Local opinion: Politicians must stay out of trans medical decisions

I am an endocrinologist taking care of, among other common hormonal conditions, adult transgender patients. I have cared for them for 30 years. Why, for heaven’s sake, do I now need to state: “It is time to keep politicians out of my clinic.”

I could write a long monologue explaining what it means to be trans, but to explain it simply from my experience, a trans person does not feel at home with the gender that they were told to be.

Some trans people have an intersex condition, which means a person was born with physical traits that we typically see as both male and female. This may seem odd to some, but it is not that uncommon. You may not know you have met such a person, as shame often causes them to hide their intersex identity. It can be quite challenging for parents to know how to rear their intersex child, because society doesn’t easily accept a person who is “not clearly a woman or a man but has both in them.”

Most trans people are not intersex, but they face the same problems of not being accepted for who they are, especially by their own family and friends. It can be scary for a trans person to tell their loved ones about their feelings of identity, for they know they can become ostracized, even rejected. Just imagine growing up like this and not feeling safe to confide in the people closest to you. You are young and risk being kicked out of your home.

As an endocrinologist, I treat hormone issues, most commonly diabetes and thyroid-related problems, but also trans people. Many, but not all, need hormone therapy to help them feel that they belong in their own body. This is not a choice or an option: hormone therapy is a medically necessary and widely accepted treatment that allows them to feel well, both physically and mentally. The hormones we use are widely available, well-tested and used for other medical conditions. They are even generic, meaning they have been around a while.

What has changed in transgender care?

Having done this for 30 years, I have seen many good things emerge. For example, we have built on so much experience so that now we have clear guidelines whom and how to treat. We have learned how to use the hormones safely and effectively. We know how to monitor. This is not some sort of experiment; it is now proven science.

For me as a doctor, technically, it is just like any other medical treatment. But for a trans person, obtaining treatment is not easy at all. First, trans people often experience so much trauma, especially early in life, from not being accepted for who they are, that it can make the hormone therapy much more challenging. Second, politicians have entered the fray and are second-guessing medical decisions made by highly trained and experienced physicians and their patients.

When there is apparent political gain, all kinds of false stories emerge. Stories like: a person can wake up and decide on a whim to take hormones to be the other gender, or a person ‘chooses’ to want to be in another body. No, a trans person doesn’t choose to be trans; no one would enter such a difficult path to even begin with! Starting hormones requires multiple medical visits and typically also seeing a counselor as well, both to get the dosing right and to provide mental health support. This treatment is supported by widely accepted clinical guidelines, just like they exist for many other medical conditions. After this initial phase, a follow up is typically every 6 months, later every year, always preceded by blood testing.

You may ask what medical problems are trans people at risk for? Overwhelmingly, it is related to the mental stress of not being accepted. They may have difficulties finding employment and thus getting insurance. They may find it hard to make it to the doctor’s office, get the lab work done, adjust the hormonal blood levels and get the refills without running out, so that the treatment is stable. The risks are well known to us. I often feel it is not so much the hormones that cause the risks, but the mental challenges of not being accepted, and the fear that widely accepted medical treatment may be taken away.

Being trans is not a choice, but the choice a trans person needs to be able to make is to decide how to live their lives, with or without hormone therapy, without political interference.

We must ask ourselves why politicians like to target this community. I once asked about 20 of my patients (seeing them for completely different conditions) if they felt a doctor or a politician should decide (with the patient) on hormone treatment for trans patients. 100% agreed: the doctor. Would you want a politician interfering with your medical treatment? Trans is not a new medical ‘condition’. People are only recently daring to come out, and they need support, not to be ostracized.

Not long ago, I had a pre-medical school student shadow me in clinic. All she had learned in school about trans patients was shattered in just one morning. It was not the medical part, but she witnessed the trauma that trans people have experienced. It was a painful eye opener. She is a young doctor now. Let us not have politicians decide whom and how she treats people, let us not allow politicians to ‘inform’ us about medical conditions, and let us not be fools.