The phone rings. Another admission. The pediatric ICU has only one bed ― our “crash” bed, saved for only those in the most critical condition.
They were found hanging in their bedroom. On arrival they were not breathing. Their heartbeat was absent. EMS was able to regain a heart rhythm, although they have lost it a few times since. We’re told by EMS if they have a heartbeat, they’ll come to us. If they don’t, they’ll go to the emergency department to be declared dead on arrival.
Fifteen minutes later, they are wheeled out of the elevator and into our unit. Lifeless. They have a slow heartbeat, only 30 beats per minute. They aren’t breathing. As we wheel them into the ICU room, we lose them. We try to revive them but we cannot.
They die there in the hospital, with their parents shortly following, screaming a scream only those who lose a child can scream. They were transgender and took their life. They were 10 years old.
I wish I could say this story is an exaggeration. While details have been altered, this scenario is real and, sadly, not uncommon. More than 50% of transgender and gender diverse individuals have seriously considered suicide. The exact number is difficult to determine since we do not include gender identity on death certificates ― many of which I’ve filled out.
As a physician who specializes in LGBTQ+ care, I have a deeply personal experience with this issue. To me, the “specialized” care I do is just another component of my primary care practice. As a primary care physician, I see newborns for their well-child checks. I see adults for complex, chronic diseases such as diabetes and heart disease.
So, when my schedule has a 20-year-old patient presenting for gender care, I don’t see that patient any differently. I order lab work based on guidelines. I educate them about the risks and benefits of treatment and assess their mental health as I do for all patients, when appropriate. Just as a cholesterol lowering medication or insulin is lifesaving for a diabetic patient, hormone replacement therapy for my transgender and gender diverse patients is too.
Transgender and nonbinary youth who report having their pronouns respected by all or most of the people in their lives attempted suicide at half the rate of those who did not have their pronouns respected. And this is simply using words. Much less getting medical care they need. Providing this care and supporting this community is lifesaving. Arguing anything otherwise is detrimental and sometimes lethal for children.
My introduction to broader aspects of the LGBTQ+ community came in my first year of medical school when a panel of guests shared their stories. I learned of a transgender individual who had been harassed and feared for their life in West Texas. They were a professor with a partner and two kids. Even though I went to college in Austin ― the so-called liberal mecca of Texas ― I was very unfamiliar with the transgender and gender diverse community. I felt ashamed by this.
I went to high school in a Texas suburb. I never thought much about the LGBTQ+ community. My junior year of high school, a new girl moved from Austin who identified as bisexual. The thought of being anything other than “straight” had never crossed my mind. After this, I started exploring my sexuality and quickly realized I was a lesbian.
Unfortunately, this realization was not met with as much ease by my peers. An A+ student bound for the University of Texas who was in three Advanced Placement classes at the time, I graduated high school early from our alternative school to escape inappropriate questioning and bullying from my peers and teachers.
As disappointed as I was in this response, I wasn’t surprised. I had grown up surrounded by those whose views differed from mine. The only kid in all of fifth grade to vote for Al Gore in class, I knew I stood out. Moving to Austin, I felt more affirmed in my identity than ever and our campus even had an LGBTQ+ center. Finishing college, I thought, we have a long way to go but things are good. As a cis, femme-appearing, able-bodied white woman, little did I know how much privilege I truly had.
I completed my medical school training in West Texas. As a first-year medical student, I was asked to spearhead an LGBTQ+ group for medical students. This turned into a group of over 100 members representing various departments of the health sciences center. Through this, we implemented an “allies training” in the hope of empowering peers to advocate for LGBTQ+ colleagues and patients.
On day one of the training ― “LGBTQ+ 101” ― I was discussing gender and sexuality as a spectrum rather than binary concepts. Out of the corner of the tunnel vision I had because I was so nervous, I saw a hand raise in the crowd. I recognized the face ― a provider known for being anti-LGBTQ+ and for openly refusing to prescribe pre-exposure prophylaxis (PrEP) for HIV prevention, something that was well documented to significantly reduce the rates of HIV transmission.
Nevertheless, I called on him. He asked, “So if gender and sexuality are on a spectrum, where do bestiality and pedophilia fall?” I was speechless. My whole body was in flames, hands trembling, my words momentarily escaping me. Although I don’t remember it, I was told I handled the situation well. I responded in a cool, collected manner despite the egregious question, an unfortunate acquired skill bred out of adversity.
Given my experiences in Texas, I sought to move to a more progressive area of the country for residency training. When I matched in Providence, Rhode Island, I was ecstatic. Finally, a blue state. Finally, somewhere that will understand.
Little did I know, Rhode Island would not be equipped to care for LGBTQ+ communities either. Working at a local safe space for LGBTQ+ youth, I conducted a small study. We determined that a significant portion of youth identified as transgender or gender diverse, with most using terms not even included in the acronym “LGBT.” Furthermore, 50% had never been asked about their sexual orientation or gender identity by a health care provider, a question that is, again, potentially lifesaving. Luckily, I had the opportunity to work with an incredible team so I could experience the joy of providing transgender and gender diverse persons with the care they needed.
Now, as a practicing physician in Los Angeles, I am a part of a specialized gender health program, a wonderful cohort of people who provide multifaceted care to transgender and gender diverse individuals of all ages. Yet, even here, the physicians who are “LGBTQ+ specialized” are responsible for educating medical students, residents, faculty and entire health systems, in addition to providing care for these communities. This burden is great and we all feel it.
No matter where I’ve been in my career as a physician, I’ve had the privilege of taking care of patients who have gone from the brink of suicide to being happy, successful, productive members of society. The scenario that sticks out most in my mind was a wonderful individual we invited for a panel in Texas. She had made multiple suicide attempts starting around age 6.
Originally from the Deep South, her mom struggled to find a provider who would even see her, much less someone who was knowledgeable in transgender care. Finally, she found a program and was started on treatment. She graduated high school as prom queen and at the top of her class. The importance of these accomplishments was palpable, as she beamed when she spoke.
Being in this field and hailing from Texas, I feel compelled to write this piece. I am appalled by my home state. Not only is transgender and gender diverse health care always being impeded, but now supportive parents (and providers) are being accused of child abuse. I would argue, rather, this act by the legislature serves as a form of child abuse.
I have friends who practice in Texas, taking care of transgender and gender diverse communities. Providers who have to answer questions like these regularly. Who have to put their mental, and sometimes even physical, safety and well-being at risk to advocate for their patients. I hope they stand strong.
In the midst of a pandemic and broken health care system, empathy is in short supply. I ask of you all, my fellow health care colleagues, and the citizens of Texas, please oppose what is happening. If we don’t, we will lose children and bear the responsibility for it.
If you or someone you know needs help, call 1-800-273-8255 for the National Suicide Prevention Lifeline. You can also text HOME to 741-741 for free, 24-hour support from the Crisis Text Line. Outside of the U.S., please visit the International Association for Suicide Prevention for a database of resources.
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