Planned Parenthood of the Heartland and its medical director, Dr. Sarah Traxler, are appealing the dismissal of their lawsuit challenging a Nebraska law that bans most abortions after 12 weeks of pregnancy and restricts gender-affirming care for transgender people under age 19.
They argue that the law violates the Nebraska constitution, which stipulates that any piece of legislation should deal with one subject only. Attorney General Mike Hilgers had countered that the legislation complied with the constitution because the restrictions on abortion and transition procedures both deal with health care. Lancaster County District Court Judge Lori Maret agreed with Hilgers and dismissed the suit August 11. Lancaster County includes Lincoln, the state capital.
The Planned Parenthood group and Traxler filed a notice of appeal Friday with the Nebraska Supreme Court. They are represented by the American Civil Liberties Union, its Nebraska affiliate, and Powers Law.
The trans care restrictions had been subject to a filibuster led by Sen. Machaela Cavanaugh, who vowed to block every bill pending in Nebraska’s one-chamber, officially nonpartisan legislature in order to keep the anti-trans measure from passing. However, her fellow lawmakers eventually overcame that filibuster. The legislature folded the 12-week abortion ban into the anti-trans bill, Legislative Bill 574, and passed the combined measure in May. Republican Gov. Jim Pillen signed it into law within days. The abortion ban took effect immediately, and the trans care regulations go into effect October 1.
The ban on gender-affirming care has taken a different form from the one originally introduced, but opponents say it could still do great harm. The original bill would have banned puberty blockers, hormone treatment, and gender-confirmation surgery for anyone under 19 for the purpose of transition, although genital surgery is almost never performed on minors. The new legislation bans only surgery, both genital and otherwise, but allows Nebraska’s chief medical officer to regulate the use of puberty blockers and hormones.
That officer, Timothy Tesmer, was appointed by Pillen and has said he opposes all gender-affirming procedures for minors, so putting the power in his hands would likely result in a policy as restrictive as the one proposed in the first version of LB 574, possibly more so, according to opponents. Those already receiving nonsurgical care are exempt from new regulations.
“We will never stop fighting for the reproductive freedom, bodily autonomy, and health of our Nebraska communities. We are doubling down on that commitment with this appeal,” Ruth Richardson, president and CEO of Planned Parenthood North Central States, which includes Planned Parenthood of the Heartland, said in a press release. “Planned Parenthood is dedicated to continuing to provide abortion care to the patients we can legally see within the 12-week limit and will continue to connect other patients in Nebraska with the resources they need to get to the essential care they so desperately need, wherever they may be. Every person deserves the freedom to control their body, health, and future — and that right shouldn’t be determined by your zip code.”
“We are hopeful that the Nebraska Supreme Court honors the language in our state’s constitution that ‘no bill shall contain more than one subject,’” added Mindy Rush Chipman, ACLU of Nebraska executive director. “We will continue to advocate for Nebraskans’ rights and do all we can to block both the abortion ban and the restriction on gender-affirming care for trans youth.”
As the country and world become more aware and accepting of LGBTQ identities, an increasing number of people are coming out as nonbinary, which means their gender identity is neither exclusively male nor female.
A Pew Research Center survey published last year found that about 1.6% of U.S. adults identify as transgender or nonbinary. Transgender means someone’s gender identity, or the personal sense of their gender, differs from the sex they were assigned at birth, which is based on their external sex characteristics.
Transgender can be thought of as an umbrella term, and nonbinary exists under that, though not all nonbinary people identify as transgender. Some nonbinary people also identify with other terms that describe identities outside of the male-female binary, such as genderfluid, genderqueer or bigender.
Younger adults are more likely than older adults to be trans or nonbinary. Pew found that 5.1% of adults under 30 are trans or nonbinary, including 2% who are a trans man or trans woman and 3% who are nonbinary.
Two national surveys of LGBTQ people ages 18 to 60 found that 11% of them identified as nonbinary, according to a June 2021 reportfrom the Williams Institute, a think tank at UCLA School of Law.
Though the term nonbinary has gained increasing mainstream recognition over the last decade, nonbinary people are not new or a trend. Out & Equal, a nonprofit that advocates for LGBTQ workplace equality, created a resource that traces nonbinary identities back to 2000 BCE.
Different cultures also have their own terms for nonbinary identities, according to GLAAD, an LGBTQ media advocacy group. Some Native American people, for example, use the term two-spirit to describe people who are neither exclusively men nor women.
Nonbinary people can use any personal pronoun, including “he” and “she.” Many use the gender-neutral pronoun “they,” and some use neopronouns, such as “xe,” “xir” and “xirs.”
According to a 2021 Pew survey, a quarter, or 26%, of Americans say they know someone who uses gender-neutral pronouns, up from 18% in 2018.
Nonbinary people can dress in various ways, and some will pursue social and/or medical transition, while others won’t. Nonbinary is also different from intersex, which refers to people who are born with reproductive or sexual anatomy that falls outside of what people would typically describe as male or female.
International Nonbinary Day is celebrated annually on July 14 and is an opportunity to honor and recognize the nonbinary community.
The day was first celebrated in 2012, after nonbinary writer Katje van Loon wrote a blog post suggesting the nonbinary community be honored on July 14, which falls halfway between International Women’s Day (March 8) and International Men’s Day (Nov. 19).
“We can feel invisible in a world that still hasn’t completely understood what we are. So it’s nice to have a day that recognises our existence,” Loon wrote. “I want people to be happy with themselves. And if having a day helps you be happy with yourself, that’s great. That is the best outcome I could have hoped for from that one-off blog post that I wrote 10 years ago.”
As an increasing proportion of Americans identify as LGBTQ, leaders in sexual and gender minority health care say that the nation’s medical schools are largely failing to adequately prepare the next generation of doctors to properly care for this population.
The need is critical, according to experts in medical education and LGBTQ care. Lesbian, gay, bisexual, transgender and queer people, as stigmatized minorities, often have difficulty accessing health care that properly addresses their health concerns, that is sensitive to their sexual and gender identities and that is not flat-out discriminatory, researchers have found.
“It’s terrible that there’s a whole population of people who aren’t getting the health care they need,” said Ann Zumwalt, an associate professor of anatomy and neurobiology at the Boston University Chobanian & Avedisian School of Medicine and a leader in the effort to improve medical school curricula pertaining to LGBTQ care.
In 2014, the Association of American Medical Colleges, or AAMC, released a call for the 158 U.S. and Canadian medical schools to provide comprehensive training in caring for LGBTQ people and those born with sex-development differences.
Since then, the need for such instruction has only ballooned, given the dramatic increase in LGBTQ identification among young people in particular.
“The current political and social climates are unfortunately leading to many, many health care-professional students and residents feeling uncertain and frightened to engage in LGBTQ+ education and training.”
DR. DUSTIN NOWASKIE, OUTCARE HEALTH
A constellation of medical schools has heeded the AAMC’s call — progress that inspires hope among queer-health advocates. But the schools’ adoption of comprehensive LGBTQ-focused curricula are the exceptions to the rule. The organization’s call, which was buttressed by a 300-page roadmap for reform but lacked the teeth of a mandate, has mostly gone unheeded nearly a decade later.
Progress at medical schools has been stymied by a myriad of factors, including the lack of LGBTQ-related content in medical licensing exams; inadequate or nonexistent knowledge and clinical experience among educators; administrators and the medical old guard’s resistance to change and concerns about competing educational priorities; and outside political pressures as conservatives seize upon transition-related care for minors and diversity policies as wedge issues and as they scrutinize higher education.
Dr. Alex S. Keuroghlian, director of education and training at the LGBTQ-focused Fenway Institute in Boston, and six other medical educators who asked to remain anonymous out of fear of the very reprisals they described told NBC News that recent state-level efforts to restrict diversity programs in education and transition-related health care for transgender minors have instilled fear in some medical schools that their LGBTQ-related medical training could draw increased scrutiny and punitive attacks from legislators.
Keuroghlian, who is also an associate professor of psychiatry at Harvard Medical School, said that the recent state gender-care bans would likely have a chilling effect “on our ability to teach in an evidence-based way that is grounded in human rights and autonomy.”
Where are the needs?
Researchers who have assessed the capacity of the nation’s health care workforce to serve the specific needs of LGBTQ Americans have found them woefully unprepared, especially to care for transgender people. And LGBTQ people remain in dire need of improved physical and mental health care, according to a trove of studies.
Despite the population skewing younger, 23% of LGBTQ people report being in poor health, compared with 14% of the non-LGBTQ population, according to the health-care analysis nonprofit KFF. And research finds that as many as 1 in 5 LGBTQ people have experienced discrimination during health care encounters, including refusals to prescribe medication and even verbal attacks.
Resulting alienation from the health care system, researchers say, is a key driver of the various health disparities that plague LGBTQ Americans. Such apparent consequences include elevated rates of heart disease, cancer, depression and anxiety, substance use disorders and risk of suicide. These disparate outcomes, according to researchers, are likely also fueled by the damage that being a member of a stigmatized minority can apparently inflict upon the mind and body. These are pervasive problems that the health care establishment would ideally mitigate, not exacerbate.
And yet a 2011 survey of 176 U.S. and Canadian medical schools found that their students received a median of just five hours of LGBT-related training. One in 3 schools devoted no such time during clinical rotations.
Dr. Dustin Nowaskie is the founder and president of OutCare Health.Courtesy Dustin Nowaskie
Dr. Dustin Nowaskie is the founder and president of OutCare Health, a nonprofit LGBTQ health-equity organization that is at the forefront of a growing movement to improve medical training on this front and has developed queer-medicine training programs for both medical students and physicians. Nowaskie, who uses gender neutral pronouns, argued in a 2020 paper that medical schools should, in fact, provide at least 35 hours of such training. This instruction, according to Nowaskie, should start with basic terminology and cultural sensitivity and expand to issues such as health conditions that occur at higher rates among LGBTQ people, including sexually transmitted infections and skin cancer.
“These skills should absolutely be required,” Nowaskie said, because of the expanding LGBTQ population and the inevitability that doctors will frequently treat such patients. Nowaskie said they consistently hear from medical students nationwide that LGBTQ-specific instruction is “often minimal,” and that it is “very outdated,” relying on language, terminology and an overall understanding of queer people that has otherwise been retired thanks to recent social progress.
A recent Gallup poll found that over the past decade, the proportion of Americans openly identifying as LGBTQ has doubled, to 7.2%, and that 1 in 5 young adults say they identify as something other than a cisgender heterosexual. The Williams Institute at UCLA Law recently estimated that 0.5% of older adults identify as transgender, compared with 1.4% of adolescents and 1.3% of young adults.
A team directed by Dr. Carl Streed, research lead for the Center for Transgender Medicine and Surgery at Boston Medical Center, is preparing to publish an update of the 2011 medical school survey. Streed was keen to highlight medical schools that have adopted comprehensive LGBTQ-related curricula — including, among many others, the University of Kentucky at Louisville, Stanford University and Boston University, where Streed is an assistant professor. But Streed tempered expectations that his team would identify much of an uptick in overall training.
“Who ends up being remotely comfortable and competent” in caring for sexual and gender minorities, Streed said, “is a matter of wherethey trained rather than whether they’ve been trained.”
Any progress over the past decade has transpired against a split-screen backdrop of sweeping advances for LGBTQ civil rights and, in response, a fierce backlash against transgender rights, in particular. At least 20 states have now passed various restrictions on transition-related care for minors — a legislative effort that even many physicians who express misgivings about the science backing such treatment say they oppose.
“The current political and social climates are unfortunately leading to many, many health care-professional students and residents feeling uncertain and frightened to engage in LGBTQ+ education and training,” Nowaskie said.
“At the same time,” Nowaskie said, “these climates are perpetuating health care stigma among biased, discriminatory providers.”
How medicine can fail LGBTQ people
Delia M. Sosa, a first-year medical student in Ohio, wants to focus on LGBTQ care. Sosa, who uses gender-neutral pronouns, said they are motivated, in part, by their own alienating encounter with the medical old guard.
After growing up in what they described as a conformist Christian community in New England, Sosa came into their trans and nonbinary identity in their early 20s. At 21, they sought to establish a relationship with a primary care physician in their hometown in hopes of eventually having a double mastectomy, or what’s known in trans medical care as top surgery. But after Sosa disclosed to the doctor their queer identity and the fact that they were dating a nonbinary person, they recalled, “she looked at me with a look of confusion” that was also “mixed with frustration.”
“Medicine is playing catch-up in a lot of ways. … I get some really seasoned, experienced physicians who come up to me and say, ‘I never had a chance to learn about this, yet I know this is something I need to learn.’”
DR. SARAH PICKLE
Sosa said they spent the bulk of the appointment providing the doctor a trans-identity 101 tutorial, including breaking down the difference between gender and sex, what it means to be nonbinary, what gender neutral pronouns are and how sexual orientation can be fluid with respect to the gender of partners. They found the experience so off-putting, they let three years pass before seeking surgery again, which they ultimately had last year.
Dr. Sarah Pickle, a family physician and medical educator in Ohio, is a leading proponent of medical schools cultivating a deft hand in up-and-coming physicians in how to care for LGBTQ people. Pickle insists that such training, which focuses, for example, on speaking with sensitivity and inclusivity regarding queer people’s differences, can be crucial in keeping LGBTQ people engaged in care.
“Medicine is playing catch-up in a lot of ways,” Pickle said. “I get some really seasoned, experienced physicians who come up to me and say, ‘I never had a chance to learn about this, yet I know this is something I need to learn.’”
Sosa discovered their own evidence of the potential perils of physicians’ lack of knowledge about treating LGBTQ patients when researching trans people’s experiences with cancer care. Some oncologists, Sosa found, were confounded over how to manage such treatment in a patient taking cross-sex hormones.
“I can’t tell you how many stories I heard of trans folks where they had delayed care because an oncologist didn’t know what to do with them,” Sosa said.
One expert in LGBTQ medicine, who preferred to remain anonymous because of attacks from the far right, described an often cavalier attitude among specialists toward trans patients’ hormone therapy. A cardiologist, they said, might advise a patient to simply go off hormones due to cardiovascular risk, rather than thoroughly reviewing the risks versus benefits of a therapy that is fundamental to many trans people’s sense of self and well-being.
This health care provider and medical educator expressed frustration that such doctors often remain ignorant to studies that provide insight into managing hormonal therapy in the context of certain health problems.
Who is leading the change?
Keuroghlian stands at the vanguard of the movement to train doctors in caring for trans and gay patients.
At Harvard, he and a team of colleagues led a three-year effort to design and implement a new curriculum that provides comprehensive training in such care.
The curriculum, which other schools are free to adopt, permits all professors, regardless of their own identity or experience, to weave LGBTQ themes and practices into their own instruction. So, for example, a course on endocrinology would include instruction on cross-sex hormonal treatment and an embryology course would teach about intersex variations.
Bringing a broad swath of medical educators up to speed is crucial, Keuroghlian said. A major roadblock to progress has been the fact that the professors, who are meant to pass on their own acquired knowledge, have typically never received their own training in sexual and gender minority care. So, in addition to the four-hour training he helped craft for Harvard faculty about how to teach this subject, Keuroghlian is among the educational pioneers, a group that includes Nowaskie, who are designing medical education seminars to train other health care providers nationwide.
Dr. Christopher Terndrup is an associate professor of medicine at Vanderbilt University Medical Center.Courtesy Vanderbilt University Medical Center
Dr. Christopher Terndrup, an associate professor of medicine at Vanderbilt University Medical Center in Nashville, Tennessee, noted that most demand for LGBTQ health education “is actually pushed by the medical students themselves.”
But such eagerness from the new generation can hit old bureaucratic walls, according to Dr. Nelson Sanchez, an associate professor of clinical medicine at Weill Cornell Medicine and the chair of the annual LGBT Health Workforce Conference. Sanchez said administrators often resist calls for such curriculum by insisting that a zero-sum game governs all medical-school education hours.
Dr. Lily Rolfe, who recently graduated from Rush Medical College in Chicago and is matriculating to a residency in family medicine, with a focus on caring for LGBTQ patients, at Swedish Hospital in Seattle, conducted an informal survey of students at Chicago area medical schools about the quality of their education in caring for LGBTQ people.
“It’s always, ‘The gay guy has HIV,’” Rolfe quipped regarding the typical way the respondents characterized their limited education on this front.
“HIV is important,” Rolfe said. “We should learn about it. But that shouldn’t be the entirety of LGBT health.”
Otherwise, the Chicago students said that social determinants of health pertaining to sexual and gender minorities were commonly addressed. But the survey respondents, Rolfe said, “noticed a lack of discussion about trans people, including gender dysphoria; gender euphoria; medical, social, legal and surgical transitioning; and a lack of the discussion of the over pathologization of trans people.”
Harvard’s LGBTQ curriculum, meanwhile, goes beyond just infectious disease, including basic concepts and terminology about gender and sexuality; stigma’s impacts on health inequities; major health concerns that are more common in LGBTQ people, such as anal cancer in gay men or breast cancer in lesbians; effective doctor-patient communication methods; navigating power imbalances and implicit bias; addressing microaggressions; and how to generate learning opportunities if an LGBTQ patient responds negatively to a physician’s words or actions.
Other med schools that have also established substantial training efforts on such subjects include Louisiana State University, the University of Mississippi at Jackson, the University of Wisconsin at Madison, Vanderbilt University, the University of Pennsylvania and Cedars-Sinai in Los Angeles.
The current hostile political environment notwithstanding, Keuroghlian said he remains optimistic for how well prepared the next generation of doctors will be.
“People in medical school are increasingly passionate about doing this work, because there’s more understanding for the need for skilled, culturally responsive care,” Keuroghlian said of sexual and gender minority care.
“There’s also a sense of social justice and health equity that drives young people to do this work,” he said. “They see this as one of the major health rights issues of their generation, and that’s very engaging for them.”
With hundreds of anti-LGBTQ+ bills filed over the past year, both at the federal level and in state legislatures across the country, it’s a difficult time for the queer community. Republican politicians, far-right online personalities, neo-Nazis, and white supremacists have launched vicious attacks against the community, especially drag queens and transgender people.
June is usually a celebration for the LGBTQ+ community, but this year many have found it challenging to enjoy Pride like in previous years. They’ve been traumatized by the nonstop vitriol and threats of violence.
So how can you take care of yourself this year? The onslaught of negativity can quickly take its toll, so LGBTQ Nation spoke with a therapist and psychologist to get tips on how to recognize your trauma, protect your mental health, and show yourself some compassion at the same time.
“These relentless attacks against LGBTQ folks, at minimum, leave us afraid, anxious, and insecure. When we leave our homes, are we safe? Will I be faced with attacks ranging from disgust to outright physical harm?” clinical psychologist Roxy Manning, Ph.D. pointed out. “Someone might call themselves an ally, but will they publicly intervene when horrendous comments are directed at me, or is their allyship restricted to privately commiserating with me and telling me that what happened was so wrong? We begin to doubt ourselves.”
“So many of us walk the world in this state of perpetual anxiety and uncertainty – am I safe, do I truly belong, am I truly welcome, am I appreciated and valued? And these attacks make it impossible for us to fully trust a ‘yes’ to any of those questions, no matter how often we are told otherwise. At our most elemental level, we know that it will only take another slur yelled as we walk down the street or another bullet ripping through our community to let us know how shaky that welcome truly is.”
The Human Rights Campaign recently declared a state of emergency for queer people in the United States, particularly in states politically dominated by Republicans. Pride festivals have been canceled due to threats of violence or legal ramifications. And social media has become an even more giant cesspool, if possible. For a community that already suffers disproportionately from depression and suicide risks, Talkspace therapist Cynthia Catchings, LCSW-S, warns that it is essential to be aware of your mental health risks.
“Fear of the unknown and knowing that there is an emergency can create stress and anxiety. That can result in other negative thoughts and actions, including panic attacks, depression, or PTSD,” she said. “Look out for negative emotions; drastic mood changes; fear, anxiety, or panic attacks; a lack of interest in things that you enjoyed doing before; irritability; not feeling like socializing or talking to others; crying spells, poor hygiene, lack of or excessive sleep; and changes in eating habits.”
“Staying informed but moderating the information intake is essential to avoid more severe mental health issues. You can take some time to observe and reflect on how you feel. It also helps to be open to listening to what those who care about you tell you. A person that loves you will share their concern. Being open to listening to them. Speaking with a mental health professional or joining a support group can help too.”
Dr. Manning agrees. “As we work on expanding our capacity for self-compassion, we can find support in not doing this alone. It can seem counter-intuitive. People used to tell me, ‘You just need to learn to accept yourself.’ But it’s hard to accept yourself when all around you, people are putting you down, making fun of you, and demonstrating that they think you have little value. We can more easily access self-compassion when we experience compassion, when we see reflected in other people’s behavior that we are worthy of care, consideration, and acceptance.”
“Other people can show us the path to self-compassion when it’s new to us, and can keep reminding us that this is possible. For a long time, when I judged myself harshly, I would remember the voice of a dear friend who always received me with total compassion. I couldn’t always find the words to be compassionate to myself, but recalling his words would be a needed jumpstart.”
But what if our emotions keep us from celebrating Pride? That’s okay, they say. Pride started as a protest against authorities abusing their power to persecute the LGBTQ+ community, after all. Give yourself time to process everything from an inside point-of-view instead of solely external, and see if that helps you feel better.
“Not wanting to celebrate is okay,” Catchings says. “Any feeling we are experiencing that makes us avoid participating during the celebrations has a valid reason. However, it is important to take some time to reflect on the reasons why you feel that way. Ask yourself if that attitude is creating more issues or if you will be more resentful in the future for not celebrating this year.”
Mindfulness activities, journaling, yoga, breathing exercises, practicing a hobby or sport, or participating in a support group can help to soothe your emotions. Still, Dr. Manning warns that some techniques may seem helpful at the time but aren’t.
“As a Black psychologist, so many people have shared messages of anti-compassion they’ve learned from their family, often with the best intentions. Instead of giving ourselves permission to feel, to self-empathize, we’re told just to get back out there, pretend,” she said. “For many of us, without the capacity for the healing effect of self-compassion, we seek strategies to distract ourselves or numb ourselves.”
“We use food, alcohol, drugs, and increasingly, the internet and social media. We want to feel cared for and nurtured, so we turn to meaningless sexual encounters. We rely on accessing and expressing anger and judgment at ourselves or others. We even have behaviors that seem prosocial but still serve to distract us from our feelings.”
“Many of us have some emotions we think it’s okay to experience, and others we demonize. I might allow myself to feel anger and rage but not allow myself to feel grief and despair. We think we have to ‘chin up’ and soldier on, be professional, don’t let them see it hurts,” Dr. Manning added. “We can welcome and hold all our reactions and emotions with compassion.”
“One way we can access that compassion for our reactions is to recognize that each emotion is fueled by an underlying need, something that is deeply important to us. If we feel anger, it might be fueled by our deep longing for justice, for relief from pain. We can even feel compassion for our numbness – our inability to feel may be our body’s best strategy to relieve the intense pain.”
“Remember that you are the change that you want to see in the world, and not celebrating or participating in some way may sabotage progress and your own happiness,” Catchings pointed out. “If you feel like it after reflecting on your reasons not to celebrate, pick up those colors and wear them proudly wherever you go!”
The American Medical Association has strengthened its position supporting the care for all transgender and gender-diverse people.
The AMA’s House of Delegates, holding its annual meeting in Chicago, voted Monday to pass the Endocrine Society’s resolution on protecting access to gender-affirming care, according to an Endocrine Society press release.
In the resolution, the AMA committed to opposing any criminal and legal penalties against patients seeking gender-affirming care, family members or guardians who support them in seeking medical care, and health care facilities and clinicians providing it.
The AMA promised to work with federal and state legislators and regulators to oppose policies restricting access to the care and collaborate with other organizations to educate the Federation of State Medical Boards about the importance of gender-affirming care.
The American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American Urological Association, the American Society for Reproductive Medicine, the American College of Physicians, the American Association of Clinical Endocrinology, GLMA: Health Professionals Advancing LGBTQ+ Equality, and AMA’s Medical Student Section cosponsored the resolution.
The AMA already has a long history of supporting gender-affirming care, including support for insurance coverage of the procedures, which include puberty blockers for young people, hormone treatment, and surgery. Medical associations agree that genital surgery should be delayed until patients reach age 18.
But right-wing politicians are increasingly attacking such care, calling it experimental and unproven, when in fact more than 2,000 scientific studies have examined aspects of gender-affirming care since 1975, including more than 260 studies cited in the Endocrine Society’s Clinical Practice Guideline, the society notes in its press release.
Twenty states have passed laws banning most or all gender-affirming care for minors, and some states restrict the care for certain adults as well, such as those who receive insurance coverage through Medicaid. Five of the states make it a crime to provide the care. At the federal level, far-right Republican Congresswoman Marjorie Taylor Greene last year introduced a bill that would have made it a felony to deliver the care to minors. It went nowhere, but Green reintroduced it this year.
The United Kingdom’s National Health Service recently decided to limit the use of puberty blockersto clinical trials, a move that received criticism from LGBTQ+ activists.
In the U.S., 11 states and several cities, including New York City, Kansas City, Mo., and Washington, D.C., have taken steps to protect access to gender-affirming treatment.
Several studies have made clear that gender-affirming care saves lives. A 2020 study, for instance, found that trans adults who had received puberty blockers in their youth had lower likelihood of lifetime suicidal ideation than those who wanted the treatment but did not receive it. A recently released study found that receiving hormone treatment as teens significantly reduced the risk of ever attempting suicide.
The American College of Pediatricians, a small, right-wing extremist group of physicians who for two decades has struggled to gain traction finds itself for the first time with more power than it has ever had as the far-right takes greater hold on America.
But along with their new-found power comes a deep dive into at least 15 years worth of their internal documents, the result of the group reportedly publishing a link to its own unsecured Google drive in April, which WIRED uncovered and reported on back in May.
The Washington Post combed through 10,000 of the group’s documents, and on Thursday publishing its exposé on the American College of Pediatricians, which the Southern Poverty Law Center lists as an anti-LGBTQ hate group.
“The American College of Pediatricians (ACPeds) is a fringe anti-LGBTQ hate group that masquerades as the premier U.S. association of pediatricians to push anti-LGBTQ junk science, primarily via far-right conservative media and filing amicus briefs in cases related to gay adoption and marriage equality,” SPLC writes in its extensive report.
According to The Washington Post, the American College of Pediatricians is a “small group of conservative doctors” that “has sought to shape the nation’s most contentious policies on abortion and transgender rights by promoting views rejected by the medical establishment as scientific fact.”
The American College of Pediatricians promotes the discredited practice of “conversion therapy,” which has been called “torture” by some who have been subjected to it. Conversion therapy, which purports to change a human being’s sexual orientation or gender identity, is outlawed in several states, while most credible medical organizations have denounced it.
The group’s success comes at the expense of transgender youth.
“The organization’s quest to ban the use of puberty blockers and hormone therapy for transgender minors has culminated in a string of recent legislative wins following lobbying in at least eight states, internal documents show,” The Post reports. “Arkansas first enacted such a law in 2021, after Michelle Cretella, then executive director of the American College of Pediatricians, described such care as ‘experimental and dangerous‘ to legislators. A federal appeals court temporarily blocked it.”
“Versions of the law have since passed at least 20 other state legislatures, including Florida, Idaho, Indiana, West Virginia, Oklahoma, Missouri, Montana, Texas, North Dakota and Louisiana this spring alone; some face court challenges and one was vetoed by a governor. Similar bills are making their way through legislatures in North Carolina and Ohio.”
In other words, lawmakers in about half the country are working to harm transgender children, with the help of the American College of Pediatricians.
Also among the American College of Pediatricians’ more dangerous efforts over the years have been its attacks on homosexuality.
“Internal records from 2010 show how the group tied homosexuality to health risks — even death — in a letter campaignto educators, citing a 1991 study to demonstrate that for each year adolescents delay ‘self-labeling as ‘gay’,’ the risk of suicide decreases by 20 percent.”
That claim we know today is false.
“According to more recent research, suicide risk rises with therapy directed at changing sexual orientation. Lesbian, gay and bisexual people who experienced conversion therapy were almost twice as likely to think about suicide and to attempt suicide compared with peers who had not experienced conversion therapy, according to the Williams Institute at the UCLA School of Law,” The Post adds.
2010 may seem like light years ago, but LGBTQ rights were very much a large part of the national conversation back then.
In 2010, President Barack Obama directed the federal government to extend spousal benefits to same-sex couples. A critical portion of the anti-LGBTQ federal law, the Defense of Marriage Act, was ruled unconstitutional by a federal court. President Obama also signed into law the repeal of “Don’t Ask, Don’t Tell” that year. And a federal judge ruled California’s infamous Prop 8 was unconstitutional.
But also in 2010, just as LGBTQ people were starting to be able to access the rights and recognition they had always been denied, the American College of Pediatricians sent a letter, The Post reports, “to 14,800 public school superintendents [that] urged school officials not to affirm any student expressing homosexuality. It directed them to a website operated by the group that pushed ‘sexual reorientation therapy’ for those with ‘unwanted homosexual attractions.’”
The Heritage Foundation, a once-vaunted right-wing think tank that has succumbed to pro-Trump MAGA far-right extremism, is a big fan of the American College of Pediatricians.
“They have had the courage to take stands in court and to speak as medical professionals in relating their experience when it comes to questions of human dignity in unborn life, freedom of conscience, and the protection of children,” Roger Severino, Heritage’s vice president of domestic policy, told The Post.
Severino, a far-right religious extremist, served in the Trumpadministration as the head of the Department of Health and Human Services’ Office of Civil Rights.
In its report on Thursday, The Washington Post adds that Severino “said [he] relies on the American College of Pediatricians for scientific expertise.”
Amplifying far-right wing anger that the LGBTQ Pride flag was hanging from the White House during President Joe Biden’s historic Pride celebration over the weekend, the Heritage Foundation lashed out, attacking the entire LGBTQ community and the Biden administration.
On Wednesday the Heritage Foundation declared that the LGBTQ Pride flag “does not represent anything good and it certainly does not represent America.”
Recently coming off of Bi+ Health Awareness Month, annually in March, we’ve been pointed to our Bi+ population who not only contend with the challenges commonly experienced by their LGTQ+ peers, but also must overcome a host of obstacles specific to their community. There has been immense progress in LGBTQ+ equality over the previous decades, yet too many Bi+ community members continue to suffer under the yoke of age-old prejudices.
While these 31 days are designated to focus on complications confronting and negatively impacting Bi+ people, as well as creating awareness around better meeting the population’s needs, our efforts to stand in solidarity with the Bi+ community cannot simply begin and end each March. More must be done for a community that our society has ignored and overlooked for decades.
According to Gallup, Bi+ people actually make up more than half of LGBTQ+ Americans, who now represent 7.1 percent of our country’s population. However, this community experiencessignificantly worse physical, mental, and social health outcomes compared to their gay, lesbian, and heterosexual peers.
Our Bi+ neighbors often experience a wider array of negative medical conditions compared to heterosexual adults that are frequently aggravated by the unique discriminations they face related to their sexual orientation. These conditions range from higher rates of elevated cholesterol and asthma, as well as increased prevalence of smoking and alcohol use that can also heighten the risk for other health problems.
Our health care system and the oft unchecked anti-LGBTQ+ biases ingrained within it make it even more difficult to address these issues. Many Bi+ people refrain from disclosing their sexual identity to healthcare practitioners based on past negative interactions with their physicians, which results in delaying or avoiding necessary appointments and procedures. Adding to the matter, 80 percent of physicians assume patients would decline to disclose their sexual identity to their doctors, making the health care process for the Bi+ more difficult.
Working at SAGE, my colleagues and I see these exact instances constantly with the Bi+ elders we engage with, along with the other elders who utilize our services and resources across the LGBTQ+ community. Bi+ elders are significantly more likely to live at or below 200 percent of the federal poverty line and more likely to have lower income levels as compared to their gay and lesbian peers. We also see higher rates of depression and worse health outcomes as well among Bi+ people, creating further complications they must navigate.
You may be asking why this is the current state of the Bi+ community in the U.S., especially for our elders. It is likely, at least in part, attributable to multifaceted discrimination. Bi+ people are at risk of marginalization by anti-LGBTQ+ sentiment while simultaneously seeing their voices and narratives erased or disbelieved within LGBTQ+-centric circles.
So while those who would oppose equal protection under the law for LGBTQ+ people — those who have found ever more vociferous champions of their prejudices among our elected officials over the past several years — do not hesitate to denigrate the BI+ community, other members of the LGBTQ+ community are necessarily creating spaces that are inclusive of Bi+ people.
We must do better — those in the community; those outside of the community; those leading our health and nonprofit organizations; those elected into office and beyond. We all must do better at standing in solidarity with communities other than our own.
Improvement in this area can begin with two crucial steps — inclusivity and increasing resources. You might assume that inclusivity wouldn’t be an issue for the LGBTQ+ community, but those same assumptions are what often lead to the sidelining of Bi+ people and their narratives. Listening to, understanding, and respecting other people’s identities and experiences is the foundation of inclusivity, and this must be remembered as more pro-LGBTQ+ programs are developed.
We must also make mental health programming more accessible for Bi+ people given that they are at greater risk of experiencing protracted isolation and loneliness. The community’s elders are more likely to experience social isolation compared to other LGTQ+ adults, and LGBTQ+ elders as a whole are twice as likely to be single and live alone when compared to their non-LGBTQ+ peers. Mental health concerns and their treatment has become more known and accepted worldwide, but this focus and investment must be nuanced to be as inclusive as possible of all demographics.
The positives here are that we have clear steps for creating more welcoming spaces for the Bi+ community, avenues to guide future research and paths for creating more accessible and comprehensive resources. However, time must not be wasted. Addressing the specific needs of Bi+ people can no longer be a second thought, as it has been for far too long.
It is long past time to critically reevaluate and rethink how we as individuals and professionals stand with Bi+ people in America and elsewhere.
Kylie Madhav is the Senior Director of Diversity, Equity, and Inclusion at SAGE where she defines the strategic vision for SAGE’s external-facing DEI work and leads in designing the organization’s DEI action plans, goals, and benchmarks.
As mpox cases start to rise again in some key areas, experts are urging queer people to remain vigilant and get vaccinated.
Mpox cases are down significantly since the epidemic reached its peak in the summer of 2022. The shift prompted the World Health Organisation (WHO) to declare that the outbreak was no longer a public health emergency on 11 May – but that doesn’t mean the virus has disappeared.
The WHO is now warning that mpox cases could rise again during the summer months as queer people congregate for Pride festivals and other gatherings.
“[Mpox] still is circulating, it still is with us, and still does represent an ongoing risk,” Dr Richard Pebody, mpox lead with the WHO, tells PinkNews.
“It’s much lower levels of cases now than what we were seeing before, but we also know – and this is the key message I really want to get out to folk – is that there is still the potential for flare-ups, for further outbreaks, this spring and summer.”
He continues: “We’ve seen recently a flare-up in France for example. We’ve also seen a flare-up just recently in the States, in Chicago. These have again really been occurring primarily in the GBMSM (gay, bisexual and men who have sex with men) community and many of the cases had a vaccine last year as well, so it is highlighting the ability of the virus to still circulate and to cause illness.”
Mpox (previously monkeypox) is no longer considered a public health emergency, but it’s still circulating. (Getty)
That’s why the WHO is now launching a new campaign to remind the public that mpox is still circulating as the summer season begins.
“We know festivals where people get together there is an increase in sexual contact. There is the potential for further clusters and outbreaks in those types of settings,” Dr Pebody says.
“It’s really about putting this out there and raising people’s awareness that, on the one hand, we [should] celebrate where we are now, but also to highlight what we can do to keep ourselves and those around us safe.”
WHO urges people to get tested if they develop mpox symptoms
Dr Pebody says there are a range of things people can do to protect themselves and others from mpox this summer.
“On the one hand, if you suspect that you’ve got mpox yourself – so if you’ve started to develop a rash which is consistent with mpox – then get yourself checked out.
“Give the festival or the event a miss. Avoid close contact with others and that will certainly reduce your risk of then spreading that on to others – that’s a really important thing.”
People can also reduce their risk of contracting mpox by taking a smallpox vaccine if one is available in their country. Vaccines reduce both the risk of infection and the risk of severe illness.
The WHO wants people to stay safe this summer, but they also want to reassure queer people that they can still have fun while socialising or having sex with new partners.
“I would really try to reassure people not to be frightened,” Dr Pebody says.
“Certainly now in Europe, the incidence of mpox is much, much lower than it was last year. We’re in a much better position so we certainly don’t want to frighten people. What we want to do really is to remind people that mpox is still potentially out there, but there are things we can all do to reduce that risk of potentially being exposed.
“If you’re planning to go to a festival, to an event, do go – have fun, have a good time, but just remember what you can also do to protect yourself and others.”
The Food and Drug Administration said Thursday that it finalized a new rule that will allow more gay and bisexual men to donate blood.
Under the latest guidelines, all potential donors would need to complete individualized risk assessments — regardless of gender or sexual orientation. People who have had anal sex with new partners or more than one partner in the last three months would be asked to wait to donate blood.
The updated guidelines mean most gay and bisexual men who are in monogamous relationships with other men will no longer need to abstain from sex to donate blood.
Previously, the FDA allowed donations only from men who have sex with men if they hadn’t had sex with other men for three months.
“The implementation of these recommendations will represent a significant milestone for the agency and the LGBTQI+ community,” Dr. Peter Marks, director of the FDA’s Center for Biologics Evaluation and Research, said in a release.
The agency will continue to monitor the safety of the blood supply, he added.
The FDA’s restrictions on blood donations from men who have sex with men stem from the AIDS crisis, which began in the early 1980s, when little was known about HIV.
The agency first proposed the new rules, which are in line with those in Canada and the United Kingdom, in January.
People who are taking medication to prevent or treat HIV infections would be asked to wait to donate blood under the new guidelines.
In the last five to 10 years, attachment theory has been all over the internet. If you’re an LGBTQ+ individual with an interest in psychology or who has gone to therapy even a few times, chances are you’re familiar with it.
There’s more nuance to it, but for the sake of keeping things succinct: Attachment theory posits that individuals with avoidant attachment evade difficult conversations and vulnerable feelings, while those with anxious attachment tend to turn towards them to a degree that the avoidant partner can find overwhelming, responding with “fight” rather than “flight” as the avoidant does. At least outwardly, they seem to want more contact and connection than their partners do and feel less comfortable being alone.
Avoidants, on the other hand, seem to need less of this and have a greater need for independence and autonomy. They’re more uncomfortable about being too enmeshed.
Outside of conflict, two anxious and avoidant-leaning people may have a loving relationship. When in conflict though, the shields and weapons come out and the dysfunction appears. According to Julia Hogan, LPCP, “Our attachment styles are often most noticeable when we are facing some kind of conflict with another person, because that’s when our sense of safety and security feel most threatened.”
To the anxious, the avoidant appears cold and withholding. To the avoidant, the anxious appears intrusive and needy.
It’s estimated that 25 percent of the general population are anxious and 25 percent are avoidant, though according to Seattle Pacific University, “LGBTQ+ couples are slightly more likely to be insecurely attached,” meaning either anxious or avoidant.
Forging connection through healing & understanding
Though I once thought the styles were categorical, more recently I’ve come to acknowledge that few people are 100% clear-cut avoidant or anxious. People can feel more or less secure at different times, depending on the stressors they’re facing, their physical health, and how they’ve been sleeping, among other factors. Anxiously attached folks can occasionally respond in an avoidant way, and avoidants can occasionally respond in an anxious way.
Still, often relationships find one partner taking the anxious role, while the other takes the more avoidant role during conflict (or the dynamics switch throughout the course of the relationship). According to counselor Jeff Guenther, “Anxious and avoidant people often find themselves attracted to one another because they reinforce each others’ beliefs.”
It takes effort to get couples in anxious-avoidant relationships to function seamlessly. As counselor Jessica Baum put it, “Someone who loves connection and having their needs met is [generally] not a great match with someone who wants to be distanced.”
But it’s also not impossible, especially when two partners share chemistry, values, and interests when not triggered. Each can find ways to resolve their past painand forge a healing connection.
Clinical psychologist Carla Marie Manly acknowledges that “if a fearful-avoidant individual who is engaged in solid self-work connects with an anxiously attached person who is also mindful of personal wounds and needs, the relationship can develop slowly but surely in a safe, lovingly attached way that benefits both partners.”
Counselor Casey Tanner, who goes by the handle @queersextherapy on Instagram, acknowledges that her and her partner’s attachment styles ebb and flow, but that she is “solidly the more anxious one” while her partner leans somewhat more avoidant. Still, the two practice empathy and continually strive to work within an awareness of the other’s respective style.They’ve learned the language of the other’s attachment so that they’re less likely to misinterpret one another.
Tanner wrote in an Instagram post:
“I’ve learned that when Mal gets quiet during conflict, it’s not because she’s not invested or has had ‘too much’ of me. Rather, she’s working very hard in those moments to find words that are going to accurately represent her feelings. Sometimes, she’s spending time in silence rehearsing what happened between us to figure out what went wrong. I’ve learned I can be supportive by letting her take her time.”
“I’ve started to understand that when it’s hard for her to tell me what she needs, it’s not because she doesn’t trust me or thinks I’m not capable of meeting them. Instead, she’s trying to talk herself out of her needs all together, doubting whether or not they’re ‘worth bringing up.’ I’ve come to understand that the needs she chooses not to express are not about me, and not mine to solve.”
I think it’s common in the face of conflict to launch into binary thinking, quickly applying our pre-existing lens to any and all situations. Threat or friend — into the box the other person goes, instantly. Anxiouses and avoidants tend to polarize each other in this way, often. In doing this, they stay stuck in an unsatisfying dynamic where neither’s needs are being met. When each is convinced the problem lies fully in the other person, they’re less likely to work on their own contribution.
Tanner’s advice breaks with the polarizing tendency often found in attachment literature,presenting a newer and more hopeful path.
Check back next week for specifics backed by relationship experts and psychologists on what can be done on both ends.
