At Children’s Hospital of Philadelphia’s Gender and Sexuality Development Clinic we care for more than 700 transgender and gender non-conforming children, adolescents and their families. Currently, the Pennsylvania General Assembly is considering legislation that would discriminate against some of them by eliminating coverage for sexual- or gender-reassignment surgery offered by the Children’s Health Insurance Program (CHIP), which insures nearly 200,000 children in the state.
I believe that children should be able to access coverage that they need and that decisions about any child’s care should be made in accordance with the best evidence and standards of care.
When we make decisions in our clinic to recommend gender-affirming surgeries, we carefully weigh the procedure’s risks and benefits, evaluate the youth’s developmental stage and ability to make decisions about irreversible treatment, and ensure our patient is ready to do what is needed to recover from surgery. Medical and mental health providers with expertise in transgender care, along with parents and the patient, make the decision together, as complex medical decisions should be made for all children.
This process helps us determine whether or not gender-affirming surgery will significantly improve a child’s health outcome. For example, I recently saw one of my 18-year-old patients who had received hormone therapy and gender affirming surgery go from severely depressed, anxious, and solitary to now attending community college and greeting me with a smile during her appointments.
It’s unclear why some lawmakers have chosen to exclude sexual- or gender-reassignment surgery – medically necessary care for transgender youth – from CHIP when we know that gender-affirming surgeries can improve psychological and social functioning and even save lives. In fact, more than 40 percent of transgender people who are not affirmed in their identities will attempt suicide.
While this legislation would ultimately affect a relatively small number of people, it may send a message to youth, particularly those who are transgender, that they are not deserving of health care that meets their needs.
As a pediatrician, this is highly concerning to me. When young people hear these kinds of messages, it can create an environment where bullying and discrimination are more acceptable than respect and support for those who are different. In fact, three out of four gender non-conforming students experience bullying and harassment, and more than 15 percent leave school because of it, creating additional risk factors for their health.
I respectfully ask policymakers to allow time for hearings and public dialogue – listening to the voices of transgender youth, their families, and health-care providers – of what it means to provide adequate health insurance coverage to all low- and middle-income children, without exception, before deciding the fate of these children.
Nadia Dowshen, MD, MSHP, is a pediatrician and adolescent medicine specialist and the co-founder and medical director of Children’s Hospital of Philadelphia’s Gender and Sexuality Development Clinic. She is on the faculty of CHOP’s PolicyLab and assistant professor of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania.