Protecting gender affirming care on the North Shore

Since its opening in February 2013, the Lurie Children’s Hospital Gender Development Program has provided a safe haven for transgender youth on the North Shore. In a country that has become increasingly concerned with the health and lives of transgender youth, finding access to gender affirming care can be challenging, especially for kids and teens under the age of 18.  

Gender affirming care is a multi-faceted approach to the healthcare of patients navigating their gender identity. This includes physical care such as Hormone Replacement Therapy, psychological care such as psychiatric evaluations, therapy and medication, and providing social resources that provide support during school, family adjustments and other changes inherently involved in one’s gender transition. 

On the North Shore, Lurie Children’s Hospital, Northwestern Health and North Shore University Health System all offer health care for transgender and gender non-conforming patients. Both Froedtert Inclusion Clinic and Children’s Hospital of Wisconsin Gender Health Clinic are located about 80 miles north of Evanston. For pediatric care closest to Evanston, Lurie Children’s Hospital offers the most accessible care, however the gender health clinic consistently receives threats from many conservative groups across Illinois and beyond. 

Just last month, Lurie Children’s Hospital experienced public backlash against their Gender Pathways Program.

“Awake Illinois,” a conservative organization based out of Naperville, Illinois, has been promoting false claims against the Hospital and their mission. Not only are these claims being spread through conservative social media platforms, threats to Lurie forced its youth transgender support groups to be moved online for the time being. 

Despite the threats to the clinic, Lurie continues to provide care to their transgender patients. 

In a statement regarding the threats, Lurie stated, “We stand in solidarity with our transgender patients and families, community, and colleagues who are providing gender-affirming care. We strongly condemn any threats on and harassment toward the transgender community.”

“Lurie has long supported gender-affirming care for youth,” the hospital continued in the statement. “All young people should have access to comprehensive, gender-affirming, and developmentally appropriate health care that is provided in a safe and inclusive environment.” 

As one of the first Pediatric Gender Health clinics to open its doors in the Midwest, Lurie has experience handling threats such as the “Awake Illinois” threat from September, and has continued to provide gender affirming care for the nine years the clinic has been in existence. The clinic emphasizes the importance of providing this care, and has provided transgender youth with the resources they need to stay healthy, both mentally and physically.

When transgender and gender non-conforming teens are unable to access gender affirming care, studies have shown a decline in their overall mental and social well-being. The Trevor Project, a non profit that primarily focuses on suicide prevention for LGBTQ+ youth, conducts annual studies on the mental health of queer and transgender youth. In December 2021, it was found that LGBTQ+ youth are four times more likley to attempt suicide than their peers. This National Survey also found that 45 percent of LGBTQ+ youth seriously considered attempting suicide in the past year, including more than half of transgender and non binary youth. 

It is well documented by Medical Research Facilities, the American Academy of Pediatrics and the American Medical Association that gender affirming care is essential to improving the mental and physical health of transgender youth.

Whether that care is puberty blockers, hormone replacement therapy, mental health services, support with social transition or surgery, patients and their families can choose a path that best fits their needs. By recieving personalized gender focused healthcare, transgender youth are less likely to have thoughts or feelings of suicide, as well as other severe symptoms of mental illness. 

Even with these proven benefits, many lawmakers today have turned gender affirming care for youth into a political issue. 

In 2022 alone, more than 240 bills targeting the rights of transgender Americans have been filed, the highest rate of anti-trans legislation in the history of America. These bills have the capacity to restrict things such as trans people’s rights to play sports, use their preferred bathroom, receive gender affirming healthcare, and the right to be called their preferred name and pronouns in a classroom setting. 

Florida Governor Ron Desantis is well known for his support of harsh anti trans legislation, a stance that is a primary factor of his speculated 2024 presidential campaign. Earlier this year, Desantis passed legislation known as the “Don’t Say Gay” bill, which banned the instructiuon of LGBTQ+ topics within elementary level education. His proposed bills include bans on gender affirming healthcare, as well as banning teachers from respecting the preferred name and pronouns of their students, and requiring them to “out” any LGBTQ+ students to their parents. 

Marjory Taylor Greene, a Representative from Georgia, proposed the “Protect Children’s Innocence Act,” which would make anyone involved in providing gender related healthcare services to anyone under 18 a Class C Felony, a bill strongly supported by Desantis. 

“If providing gender affirming care for people under the age of 18 becomes a felony we are likely going to see an uptick in suicide attempts, worsening depression and anxiety, and greater stress and burnout in the medical community,” said Annie Lakatos, a nurse practioner at the Froedert Inclusion Clinic in Milwaukee, Wisconsin. 

“It has been well documented that adolescents within the LGBTQIA community suffer from higher rates of suicide. We know that when adolescents and kids are not able to access healthcare that they need, specifically healthcare that has been demonstrated to improve their physical and emotional health, then we will see the repercussions. Health care providers are not immune to the stress, also referred to as moral injury, that accompanies the inability to provide the best healthcare they can—especially if the reason is purely political. Ultimately, this will hurt individuals, families and communities.” 

Ida Joyce Sia, a nurse here at the ETHS Health Clinic, also opposes Greene’s Bill. 

“It’s absurd, in my opinion, to make [gender affirming care] a felony and to criminalize healthcare that saves lives,” she expresses. 

Even when physical care can be accessed, recent growth in the demand for mental health care can make it difficult to receive the care a patient may need. During the peak of the pandemic, higher rates of mental illness such as depression and anxiety were reported, likely due to uncertainty regarding the future, as well as isolation during quarantine. Because of this increase, many more people began seeking psychiatric care, a historically undervalued and understaffed medical field. 

Annie Lakatos finds it increasingly difficult to refer her patients to the necessary providers.

“The aspect of my job that I find most challenging is attempting to connect people to specialty care, specifically psychiatry support, that may be unavailable or under-resourced. The COVID-19 pandemic placed a spotlight on the fact that many people suffered from anxiety and depression during the pandemic, and the importance of therapy and psychiatry support is imperative to overall health. Mental health is not an isolated need; we all need to take care of our mental and physical health,” Lakatos shares.  

Another challenge for youth seeking gender affirming care is the need for parental consent. For services such as psychiatric support and Hormone Replacement Therapy (HRT), parental consent is required for patients under the age of eighteen. 

“The biggest reason I can’t access [gender affirming care] is the fear surrounding my parents finding out,” says a junior at ETHS who is hoping to receive Hormone Replacement Therapy in the future. 

Even if parental consent is obtained, many private health insurance companies will not cover the cost of HRT Prescriptions, making it even more inaccessible.   

While Lurie offers the most comprehensive gender affirming care on the North Shore, it is not available to everyone. For transgender teenagers who do not have access to health insurance, or have unsupportive parents, there are several available resources to support them before they can obtain access to gender affirming care. 

At the ETHS Health Center, students have access to free counseling sessions, as well as reproductive health services. Both reproductive and mental health are integral parts of gender affirming care and can be accessed by everyone at the ETHS Health Center, regardless of identity or financial status. While the center does not provide services such as Hormone Replacement Therapy, it is a great resource for both transgender and cisgender students looking to take initiative over several aspects of their health. 

The Trevor Project provides several crisis text and call lines aimed at LGBTQ+ youth experiencing mental health crises. Their website creates access to resources for teens to share with their families regarding gender identity and sexual orientation, as well as topics related to Hormone Therapy and other forms of gender affirming care. 

Protecting access to gender affirming care is essential to the health and safety of America’s youth and is even more important as federal lawmakers bring healthcare into the National political spotlight. In a time where bodily autonomy is a luxury and not an inherent right, it is necessary to prioritize the healthcare and support of transgender youth.