In what has become an increasingly frequent occurrence, the World Professional Association for Transgender Health (WPATH) has had to issue yet another statement denouncing dangerous new state legislation restricting access to care -- this time in response to Florida's new draft rule to ban gender-affirming care for adolescents. This ruling will adopt a new standard of care that will prohibit physicians from prescribing medicine for gender-affirming care, such as hormones and puberty blockers, and from performing surgery for those under the age of 18.
This deeply concerning ruling coincides with a stark increase in threats to children's hospitals and healthcare systems providing gender-affirming care, causing many to take down valuable information from their public websites and social media platforms. Pervasive misinformation and harassment to providers makes the already difficult-to-navigate process of accessing gender-affirming care even harder.
The Consequences of Removing Information and Resources
Following violent threats, including a bomb threat, to notable healthcare systems such as Boston Children's Hospital and Akron's Children's Hospital, some hospital systems and private practices that provide gender-affirming care have modified the information available on their websites and social media platforms. Many medical practices continue to be targeted aggressively by groups on social media, name-calling care providers "pedophiles," "groomers," and "mutilators of children." These misinformed threats often call on others to "stop them" or make blatant death threats. While some practices have altered specific information about their providers, others have completely removed pages about the gender-affirming services they provide. The intention is to protect staff and put a stop to these threats, but the removal of this online information comes with consequences for patients and the general public.
At a time when there is so much vitriol directed at trans people, it is especially important to have safe, reliable places for trans youth to learn about care options. There is much misinformation online regarding trans healthcare, including from well-intentioned sources. Many trans and gender diverse patients begin their exploration with research online before seeing a provider. There are thousands of Reddit threads and Facebook pages dedicated to information on gender-affirming care. While posting individuals may have good intentions in documenting their experiences, the opinions they share might mislead new patients when making personal decisions. This, in combination with the ill-intentioned misinformation posted online, can cause confusion for those newly exploring, especially adolescents.
If reputable medical institutions and practices retreat, where will people find safe and accurate information? It remains imperative that providers find ways to continue to provide care and educational resources.
Our Approach to Addressing the Issue
Despite our best efforts to reassure staff, several members of our team have begun to worry about their own safety and have felt the need to have their pictures and other information taken off our websites. We have even had some team members wonder if we should pull back on our care. However, this would only worsen the situation for our most at-risk patients.
We see this challenging situation as a balancing act: we need to continue to provide patient care and resources, while also protecting our team members.
At this year's international WPATH conference, a circulated suggestion was that healthcare providers decrease their digital footprint by using online services that remove them from databases and websites. Coupled with this idea of protecting individual provider information is the importance of acknowledging the mental toll these threats take on our healthcare professionals. Gender-affirming care providers must feel supported and protected in order to continue providing safe, high-quality care for our patients.
A related concerning trend has been the proliferation of online misinformation regarding transgender people. Unlike the direct threats targeting transgender patients and healthcare providers, misinformation campaigns are often aimed at the general public in an effort to weaponize fear and biases against transgender people, often for political purposes. As health professionals, the best thing we can continue to do is to educate the general public about who queer and trans people are -- to correct these skewed and limited perspectives by normalizing care for all people. The better the public understands what we do for trans people, and who these people seeking care are, the harder it becomes to blindly hate.
Misinformation thrives in the shadows. The antidote is to bring light to our work and the people for whom we care.
Subha Karim is a clinical research coordinator in the Department of Surgery at the Mount Sinai Health System in New York City. Joshua Safer, MD, is the executive director of Mount Sinai's Center for Transgender Medicine and Surgery. John Henry Pang, MD, is a plastic and reconstructive surgeon with Align Surgical Associates, an academic contributor at Mount Sinai's Center for Transgender Medicine and Surgery, and a member of the WPATH.