate the adolescents themselves about their individual rights with regard to medical decision-making particularly as it relates to mature minor statutes on the state level or legal emancipation as a last resort for those who may be at the point of crisis or self-harm.

In essence, for many individuals like Leelah, access to one of the many centers across the country that care for gender non-conforming children or adolescents could literally be a lifeline to a future as their authentic selves.

And most importantly, access to care at these sites can save lives starting today.