Gender-affirming care should be embraced, not met with vitriol and bomb threats

As a pediatrician and a parent of a transgender son, I have become increasingly alarmed by the level of vitriol in the U.S. surrounding the provision of gender-affirming care to children and adolescents.

Those three words, “gender-affirming care,” indicate a thoughtful approach to individuals whose gender identity — feelings of self — doesn’t correspond to the sex assigned them at birth. I am appalled that delivering this kind of care has caused well-publicized incidents of bigotry and threats of violence, including a series of vitriolic communications sent to health care workers at Boston Children’s Hospital and a bomb threat directed at the same facility.

Gender-affirming care means allowing young people to explore and define their gender identities at their own pace. It is something one of my children, and our whole family, has benefited from.

This care is provided at developmentally appropriate ages, using evidence-based tools that may include hormone therapy, or medications to delay puberty. These treatments generally can be easily reversed and are not permanent. This buys time for the child, with support from adults, to sort out their gender identity. Contrary to claims of some, gender-affirming care for minors usually does not include permanent treatments such as surgery.

Statistics from the Centers for Disease Control and Prevention and other research reveal that gender-fluid or gender-questioning adolescents are at increased risk of depression, suicide, bullying, and dangerous behaviors. The same report showed that among transgender youth who responded to a national survey, 35% had attempted suicide and a similar percentage were bullied at school.

“The emotional and psychological trauma of rejection, whether by family, friends, society, or lawmakers, can leave scars that never heal,” explains Dr. Moira Szilagyi, president of the American Academy of Pediatrics. She notes the strong consensus among most prominent medical organizations worldwide that evidence-based, gender-affirming care for transgender children and adolescents is medically necessary and appropriate — even lifesaving.

Other research has demonstrated that affirmation and support of LGBTQ+ individuals by caring adults, and the ability of these children and adolescents to function in society as their authentic selves, dramatically reduce risks that include suicide, depression, premature sex, violence, substance use.

My decades of pediatric practice taught me that the overwhelming majority of parents love their children and want them to be safe, healthy, happy, and successful. Support and acceptance of a non-binary child will help accomplish all those goals.

I have witnessed the importance of support and acceptance within my own family. My husband and I have traveled the remarkable journey of parenting two children — now adults with kids of their own — on the LGBTQ+ spectrum. Our older son came out as gay in high school and helped us navigate a path to acceptance, then to celebration and advocacy, for his right to marry, love his husband, and raise our grandson. Our younger child had a more circuitous journey, identifying first as lesbian, marrying a wonderful woman and parenting their daughter together, but wrestling with gender dysphoria in his 30s and then transitioning to his authentic male identity, with the support of his parents, wife, employer (the federal government), friends, other family members, and health care professionals.

Living as his authentic self has made our son happier and more productive. Our only regrets are not recognizing his dysphoria earlier and helping him avoid some of the immense hurdles he faced throughout his transition as an adult.

Having a gender-questioning child may be unexpected and uncomfortable for many parents. In an ideal world, everyone would respond to their children with curiosity and open-mindedness, but the truth is we all bring our own expectations, assumptions, life experiences, and limitations to parenting.

My husband and I were initially caught off guard by learning both our children were gay/lesbian/transgender. But responding to them with love, opening ourselves to learning and understanding, and becoming advocates for their equitable rights have provided validation for our children while enriching our own lives in myriad ways.

Support organizations such as PFLAG, as well as pediatric and family medicine practices, school nurses and guidance counselors, and other trained professionals are available to help parents learn and network with other families.

Hate, threats, and violence aimed at members of the LGBTQ+ community and their families and medical providers hurt gender-diverse children. Physicians need to be safe to do their work and patients and families have a right to seek and receive health care in an environment that is safe and secure. A backdrop of threats of violence against those who are trying to heal can only compound the stress facing families of severely ill children undergoing treatment.

Our communities can do better to support the wonderful diversity that enriches our lives. Government has an obligation to prevent disruptions of health care and to prosecute those who attempt to use fear and violence to create disruptions and put lives in danger. People who care about children can and must reject vitriol and hate directed at those who want nothing more than to live as their authentic selves.

Carole Allen is a pediatrician and the immediate past president of the Massachusetts Medical Society.