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Trans health clinics afford lifesaving care to youth with gender dysphoria, research shows.

Stephen Zenner/SOPA Images/LightRocket via Getty Images

Vanderbilt University Medical Center opened its Transgender Health Clinic in 2018 in order to, in its own words, serve “a high-risk population” who “have been consistently underserved by the U.S. health system.” It’s the first and only such center dedicated entirely to transgender health care in Tennessee, according to data from the Human Rights Campaign.

But like so many clinics that offer similar services, it has become the center of a political firestorm, the focus of an attack by right-wing media that has stoked the ire of Republican lawmakers and triggered harassment of clinic staff.

Last Tuesday Matt Walsh, a conservative pundit and columnist for the right-wing website The Daily Wire, released what he called an “investigation” into Vanderbilt’s Clinic for Transgender Health to his over one million Twitter followers. Among other things, he asserted that VUMC established the clinic in 2018 because gender-affirming surgeries were “money-makers,” that the center threatened “consequences” for staff who declined to provide gender-affirming care and that it tried to “enforce compliance” from parents who might be hesitant to consent to care for their minor children. Snippets of video are presented as evidence for these claims.

The allegations spread far and fast. As of Friday, Walsh’s Twitter thread had over 37,000 retweets. Fox News host Tucker Carlson picked up the story and ran it Wednesday night as the lead item on the country’s top-rated cable news show, displaying the names and photos of VUMC’s Board of Directors while railing against the clinic’s “crimes.”

VUMC issued a statement saying Walsh’s posts “misrepresent facts about the care the Medical Center provides to transgender patients.”

“We have been and will continue to be committed to providing family-centered care to all adolescents in compliance with state law and in line with professional practice standards and guidance established by medical specialty societies,” the statement read.

In an email to Inside Higher Ed, Alyssa Cordova, The Daily Wire’s vice president of public relations, wrote that VUMC’s defenses “do not specifically deny” Walsh’s allegations—which include, in Cordova’s words, that parents are “consenting to the drugging and mutilation of children.”

Cordova also pointed out that the evidence for Walsh’s claims is in video footage originally posted on the medical center’s own website. That evidence includes a clip of the clinic’s director saying that mastectomies, or top surgeries, could be “moneymakers” because they require follow-ups.

Michelle Forcier, assistant dean of admissions at Brown University’s Alpert School of Medicine and a pediatrician who specializes in gender care, said the presentation of these clips as representing an abnormal or immoral perspective in the world of health-care management is disingenuous.

“Anybody who works in a hospital setting knows that there are budgets, there are looks at costs and expenditures, and more resources go to programs that bring in more money. That’s the economics of health care,” she said. “Any cardiovascular center, for instance, looks at their surgical income versus outpatient, and surgery is always going to make more money than outpatient services. None of that should be shocking news.”

A spokesperson for VUMC declined to answer any more specific questions, and employees associated with the clinic declined interview requests.

Walsh has targeted a slew of other trans health-care providers in the past, particularly those that offer care to trans youth. That includes the Boston Children’s Hospital’s Center for Gender Surgery, which for the past two months has received a barrage of harassment and death threats, as well as a bomb threat.

It appears Vanderbilt has taken proactive measures to minimize the impact of threats and harassment. The university medical center removed the webpage for its transgender clinic, and the clinic has temporarily shifted in-person appointments to telehealth.

A Tactic Both Frightening and Familiar

Whatever the ultimate goals of the commentators and lawmakers scrutinizing trans health clinics, the immediate impact of their work has been to intimidate professionals in the field into silence. Of the eight specialists in transgender health contacted by Inside Higher Ed for this article, only two agreed to speak on the record.

All said they fervently believed in their work, but that the risks of openly defending their practice have become too great to make speaking out to defend it worth the dangers of harassment. Those working at public universities in red states also expressed concerns about drawing unwanted attention to their institutions.

Forcier said that when it comes to gender clinics, conservative activists appear to be taking a page out of the antiabortion playbook: targeting individual medical centers and providers, creating a culture of fear that reverberates around the field, and drumming up political challenges for institutions that support the work.

Worst of all, she says, it seems to be working.

“When programs are getting bad press, or programs are being threatened or harassed, the larger institution looks at that program and says, ‘What’s the cost and benefit of doing this?’” Forcier said. “And it’s also going to scare away many people who can and should be providing even basic gender care as pediatricians … for most pediatric providers and pediatric hospitals, we’re just not used to this type of targeted hate and violence. This is new.”

In the days following Walsh’s Twitter posts, members of far-right social media groups on sites like Reddit and 4chan called for the murder or arrest of VUMC doctors and supporters and advocated for Nazi-inspired intimidation tactics like book burnings.

The harassment is not new for providers of pediatric gender care. Forcier herself has received so many hate emails during her years as a gender specialist that she has a special folder in her inbox where she keeps them—“in case they’re ever needed to track down a threat,” she said.

Michael Haller, a professor and chief of pediatric endocrinology at the University of Florida, often works with transgender and gender nonconforming pediatric patients. He told Inside Higher Ed that he's received emails, social media messages and physical letters sent to his home address calling for him to be "jailed for life," "drawn and quartered" and "castrated." One harasser sent him rants comparing him to Nazi doctor Josef Mengele; Haller's grandparents were Holocaust survivors.

"While I will continue to be public and vocal in my efforts to protect the rights of trans people to exist and receive care, these attacks have undoubtedly quieted the voices of many advocates who are understandably afraid of being the target of verbal and written threats, or worse," Haller said.

Forcier is personally familiar with Walsh’s brand of misinformation and targeted harassment. A few years back, she agreed to be interviewed for his documentary What Is a Woman? whose central thesis is that transgender identity is a harmful and unscientific fad. Forcier said she agreed to the interview because she’s passionate about the issue and a committed advocate for transgender youth health care, but that she was greeted with obstinacy and bad-faith questions. She’s been wary of doing any media interviews—including with Inside Higher Ed—ever since.

“When you’re targeted in terms of hate crimes and victimization, you’re careful where you go,” she said. “You’re careful who you talk to.”

Threatening Access to Lifesaving Care

Research has shown that gender-affirming health care for youth who are questioning their identity can be lifesaving; as a group, they are more susceptible to mental health problems and suicide than almost any other.

Haller said the culture war on transgender health has had a repressive impact on expanding access to this kind of care, however effective it’s proven to be.

“There are only three major pediatric gender clinics in Florida, a state of 20-something million people. We have a backlog of more than six months... Patients are actually going out of state to get treatment, which then becomes an equity issue, because there are plenty of families who can’t afford to do that," Haller said. "These politically motivated culture wars have already had a major effect on the willingness of providers to see patients, further exacerbating the already limited access to expert care in most states."

The consequences of the political backlash can be legislative as well. According to a Bloomberg News report, lawmakers in 24 states have introduced legislation that would either outright ban or severely limit the ability of clinics or medical providers to offer gender-affirming care to trans youth; before 2020, there were no such bills in state legislatures.

Those bills have become law in four states—Alabama, Arizona, Arkansas and Texas—although all but Arizona’s have been temporarily blocked by federal courts. It’s possible that the uproar over VUMC’s trans health clinic could bolster support for a similar bill in Tennessee; already state lawmakers, as well as Governor Bill Lee, have called for an investigation into Vanderbilt’s clinic.

“It’s so destructive in the sense that there are already issues of access and equity,” Forcier said. “In some of the states where the culture wars about bodily autonomy and gender identity are more prevalent, to shut down that single point of access or to make local health-care providers be afraid to partake, on whatever level, in providing pediatric-sensitive quality care, you’re hitting the most vulnerable. You’re hitting families and kids who already are struggling for access.”

“It’s beyond harmful,” she added. “It’s evil.”

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