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MGH

Published On May 20, 2021

POLICY

A Future Informed by Gender-Affirming Care

The transgender community is quietly reinventing the medical paradigm.

It is now possible to imagine a world recovered from COVID-19. In that future, how will medicine have changed? These 10 essays explore the technical, social and political ripples of the pandemic.

In 2020, systemic inequalities in health care and American life became so acute that they led millions to march and demand racial justice. An overlooked phenomenon is that the crisis has been transformative in the lives of transgender Americans as well. 

When unemployment hit more than 21 million workers, transgender Americans were predicted to fare the worst, especially transgender people of color and those who live in rural areas. Because the U.S. Census doesn’t specifically track LGBTQ+ Americans, the government could not measure and respond to the full impact of the pandemic on this population. We do know, however, that state legislatures used this time to forward bills that would make providing health care to transgender minors a felony. 

Transgender Americans are not new to this kind of attack from the government, and we have learned only too well the connection between policy and health. We know that transgender rights are a patchwork across the United States and this means not everyone has equal access to care. We know that access to gender-affirming health care means access to our very identity, and that denying this health care results in terrible mental health outcomes. Over the past decade, we have advocated for—and seen—a profound expansion of services and education, so that our medications, surgeries and therapies are now considered medically necessary.

Our medical rights are at a crisis point—and, we hope, an inflection point. Despite hostile legislation, we have also seen an increased political will for expanded LGBTQ+ rights, such as the landmark Equality Act currently before Congress and moves to reverse discriminatory rule changes authorized by the Trump administration.

The pandemic has helped some doors open. The national explosion of telehealth offers new possibilities for helping those who live far from gender-affirming care centers. Before the pandemic, several new virtual care startups were created to meet the specific needs of transgender people. The largest, Folx, raised $25 million in funding in the thick of the COVID-19 crisis. 

Our victories, if they come, can have effects that extend far beyond our own community. Gender-affirming care offers a model for all health care. It is an excellent expression of patient-centered care, one intimately based on patients' identity and values, and driven by the story of their lives. In this and other ways, transgender people have been on the frontier of exploration and expansion.

Transgender people have also had to learn, by necessity, to be active, informed and vocal patients—not only in their own care, but in the political and economic systems that govern it. In the coming year, the whole country will need to learn to follow our example: to become engaged in the shape of our health care system, to turn the challenges of the moment to our advantage. Transgender Americans, especially in the time of COVID-19, are showing what health care can be.

Dallas Ducar // the CEO of Transhealth Northampton.