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Letter Template for More Accessible Gender Affirming Healthcare

To Whom It May Concern

We are writing today to advocate for our trans members and their families, whose lives and futures are being put at risk by unjust restrictions to their gender affirming healthcare.

Trans people comprise a vulnerable group in society who are systematically disadvantaged by prejudice, discrimination, and threats to their basic rights. Due to these challenges, trans people suffer significant health disparities, including poorer mental health and social wellbeing. Access to gender affirming healthcare is an important part of alleviating these health disparities and enabling trans people to flourish.

Unfortunately, access to gender affirming healthcare is being restricted in several countries, including the United Kingdom and the United States, with severe consequences for trans people and their families. In the United Kingdom, the average waiting time for a trans adolescent to receive treatment at an NHS gender clinic is three years, which is well in excess of the agreed target of eighteen weeks [1]. It has also been reported that doctors are often reluctant to prescribe gender affirming hormone treatment for trans patients [2]. This is occurring in the context of a wider trend of ideologically motivated attacks on the rights of trans people by politicians, the media, and trans-exclusionary lobby groups [3, 4].

The inaccessibility of gender affirming healthcare amounts to an injustice that exacerbates health disparities between trans people and their cis peers. It reflects a double standard for access to gender affirming healthcare and access to any other form of healthcare. To access gender affirming healthcare, trans people usually have to undergo burdensome psychological assessments that can last several months and are placed on waiting lists that can last several years [5]. This assumes a position of mistrust, whereby trans people are made to feel like they have to “prove” they are “really” trans rather than being trusted as having first-person authority over their own experiences.

Such inaccessibility of gender affirming healthcare causes serious harm to the mental health and social wellbeing of trans people. This includes depression, anxiety, social withdrawal, and suicidality [6–16]. Due to the inaccessibility of gender affirming healthcare, many trans people have turned to “do-it-yourself” hormone replacement therapy by obtaining hormones from unregulated sources [17]. Trans people have also had to develop their own informal care networks due to the challenges of accessing treatment in formal care settings [18].

A substantial amount of research has shown that gender affirming healthcare can be lifesaving and results in significant improvements in the health and wellbeing of trans people [6–16]. The provision of gender affirming healthcare is supported by international professional organisations such as the World Professional Association for Transgender Health, the Endocrine Society, and University of California San Francisco, whose evidence-based guidelines are based on robust peer-reviewed research [19–21]. Accordingly, leading academic philosophers and legal scholars have argued that gender affirming healthcare for trans youth is ethical [22–25].

We are therefore writing to advocate for improved accessibility of timely gender affirming healthcare for the trans community. Access to gender affirming healthcare remains an unmet need that contributes to severe health disparities between the trans community and the cis population. By prioritising funding for and improving access to gender affirming healthcare, we can help to address these disparities so that healthcare resources are distributed fairly according to clinical need. This would also go towards respecting the basic rights of trans people to autonomy and self-determination.

Yours sincerely,

GenderGP

References

  1. Good Law Project (2023). “We are just people too”. Good Law Project, 21 February 2023. https://goodlawproject.org/case/we-are-just-people-too/
  2. Barratt, J. (2016). “Doctors are failing to help people with gender dysphoria”. British Medical Journal, 352: i694.
  3. Hines, S. (2020). “Sex wars and (trans) gender panics: Identity and body politics in contemporary UK feminism”. Sociological Review, 68: 699–717.
  4. McLean, C. (2021). “The growth of the anti-transgender movement in the United Kingdom. The silent radicalization of the British electorate”. International Journal of Sociology, 51: 473–482.
  5. Schulz, S. L. (2018). “The informed consent model of transgender care: An alternative to the diagnosis of gender dysphoria”. Journal of Humanistic Psychology, 58: 72–92.
  6. Allen, L. R., Watson, L. B., Egan, A. M., and Moser, C. N. (2019). “Well-being and suicidality among transgender youth after gender-affirming hormones”. Clinical Practice in Pediatric Psychology, 7: 302–311.
  7. Bungener, S. L., de Vries, A. L. C., Popma, A., and Steensma, T. D. (2020). “Sexual experiences of young transgender persons during and after gender-affirmative treatment”. Pediatrics, 146: e20191411.
  8. de Vries, A. L. C., McGuire, J. K., Steensma, T. D., Wagenaar, E. C. F., Doreleijers, T. A. H., and Cohen-Kettenis, P. T. (2014). “Young adult psychological outcome after puberty suppression and gender reassignment”. Pediatrics, 134: 696–704.
  9. Chen, D., Berona, J., Chan, Y. M., Ehrensaft, D., Garofalo, R., Hidalgo, M. A., Rosenthal, S. M., Tishelman, A. C., and Olson-Kennedy, J. (2023). “Psychosocial functioning in transgender youth after 2 Years of hormones”. New England Journal of Medicine, 388: 240–250.
  10. Grannis, C., Leibowitz, S. F., Gahn, S., Nahata, L., Morningstar, M., Mattson, W. I., Chen, D., Strang, J. F., and Nelson, E. E. (2021). “Testosterone treatment, internalizing symptoms, and body image dissatisfaction in transgender boys”. Psychoneuroendocrinology, 132: e105358.
  11. Green, A. E., DeChants, J. P., Price, M. N., and Davis, C. K. (2022). “Association of gender-affirming hormone therapy with depression, thoughts of suicide, and attempted suicide among transgender and nonbinary youth”. Journal of Adolescent Health, 70: 643–649.
  12. Kuper, L. E., Stewart, S., Preston, S., Lau, M., and Lopez, X. (2020). “Body dissatisfaction and mental health outcomes of youth on gender affirming hormone therapy”. Pediatrics, 145: e20193006.
  13. Rew, L., Young, C. C., Monge, M., and Bogucka, R. (2021). “Review: Puberty blockers for transgender and gender diverse youth—A critical review of the literature”. Child and Adolescent Mental Health, 26: 3–14.
  14. Tordoff, D. M., Wanta, J. W., Collin, A., Stepney, C., Inwards-Breland, D. J., and Ahrens, K. (2022). “Mental health outcomes in transgender and nonbinary youths receiving gender-affirming care”. JAMA Network Open, 5: e220978.
  15. Turban, J. L., King, D., Carswell, J. M., and Keuroghlian, A. S. (2020). “Pubertal suppression for transgender youth and risk of suicidal ideation”. Pediatrics, 145: e20191725.
  16. van der Miesen, A., Steensma, T. D., de Vries, A., Bos, H., and Popma, A. (2020). “Psychological functioning in transgender adolescents before and after gender-affirmative care compared with cisgender general population peers”. Journal of Adolescent Health, 66: 699–704.
  17. Baker, J. T., Cusanno, B. R., and Dean, M. (2023). “Dilemmas in patient-clinician communication about do-it-yourself hormone therapy: A qualitative study”. SSM – Qualitative Research in Health, 3: 100213.
  18. Malatino, H. (2020). Trans Care. Minneapolis: University of Minnesota Press.
  19. Centre of Excellence for Transgender Health (2016). Guidelines for the primary and gender-affirming care of transgender and gender nonbinary people, 2nd edition, edited by Deutsch, M. B. University of California San Francisco.
  20. Hembree, W. C., Cohen-Kettenis, P. T., Gooren, L., Hannema, S. E., Meyer, W. J., Murad, M. H., Rosenthal, S. M., Safer, J. D., Tangpricha, V., and T’Sjoen, G. G. (2017). “Endocrine treatment of gender-dysphoric/gender-incongruent persons: An endocrine society clinical practice guideline”. Journal of Clinical Endocrinology and Metabolism, 102: 3869–3903.
  21. World Professional Association for Transgender Health (2022a). “Standards of care for the health of transgender and gender diverse people, version 8”. International Journal of Transgender Health, 23: S1–S259.
  22. Maung, H. H. (2024). “Gender Affirming Hormone Treatment for Trans Adolescents: A Four Principles Analysis”. Journal of Bioethical Inquiry. https://doi.org/10.1007/s11673-023-10313-z 
  23. Giordano, S., and Holm, S. (2020). “Is Puberty Delaying Treatment ‘Experimental Treatment’?” International Journal of Transgender Health, 21: 113–121.
  24. Ashley, F. (2022). “Adolescent Medical Transition is Ethical: An Analogy With Reproductive Health”. Kennedy Institute of Ethics Journal, 32: 127–171.
  25. Murphy, T. F. (2019). “Adolescents and Body Modification for Gender Identity Expression”. Medical Law Review, 27: 623–639.
Updated on February 19, 2024

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