PORT TOWNSEND — Gender-affirming care is considered the standard of care by every medical organization, but providing it has become politicized, Dr. Allison Berry, the health officer for Clallam and Jefferson counties, told the Jefferson County Board of Health last week.
“Every single major medical organization is aligned on gender-affirming care for adults and children as a standard of care,” Berry told the board. “This is not a controversial topic in medicine but has been made a controversial topic in politics and unfortunately is leading to interruptions in the patient-care relationship between doctors and their patients. It’s also leading to decreased access to care for some of the most vulnerable in our community.”
Berry provided a presentation along with Beau Ohlgren, director of Family Ministry at Quimper Unitarian Universalist Fellowship (QUUF), on transgender/non-binary health and wellness programs.
Berry explained that gender-affirming care is a range of social, psychological, behavioral and medical interventions designed to support and affirm a person’s gender identity.
“We came up with the idea of discussing gender-affirming care because it has been in the news a lot and it struck me as one of the many parts of medicine lately that are becoming unnecessarily politicized and a lot of misinformation is spreading,” Berry said.
Ohlgren has worked at QUUF since 2015 developing programs specifically focused on education regarding sex and sexuality in the lesbian, gay, bisexual, transgender, queer, intersex and asexual (LGBTQIA) communities and helping transgender/non-binary youth and families get access to gender-affirming care.
“I work directly with over 200 trans folks who live on the Peninsula,” Ohlgren said. “Even though we live in a really affirming area, it is still really difficult, daily, for trans people to get the care they need.”
Transgender individuals are persons whose gender identity does not align with the sex they were assigned at birth. Persons who identify as non-binary are people whose gender identity does not align with a specific gender or they identify with both genders.
Some of the early interventions are social interventions, calling the individual by their preferred name or pronouns, followed by seeking support from mental health professionals, and then medical interventions such as puberty blockers, hormone therapy and surgery.
“Speaking to the medical context, gender-affirming care is an intentional and gradual process,” Berry said. “I think the way that it is often described in the news, you would come away with the idea that a young person comes to us, says that they’re trans, and we do surgery immediately. That’s just not how it works.”
There have been significant concerns around trans youth seeking gender reassignment surgery leading not only to what Berry and Ohlgren say is misinformation but to state and local governments across the nation making sweeping changes to how trans and non-binary youth and adults can or cannot seek healthcare.
At an April Board of Health meeting, Berry responded to a public comment from a citizen who shared those concerns about youth seeking gender-affirming care, specifically surgical care, referring to it as mutilation.
Berry said sex reassignment surgery is not being performed on children.
“There was some dangerous and transphobic information in that comment that I think we need to speak to,” Berry said. “There is often also this boogeyman raised of the idea that we’re performing surgeries on children. Gender-affirming surgeries are almost never done on children. What we are really talking about is puberty blockers when kids reach the age of puberty. This is something that is not done in small children because they’re not going through puberty yet.”
Berry explained there is a long process before a minor seeking gender-affirming care can even access puberty blockers and hormone treatment, noting that type of care is hard to come by in rural communities.
“Gender-affirming care for children is by definition a slow process,” she said. “It involves assessing the child’s persistent identification with the gender, it involves speaking to parents, it involves multiple physician consultations, and consultation with Seattle Children’s Hospital, which is our local referral center. It is a long process to access gender-affirming care for kids. Many might argue it’s an overly long process to access that care, particularly in a rural area like this.”
About 25 to 35 percent of adults who identify as transgender/non-binary seek reassignment surgery, Berry said, and the only records of similar surgeries performed on children have been done for intersex children — those born with both male and female genitals.
Berry also addressed the mental health impacts on transgender youth who do not receive gender-affirming care and how it’s a standard medical practice.
“Gender-affirming care is life-saving,” she said. “For children who do identify with a given gender, forcing them to go through the opposing puberty has long-term negative mental health consequences that we know and are well established. There is an increased risk of suicide in those children, which is well established.”
According to a 2023 survey conducted by The Trevor Project, an organization that helps LGBTQ youth get access to mental health care, 54 percent of transgender/non-binary youth have considered suicide.
By receiving gender-affirming care, the risk of suicide goes down by 73 percent and depression by 60 percent, the survey said.
“This is why we take it so seriously that many parts of the nation are trying to take this kind of care away,” Berry said.
More than 500 anti-trans bills have been introduced into various state and federal legislatures across the country. One hundred nineteen seek total bans on gender-affirming care for youth and adults alike, and 19 states have banned gender-affirming care entirely.
“Living in a society that is trying to legislate you out of public space will make you suicidal,” Ohlgren said.
Washington state, among others, has become a safe haven for transgender/non-binary persons seeking healthcare as Gov. Jay Inslee has signed into law bills to protect access not only for gender-affirming care but also a woman’s right to an abortion.
Reporter Ken Park can be reached by email at firstname.lastname@example.org.