Pediatric endocrinologists concerned for safety amid divisive political climate

Pediatric endocrinologists are concerned for their safety and their ability to provide evidenced-based care to transgender and gender-diverse adolescents amid political divides over gender-affirming care, according to a paper, "Exploring the Impact of Legislation Aiming to Ban Gender-Affirming Care on Pediatric Endocrine Providers," published in the Journal of the Endocrine Society.

Pediatric endocrinologists specialize in the care of children and adolescents with disorders related to hormones and the glands that produce them, such as diabetes and disorders of growth, thyroid or puberty. Some pediatric endocrinologists also provide gender-affirming care as part of their medical practice.

Among youth ages 13 to 17 in the United States, 1.4% identify as transgender, and many of these individuals are seeking gender-affirming care. The Endocrine Society's Clinical Practice Guideline recommends mental health treatment as the first course of action and the use of puberty-delaying medications and gender-affirming hormone therapy, when appropriate, in adolescents who are transgender or gender diverse.

Gender-affirming care is considered the standard of care by all major medical organizations and has been shown to improve mental health outcomes and lower the risk of suicide in transgender youth. Despite these benefits, legislation aiming to ban gender-affirming care has been proposed in 28 states and passed in 20.

In addition to politicizing medical care, efforts to ban gender-affirming care have led to widespread misinformation, online harassment, and even bomb threats targeting hospitals and physicians, according to a Human Rights Campaign report.

Last year, the American Medical Association, American Academy of Pediatrics, and the Children's Hospital Association called on the Department of Justice to investigate rising threats of violence against gender-affirming care providers.

"Our study shows pediatric endocrinologists in states with transgender health bans are most concerned about threats to their personal safety and the impact of these laws on their medical practice," said study author Stephanie A. Roberts, M.D., of Boston Children's Hospital and Harvard Medical School in Boston, Mass.

"The increasing number of bans on gender-affirming care in the U.S. and the negative impact on pediatric endocrinologists may lead to areas in the country without access to pediatric endocrine care. This includes for access to treatment of other disorders we have expertise in besides gender-affirming care such as type 1 diabetes or adrenal insufficiency, both of which can be life-threatening conditions."

The researchers surveyed 223 pediatric endocrinologists to assess how transgender health bans are affecting their practices and identify their top concerns. Of the pediatric endocrinologists surveyed, 56% were currently providing gender-affirming care, and 46% practiced in a state where anti-trans legislation had been proposed or passed between January 2021 and June 2022.

Providers practicing in states with transgender health bans reported concerns about pressures within their hospitals and medical centers that would limit their ability to provide care, threats to their personal safety and the safety of their patients, concerns about legal action being taken against them, and concerns about their career. The major themes were safety concerns and the impact of laws on medical practice.

"Our work reinforces why efforts to limit access to medically necessary care for transgender youth need to be opposed," Roberts said.