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A Biden nominee offers a chance to learn from the transgender community


Dr. Rachel Levine, nominee for the assistant secretary of Health, will become the first openly transgender federal official if confirmed by the U.S. Senate. Most remarkable is her commitment to gender-affirming care. This is a win for all Americans.

Transgender Americans shouldn’t be the only ones celebrating, though we have good reason to do so. Gender-affirming health care is patient-centered care. It benefits everyone because it opens the door to including any person’s life context in a medical environment. Despite what clinicians may believe, life is more than what happens in the clinic. 

Gender-affirming care is the process of caring for every part of one’s life that intersects with gender. Gender identity is a deeply ingrained part of who we are, impacting us in bathrooms, workplaces, schools and more. It is caring for the whole person — caring for one’s identity. We’ve worked to reshape a health care system that is responsive to one’s identity. Interventions that were at one time seen as distant, expensive and only afforded to a few are now resulting in increased care.

This arrives on the heels of a significant backslide in rights during the Trump administration’s rule: including the reversal of transgender health care protections, a rule permitting providers to discriminate based on gender identity and a movement of local lawmakers across the country attempting to limit civil rights and make it a felony for health care providers to treat transgender individuals.

Gender-affirming health care did not arrive overnight. Fifteen years ago, many transgender Americans couldn’t imagine that we would be included in our modern health care framework. In 1981, Medicare barred coverage for gender-affirming surgeries and private insurers followed suit. Since then, it has been a slow walk forward for decades. By 2005, California prohibited health care plans from discriminating based on gender identity or expression. The Affordable Care Act (ACA) banned discrimination based on sex (later to be interpreted as gender) in 2010. Eventually, The Department of Health and Human Services (HHS) prohibited marketplace plans from discriminating on gender identity and by 2014 Medicare lifted its decades-old ban on “transsexual surgery.” Finally, in 2016, an HHS rule prohibited any federally-assisted insurance plans from exclusions of gender-affirming care. 

Transgender people have been at the forefront of fighting for a truly patient-centered care model. We are expanding the bounds of what is deemed necessary. There are still many barriers and advocates continue to work tirelessly to remove those. 

Health care must learn from gender-affirming care. We have started to achieve the impossible, restore faith and humanity in a broken system. Clinicians and administrators are now trained and systematically encouraged to ask about names, identity, patient values and goals. It is routine to conduct a holistic assessment — the type we learn about during our clinical education.

Gender-affirming care also creates spaces that allow for health care clinicians and staff to be themselves, show up and reduce burnout. This is the health care we all strive for — one of authenticity.

Republicans across the country continue to introduce new legislation that moves beyond bathrooms to make gender-affirming health care the next battleground for civil rights. Some may believe that gender is immutable at birth. Their philosophical convictions should not get in the way of patient-centered care.

We should celebrate the expansion of gender-affirming care as a victory for patient-centered health care. The patient, not the physician, is finally able to decide what is necessary. 

Let’s be expansive, include lessons on tax preparation, changing tires, stress reduction and civic engagement. It’s time to take a page from LGBTQ+ centers worldwide and make the clinic a center of community.

The statistics bear out the importance of gender-affirming care. Support for transgender patients reduces rates of suicide attempts from 57 to 4 percent. No other treatment is as effective in reducing rates of attempted self-harm. Moreover, a litany of evidence exists supporting gender-affirming treatments and procedures across the lifespan.

Gender-affirming care is an ever-evolving model to learn from. When done right, it’s participatory, active, authentic and holistic. More gender-affirming clinicians in health care will undoubtedly bring forth the lessons we have learned in the transgender community. This is a chance for health care organizations and agencies and the state and federal governments to work together to bring clinical care back to basics.

As 2021 brings new conversations about healthcare reform, let’s take a page from the transgender community and put patients first. 

Dallas Ducar, NP, is the Chief Executive Officer of Transhealth Northampton. Follow her on Twitter @DallasDucar.

Tags ACA anti-LGBT anti-transgender Donald Trump Gender identity Joe Biden LGBTQ LGBTQ community Rachel Levine transgender community transgender protections transgender rights Trump administration

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