During a protest outside the U.S. Supreme Court on December 4, demonstrators voiced their opposition to the debate on whether states should be able to prohibit specific gender-transition medical treatments for young individuals. Kelly Houske, who faced a distressing medical incident while walking her dogs, shared her unsettling experience. Suffering from severe back pain, reminiscent of a previous heart attack, she sought urgent care at a local emergency room. However, her expectation of compassionate treatment was shattered when her doctor appeared distant and aloof, never entering her room. An imaging technician exacerbated her ordeal by disregarding her pain, instructing her brusquely and failing to assist her during a procedure.
Kelly Houske, aged 67, recounted multiple instances of mistreatment by healthcare professionals. A particularly distressing incident occurred in 2017 at a Tennessee hospital, where Houske, a transgender individual, faced insensitivity and neglect. Citing data indicating widespread mistreatment of transgender patients, including verbal abuse and care denial, advocates expressed concerns regarding the potential deterioration of care quality under the current administration. Executive orders limiting transgender rights, especially access to transition-related healthcare, have sparked distress among transgender individuals and their healthcare providers.
Physicians working with transgender patients have reported significant distress triggered by the executive orders. A recent report by the UCLA School of Law’s Williams Institute revealed that nearly three-quarters of transgender patients surveyed post-election fear declining healthcare quality under the current leadership. Worryingly, approximately 80% of respondents, surveyed before the administration change, planned to alter aspects of their lives to downplay their transgender identity. Social isolation and avoidance of public spaces were among the coping mechanisms adopted by one-third of respondents.
In Nashville, Tennessee, Shawn Reilly, a transgender advocate, expressed apprehension that protections for transgender patients, previously established by the Obama and Biden administrations, might be reversed. Reilly voiced concerns about potential care denial towards transgender patients under the current administration’s policies. Advocates stress that depriving transgender individuals of fundamental healthcare rights is both inhumane and unjust, particularly during vulnerable moments when access to care is crucial.
Neither the Department of Health and Human Services nor the White House responded to requests for comment regarding the concerns of transgender individuals, as well as their healthcare providers and advocates, about their treatment in healthcare settings. The issue of discrimination against transgender individuals has been highlighted during Trump’s presidency. In his first term, Trump reversed an Obama-era nondiscrimination rule for transgender patients. While Trump has not yet issued a new rule on healthcare discrimination, a webpage created by the Biden administration that outlined legal protections for transgender patients is currently blank. Concerns have been raised about Trump’s actions in the early months of his second term, including issuing an executive order denying legal recognition to transgender individuals and canceling research grants related to transgender health. Additionally, efforts to restrict access to gender-affirming care for transgender individuals of various age groups, as well as other discriminatory policies, have been met with legal challenges. The legal protections for transgender patients are rooted in the Affordable Care Act, which prohibits discrimination in medical settings based on various factors, including sex. The interpretation of these laws has varied across different administrations, with Obama and Biden broadening the scope of sex discrimination to include protections for sexual orientation and gender identity. Despite the challenges and changes in policy, anti-discrimination policies continue to have a significant impact on healthcare practices and cultural norms.
Fact-checking Trump’s remarks on transgender individuals in his Congressional address revealed that they are a controversial topic. The Department of Veterans Affairs announced a discontinuation of transgender care for certain veterans. Rolling back legal protections for transgender patients may have negative consequences, as healthcare providers may be encouraged to deny them care. Redfield warned that allowing or condoning discrimination at a federal level could embolden those already reluctant to treat transgender individuals. Without federal protection, transgender patients may lose the ability to file complaints with the Department of Health and Human Services, making the process of seeking justice more challenging. Some transgender patients have successfully sued healthcare providers for discrimination, citing provisions in the Affordable Care Act. Advocates stress the importance of protecting transgender patients’ rights to access healthcare without fear of mistreatment. While some states like California have laws safeguarding transgender patients from discrimination, others are following Trump’s lead in restricting transgender rights. Iowa recently removed gender identity from its civil rights law, setting a concerning precedent. Despite these challenges, it is crucial to ensure that transgender individuals can access healthcare safely and without obstacles. Transgender patients face disparities in physical and mental health compared to the general population, highlighting the urgent need for inclusive and compassionate care. Medical professionals should prioritize providing high-quality care to all patients, regardless of gender identity. Training programs on LGBTQ healthcare needs are increasingly available, but critics argue that medical schools must do more to educate future doctors on caring for LGBTQ individuals.
Many medical professionals lack adequate training in transgender health issues and may feel ill-prepared to care for transgender patients. Surprisingly, among all state-level medical boards nationwide, only the District of Columbia mandates doctors to undergo continuing education on treating LGBTQ patients, as reported by the Federation of State Medical Boards. While the American Medical Association and the American Society for Health Care Risk Management offer courses on LGBTQ health and bias reduction, some healthcare leaders believe that other initiatives could be hindered by President Trump’s opposition to diversity, equity, and inclusion (DEI). Some universities and private companies are discontinuing their DEI programs due to concerns about funding or contracts being at risk.
Dr. Atul Grover, the executive director of the Association of American Medical College’s Research and Action Institute, noted that the current political climate presents challenges in incorporating sexual orientation and gender identity into medical school curricula. He emphasized that some legislators believe that integrating concepts of inclusion, health equity, and diversity detracts from the scientific content of medical education. However, Grover stressed that these concepts are not mutually exclusive and should be integral components of medical training.
