As of early this week, the U.S. Food and Drug Administration had yet to respond to a Nov. 29 joint letter by 52 members of the U.S. House and U.S. Senate calling on the FDA to end its policy of restricting the donation of human tissues such as corneas, heart valves, skin, and other tissue by men who have sex with men, or MSM.
The letter is addressed to Acting FDA Commissioner Janet Woodcock and Department of Health and Human Services Secretary Xavier Becerra. The FDA is an agency within the HHS.
The letter says the FDA’s restrictions on MSM tissue donation date back to a 1994 U.S. Public Health Service “guidance” related to the possible transmission of HIV, which stated that any man “who has had sex with another man in the preceding five years” should be disqualified from tissue donation.
“We also call your attention to the broad consensus within the medical community indicating that the current scientific evidence does not support these restrictions,” the letter states. “We have welcomed the FDA’s recent steps in the right direction to address its discriminatory MSM blood donation policies and urge you to take similar actions to revise the agency’s tissue donation criteria to align with current science so as not to unfairly stigmatize gay and bisexual men.”
The letter adds, “In fact, a recent study in the medical journal JAMA Ophthalmology estimated that between 1,558 and 3,217 corneal donations are turned away annually from otherwise eligible donors who are disqualified because of their sexual orientation, an unacceptable figure given widespread shortages of transplantable corneas.”
The letter continues, saying, “FDA policy should be derived from the best available science, not historic bias and prejudice. As with blood donation, we believe that any deferral policies should be based on individualized risk assessment rather than a categorical, time-based deferral that perpetuates stigma.”
U.S. Sen. Tammy Baldwin (D-Wisc.), the nation’s only out lesbian U.S. senator, and U.S. Rep. Joe Neguse (D-Colo.) are the two lead signers of the letter. All 52 signers of the letter are Democrats.
Among the others who signed their names to the FDA letter are four of the nine openly gay or lesbian members of the U.S. House. They include Reps. David Cicilline (D-R.I.), Richie Torres (D-N.Y.), Mondaire Jones (D-N.Y.), and Mark Takano (D-Calif.).
Also signing the letter are D.C. Congressional Del. Eleanor Holmes Norton (D-D.C.), and Rep. Jamie Raskin (D-Md.).
In response to a Dec. 21 email inquiry from the Washington Blade, FDA Press Officer Abigail Capobianco sent the Blade a one-sentence statement saying, “The FDA will respond to the letter directly.”
The statement didn’t say to whom the FDA would respond or when it would issue its response.
Efrén Pérez, one of the authors of the study who is a political sciences professor at the University of California in Los Angeles, told The Guardian, “Let’s assume there are societies that generally agree on being more inclusive of women and LGBT individuals, and there are more than a few.”
“Our findings suggest that the words we choose to use can matter in getting us a little bit closer toward reaching that ideal.”
More than 3,000 people took part in the research, which involved being shown a cartoon of an androgynous figure walking a dog and then asked what was happening in the picture – with one group told to use only neutral pronouns, one female pronouns and one male.
Participants then completed tasks, including writing a story about a person running for political office and answering questions about their views on women and LGBT+ people.
According to the report, using gender-neutral pronouns at the beginning of the task made it more likely that the volunteers would use non-male names in their short story and would have pro-women, pro-LGBT+ views.
Sabine Sczesny, a professor of social psychology at the University of Bern who was not involved in the research, told The Guardian that the research was further evidence that gender-inclusive language could reduce gender-biases and “contribute to the promotion of gender and LGBT equality and tolerance.”
Laura Russell, director of research, policy and campaigns at Stonewall, said, “The language we use is important, especially when it comes to describing or referencing someone’s identity.
“This study adds to the evidence showing that when we use language that actively includes women and LGBT people, it makes a real difference in reducing gender stereotyping. Using gender-neutral language is a positive step towards creating a world where everyone is accepted without exception.”
Cornell University’s What We Know Project in conjunction with a coalition of leading LGBTQ rights groups last month published a comprehensive curation of data on studies that chart the intersection of anti-LGBTQ and racial discrimination.
The findings found that discrimination inflicts profoundly greater harm on LGBTQ people of color in a wide range of areas, including grossly disproportionate rates of: experiencing discrimination over the past year, poorer mental and physical health, greater economic insecurity, and attempts to die by suicide.
In addition, LGBTQ people of color are more likely than white LGBTQ people to live in states without protections against discrimination and that state anti-LGBTQ laws harm LGBTQ people.
“This research brief makes clear the tangible harms that discrimination inflicts on LGBTQ people of color, and the urgent need for public policy that reflects what the research tells us about how we can reduce those harms,” said Dr. Nathaniel Frank, the study’s author.
LGBTQ people are more likely than non-LGBTQ people to be people of color, and Black LGBTQ Americans are disproportionately likely to live in states without protections against discrimination. For example, 42% of LGBT people are people of color compared to 32% of non-LGBT people and the majority of Black LGBT Americans live in the South (51.4%, more than twice the share of any other region), where most states lack anti-discrimination protections.
LGBTQ people of color face higher odds of discrimination than both non-LGBTQ individuals and LGBTQ white people. For example, LGBTQ people of color are more than twice as likely to experience anti-LGBTQ discrimination (slurs or other verbal abuse) when applying for jobs than white LGBTQ individuals (32% vs. 13%). LGBTQ people of color are more than twice as likely as white LGBTQ people to experience anti-LGBTQ discrimination when interacting with the police (24% vs. 11%).
Black LGBT Americans are more likely to experience economic insecurity than Black non-LGBT Americans. For example, the majority of Black LGBT people (56%) live in low-income households (below 200% of the federal poverty level) compared to 49% of Black non-LGBT Americans, and Black LGBT adults are also more likely to experience food insecurity than Black non-LGBT adults (37% compared to 27%).
Hundreds of studies conclude that experiencing anti-LGBTQ discrimination increases the risks of poor mental and physical health, including depression, anxiety, suicidality, PTSD, substance use, and psychological distress.
LGBTQ people of color face disproportionate odds of suicidality, which is linked to discrimination. For example, while 12% of white LGBTQ youth attempted suicide, the rate is 31% for LGBTQ Native/Indigenous youth, 21% for LGBTQ Black youth, and 18% of LGBTQ Latinx youth.
While supportive laws, family, and peers lower the risk of poor health outcomes for LGBTQ people of color, anti-LGBTQ state laws inflict tangible harm on sexual minority populations. For example, states with “denial of service” laws that give license to discriminate against LGBT residents between 2014 and 2016 were linked with a 46% increase in LGBT mental distress. Black LGBTQ youth who reported high levels of support from at least one person, or who had access to an LGBTQ-affirming space, reported attempting suicide at lower rates than those who lacked such support (16% vs. 24%).
Supportive laws, family, and peers lower the risk of poor health outcomes for LGBTQ people of color.
• Suicide attempts by LGBT youth dropped by 7 percent in states that legalized same-sex marriage.22
• The corollary is that anti-LGBTQ state laws inflict tangible harm on sexual minority populations. States with “denial of service” laws that give license to discriminate against LGBT residents were linked with a 46% increase in LGBT mental distress.23
• Black LGBTQ youth who reported high levels of support from at least one person, or who had access to an LGBTQ-affirming space, reported attempting suicide at lower rates than those who lacked such support (16% vs. 24%). Those with high levels of family support had rates of past-year attempted suicide nearly one third as high as those who lacked such support (22% vs. 8%).24
• Protective measures that have been found to help reduce anxiety, depression, and suicidality among LGBTQ youth include: Establishing inclusive practices and anti-discrimination policies; peer, community, and family support, including dedicated school groups; access to affirmative mental health and social services; societal confrontation of attitudes and norms that exacerbate minority stress; and practitioner training and interventions designed to disrupt negative coping responses and build resilience.
Experiencing discrimination is associated with greater odds of harm to psychological and economic well-being, which is reflected in data on disparities for LGBTQ people of color.
• Hundreds of studies conclude that experiencing anti-LGBTQ discrimination increases the risks of poor mental and physical health, including depression, anxiety, suicidality, PTSD, substance use, and psychological distress.
• LGBT people of color have work-place experiences that are more negative than those of white LGBT employees, reporting that their success and work-life balance are fostered less extensively, they have less transparent evaluations, and they are respected less by supervisors.
• Among LGBTQ people surveyed, 51% of Black respondents say discrimination harms their ability to be hired, compared with 33% of white respondents; 41% say it has an impact on their ability to retain employment, compared with 31% of white respondents; 77% of Black respondents report that discrimination impacts their psychological well-being, a rate nearly 50% higher than the total LGBTQ survey population.
• While racial discrimination on its own is not associated with mental health disorders, the combination of racial discrimination with gender and/or sexual orientation discrimination is significantly associated with increased odds of a past-year mental health disorder.
LGBTQ people of color face disproportionate odds of suicidality, which is linked to discrimination.
• Around 25% of LGBTQ youth of all races have attempted suicide, but the rates are starkly higher for LGBTQ youth of color than their white counterparts: While 12% of white LGBTQ youth have attempted suicide, the rate is 31% for LGBTQ Native/Indigenous youth, 21% for LGBTQ Black youth, and 18% for LGBTQ Latinx youth.
• In a 95%-non-white LGBT sample, those who report experiencing anti-LGBT victimization (such as bullying and harassment) are 2.5 times more likely to report a past-year suicide attempt compared to those who do not report victimization.
• Black LGBTQ youth who experience anti-LGBTQ discrimination face twice the rate of past year suicide attempts compared to youth who do not (27% vs. 12%). Black LGBTQ youth who experience race-based discrimination also face higher odds of attempting suicide than those who do not (20% vs. 14%).
• Black LGB adults are over 40% more likely to have made a serious suicide attempt in their lifetime than white LGB adults.
• Latinx and Native American/Pacific Islander LGBT youth are 50% more likely to attempt suicide than white LGBT youth. Latinx LGBT girls are nearly twice as likely to attempt suicide than white LGBT youth.
• LGBTQ students who experience discrimination “based on multiple social identities” report more use of deliberate self-harm compared to LGBTQ students who experience racial discrimination alone or who do not experience significant discrimination of any kind.
Reflecting on the study’s findings, key executives from participating LGBTQ Advocacy groups weighed in:
“These painful figures highlight an indisputable link between discrimination, economic security, mental and physical health. People with multiple stigmatized, marginalized social and political identities, particularly Black LGBTQ+/Same Gender Loving people, bear a disproportionate amount of the weight illustrated by the data in this study. Statutory equality for LGBTQ+ people nationwide is a necessary foundation to remove the gaps in existing civil rights laws if we are to ever live up to our country’s founding promises of life, liberty, and the pursuit of happiness for all,” said David Johns, Executive Director, National Black Justice Coalition.
The majority of Black LGBTQ people live in the South, with nearly half (44%) of all Black women couples raising children. Even today, most of these states still do not protect LGBTQ people from discrimination and have overtly discriminatory laws on their books. It is no wonder the disparities are so profound and it is a testament to the strength and resilience of our people that they are doing as well as they are. For our community and for our children it’s time for federal action!” said Kierra Johnson, Executive Director, National LGBTQ Task Force.
“This important brief only further solidifies what we have known for a very long time—the combination of racism and anti-LGBTQ discrimination has serious and long-lasting effects for the health and well-being of LGBTQ people of color. This research highlights why federal non-discrimination protections are overdue and vital to protecting the most some of the most underrepresented and vulnerable members of our community. Federal anti-discrimination protections are absolutely necessary in protecting and supporting all LGBTQ people, and this is especially true for LGBTQ people of color,” said Imani Rupert-Gordon, Executive Director, National Center for Lesbian Rights.
We are lesbians and collaborators in the LGBTQ+ movement. We also have a third thing in common: We are both survivors of breast cancer. Each of our health journeys have led us to unite around a common goal to ensure that LGBTQ+ communities have what they need when facing a breast cancer diagnosis or getting treatment to prevent it.
In Dina’s case, she spent years undergoing countless procedures to mitigate her high breast cancer risks. She endured invasive surgeries that required grit, determination, resilience, and continual love and nurturing from her wife, Dom, their children, and their respective families. It went on for more than a decade.
Along the way, Dina also sought out support groups to help her cope with the emotions that arose around the bodily changes that resulted from her intense treatments. There, she faced a rude awakening. All of those groups were filled with straight women who did not react well when she spoke of her wife and her overall experience as a lesbian facing major breast health issues. In one online group, all but one of the women dropped off the call, after she shared insights from her LGBTQ+ perspective.
In another conversation, when Dina shared her sorrow over the loss she was feeling after a double mastectomy, the person she confided in quipped: “Well at least there’s still one set of boobs in your relationship,” referencing Dina’s wife, Dom, who has not faced any breast health problems herself. These incidents of insensitivity and misguided reactions left Dina feeling lonely, isolated, depressed, and unsupported.
Yet even as she rode the wave of these feelings, she felt a sense of resolve, knowing she had the skills, the contacts, and the wherewithal to make a change. As a registered nurse, author, DEI (diversity, equity, and inclusion) expert, and CEO of her own health care consulting firm, she set out to give LGBTQ+ people a new resource. She enlisted Cindi’s advice as a breast cancer survivor, LGBTQ+ public relations pro, and friend.
Cindi overcame the immense challenge of major breast cancer treatment in 2018 and 2019, penning this op-ed for The Advocate at the time about the disparities facing LGBTQ+ people with cancer. She shared important statistics in the piece from the National LGBT Cancer Network and looked to the future about how to use her experience as a catalyst for giving back. The piece also highlighted how lucky she was to have good insurance, health care providers who respected her identity, and an amazing support system (including, most importantly, her wife, Rainie) to move through the difficulties. Far too many LGBTQ+ people with cancer lack these privileges.
Today, we, Dina and Cindi, are both healthy and thriving. So, during Breast Cancer Awareness Month, we are thrilled to announce that we have formed a new nonprofit to fill the resource gap for those in our communities who are confronted with breast health challenges. It’s called the Inclusive Community for Breast Health or as we affectionately call it, “I See Breast Health,” a play on our acronym. ICBH will provide education and resources for LGBTQ+ individuals who are in treatment for, or seeking to prevent, breast cancer, and work to build cultural competence within the health care system through collaboration with academic and health organizations.
As Dina saw firsthand during her own nursing education, there is a dearth of information on LGBTQ+ populations for those being trained as nurses, doctors, and other health care roles. ICBH plans to formally partner with academic institutions and engage with current medical students and future health care providers so they have the tools they need to provide excellent breast-focused healthcare for LGBTQ+ people. Some of these collaborations have informally begun.
And although we are only just beginning our work, we’re excited to share a non-research based survey focused on identifying LGBTQ+ community support needs in the area of breast/chest health. The responses we receive will help us understand what people are facing so we can better focus our programming priorities to meet those needs. We’re also organizing our first online educational panel that will include a variety of LGBTQ+ individuals with varying experiences and perspectives on breast health. That event is planned for November and we will share specific details on our social media pages in the near future.
We are grateful to take these first steps in launching what we believe will be a vital source of information for LGBTQ+ individuals with breast health concerns. We aim to create a safe space for those in our communities who are in the midst of these circumstances and looking for help. We want to give them the freedom to be fully authentic as they seek guidance and community support. We’re excited to lay the groundwork and start executing our programming in earnest over the next year, and we look forward to reporting back to you about our progress during Breast Cancer Awareness Month in 2022.
Dina Proto, RN, is the Founder and CEO of Dina Proto International, a DE&I and LGBTQ+ Cultural Competency Consulting firm. In addition to her DE&I Healthcare Consulting firm, Dina is a Published Author, Speaker and Educator. In her book, Identity Impact: When Society’s Expectations Collide with the Authentic Self, Dina explores the clinical correlation between society’s projection of gender role and identity and healthcare disparities.
Cindi Creager is a media consultant with decades of communications experience in the news industry and LGBTQI non-profit world, including a successful tenure at ABC News, GLAAD, and her co-owned boutique public relations firm, CreagerCole Communications LLC.
“Trans men and non-binary people are often reluctant to receive cervical screening, raising their risk of undetected human papillomavirus [HPV], which could lead to cervical cancer,” said Alison May Berner, a specialty trainee and clinical research fellow in medical oncology at Barts Cancer Institute in London, a specialist registrar with the Tavistock and Portman Gender Identity Clinic and the study’s lead author, per News Medical.
The results of the study were presented at the American Association for Cancer Research’s Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved this month, indicating that it could have international implications, and Berner said she wants further research to look at trans-specific cervical screenings in a GP setting.
She said: “People assume that this population’s health care-related needs are solely related to transition. That’s not true.
“Trans and non-binary people are at risk of HPV infection and cervical cancer if they continue to retain a cervix, and they stand to benefit from programs designed specifically for them.
“If you’re a trans or non-binary person living in a place where these specialist services do not exist, I would encourage you to work with a trusted health care professional to build relationships and ensure that you get the appropriate screenings, while continuing to have your identity respected.”
Bria Brown-King, 29, a Pennsylvania native, was raised as a girl. As Brown-King got older, however, they realized they were developing differently.
“I didn’t have the feminizing puberty that the other girls in my class had,” said Brown-King, who was born with an enlarged clitoris and started to develop masculine traits during puberty, including facial hair and larger muscles.
Brown-King, who has since come out as nonbinary and uses gender-neutral pronouns, was born with congenital adrenal hyperplasia, or CAH, a rare condition in which the body produces high levels of androgens — hormones that influence masculine characteristics. Those with CAH are considered intersex, an umbrella term used to describe individuals whose sex characteristics do not match strictly binary definitions of male or female. While rare, at least 1 in 2,000people are born with a genital difference caused by an intersex trait, according to Human Rights Watch, an international research and advocacy group.
Though many children with CAH undergo “gender-normalizing surgery” to make the genitals look more typically female in infancy, Brown-King’s parents decided to wait until Brown-King was old enough to choose. But Brown-King said severe bullying over their appearance drove them to get the surgery at 13. Looking back, Brown-King, who now works for InterAct, an intersex advocacy group, said they would have made a different choice “had I known that it was OK to have the body that I had.”
These so-called gender-normalizing surgeries have been performed on intersex babies and toddlers since at least the 1950s — usually in secrecy, without ever telling the children when they get older. Until recently, doctors saw a genital difference as a “psychosocial emergency” and rushed to assign a gender and perform surgery, believing children would be psychologically harmed otherwise, according to Dr. Sue Stred, a retired pediatric endocrinologist who has worked with intersex youth for nearly three decades. Emergency surgery, however, is only necessary in rare cases — if a child can’t urinate properly, for example, according to medical experts who work with these children.
The exact number of hospitals that currently perform these surgeries is unknown, and only a handful specialize in such procedures. Adults who underwent these surgeries as children report mixed feelings, with many saying they have had no problems, while others say they are “just wrought with devastation” over complications, according to Kyle Knight, a senior researcher who interviewed dozens of intersex people for Human Rights Watch. Complications can include sexual dysfunction, loss of sensation, infertility and gender dysphoria, according to the report.
As more people tell their stories, an increasing number of organizations have condemned medically unnecessary surgeries on intersex youth, including the United Nations, the World Health Organization, Physicians for Human Rights, the American Academy of Family Physicians, Human Rights Watch and Amnesty International. Under mounting pressure, several hospitals have recently announced they would defer certain medically unnecessary genital surgeries until children are old enough to participate in the decision, including Lurie’s Children Hospital in Chicago, Boston Children’s Hospital and New York City Health & Hospitals, the largest public health care system in the United States.
“We empathize with intersex individuals who were harmed by the treatment that they received according to the historic standard of care and we apologize and are truly sorry,” Lurie Children’s Hospital announced in a statement last year. It was the first time a hospital had ever made such an apology.
‘The right answer right now isn’t clear’
There is fierce disagreement among doctors and advocates over whether surgical delays should extend to those with congenital adrenal hyperplasia. Unlike many other intersex youths whose genetics and reproductive organs make it difficult to assign a sex, those with CAH have distinctly male or female chromosomes and sex organs — and only those assigned female at birth undergo surgery because of genital and hormonal differences.
As such, some people who work with these children wonder if delaying surgery would do more harm than good. Even adults with CAH are divided over this. A recent study from Europe, which surveyed 459 intersex adults who underwent genital surgery as children, found that 66 percent of those with CAH thought infancy or childhood was an appropriate age for this surgery, while 12 percent thought they would have been better off without it.
Given these complexities, doctors and advocates have argued over whether children with CAH should be exempt from potential laws and policies that protect them from early cosmetic surgery. This was the case last year in California, when lawmakers, advocates and physician groups sparred over whether a bill, which would ban unnecessary surgeries on children with genital differences before age 6, was too broad. The bill, which was strongly opposed by the California Medical Association and Societies for Pediatric Urology, a group that represents the doctors who treat these patients, did not pass.
“The right answer right now isn’t clear,” Dr. Beth Drzewiecki, chief of pediatric urology at Tufts Children’s Hospital in Boston, said. “However, a blanket ban on surgery will not accurately support the views and voices of all of those that have variations in sex development.”
While Lurie Children’s Hospital has ended early medically unnecessary surgeries, it is considering an exemption for children with CAH, who experts say make up a majority of those who undergo feminizing surgeries. In an email, a spokeswoman for the hospital said the surgeries “will not be performed on CAH patients until we have evaluated the best practices and ethics and have released a white paper or report on the topic.”
The risks of ‘gender-normalizing surgeries’
There are no laws in the U.S. that regulate medically unnecessary gential surgeries for intersex children, Meanwhile, the current standard of care “remains an interdisciplinary team approach informed by parents’ wishes,” according to the AMA Journal of Ethics.
Taking this approach, more hospitals are hiring teams of surgeons, psychologists, social workers and genetic experts who work together to better understand a baby’s unique specific intersex trait, a process that can take weeks or even months, according to experts who work with these children. And doctors today are less likely to rush to assign a gender, though this may not always be the case.
“We still make recommendations for what gender we think the child is best going to feel, and we work that way,” Stred said. In cases where it is difficult to assign a sex, she said some doctors may recommend giving the child a gender-neutral name in case the child later disagrees with what sex they have been assigned.
Surgical techniques have improved greatly since the 1950s, with a better understanding of how to preserve sensitive nerves and tissue, according to Drzewiecki. She also said more surgeons today are giving parents options, rather than recommending surgery as a default solution.
“It’s really, I think, important to affirm to the families that their child is going to be OK with or without surgery,” she said, adding that “the most important thing is having transparency about what the risks are, and what the long-term risk over time will be, as well.”
One risk for those with CAH is stenosis, a condition in which surgically altered vaginal openings — performed in order to separate the urethra from the vaginal canal, which are typically fused in these children — can narrow over time, according to doctors. While the procedure is done to create a more typical vagina, doctors say it may be medically necessary to prevent urinary tract infections in some children, though the need for this is debated. A contentious way to prevent stenosis has been for parents or doctors to periodically insert a dilator in the opening to maintain it, though experts say this is usually traumatizing for children and, as such, is rarely done anymore.
Stenosis can lead to issues with menstruation and sex later in life, and may require additional surgery to fix, according to Dr. Frances Grimstad, a pediatric and adolescent gynecologist at Boston Children’s Hospital, who has training in these surgical repairs. And in general, she said, any early surgery performed on a child’s genitals is “playing a guessing game” as to what they will need or want in the future. Overall success rates of early surgeries are hard to pinpoint, she added, since health and insurance databases don’t accurately track them, and medical research tends to focus only on early outcomes.
“Surgeons who are doing these surgeries typically don’t follow their patients into their early 20s,” she said.
Brown-King said they developed urinary tract infections both before and after surgery and had to get additional surgery at age 19 to fix scar tissue.
“Surgery doesn’t fix everything,” they said. “I think that that’s kind of a narrative that sometimes doctors like to paint, that once you have surgery, things will be great. But that’s not necessarily the case.”
Surgery can also lead to mental health problems later in life, especially for those whose parents kept it a secret from them, according to Dr. Katharine Dalke, a psychiatrist at Penn State Health who specializes in LGBTQ and intersex populations. For many, she said, this sent a message that there was something “fundamentally wrong” with who they are, and that they “weren’t lovable otherwise.”
Parents struggle with surgery decisions
While some medical professionals are beginning to take a more nuanced and affirming approach to intersex care, the decision to perform early surgery remains in the hands of parents, who vary widely in their attitudes toward sex and gender. And many struggle to cope with the challenges of raising a child with a gential difference in a world that wants to know, “Is your baby a boy or a girl?” Under this pressure, parents may feel that “doing nothing equals doing harm,” according to Stred.
However, doctors say more parents are deciding to delay surgery, though it’s unclear how common this is. Those who make this choice often navigate a difficult journey alone, with few support groups or resources to guide them.
NBC News spoke to the father of a 6-year-old girl with CAH, who requested that his name not be published to protect his daughter’s privacy. So far, she identifies as a girl, though she is gender-nonconforming, and has had no issues with urinary tract infections, he said.
While he wants her to have “autonomy in determining her own identity,” he also said he worries she will resent him for not getting the surgery. He said he would let her get the surgery when she is old enough to decide.
“My fear is that she will want to do the surgery because of social pressure or peer pressure, and doing something simply to conform or avoid being different, I would have a harder time supporting,” he explained.
Dalke said that helping kids with genital differences begins with understanding “there’s nothing inherently pathological about” them, and that with help from parents and mental health providers, they can learn how to cope with bullying and even thrive.
For this reason, intersex advocates have fought for better education and psychological support for parents, and some lawmakers have begun to listen. That was the case this year when the New York City Council passed a bill that requires the city’s health department to provide intersex-inclusive education to parents and doctors.
There are hospitals that already provide psychological counseling for parents of intersex children, and some parents still struggle in spite of it. Recalling one mother who body-shamed her child during visits, Drzewiecki said children raised in nonaffirming environments are susceptible to psychological harm. And while it’s ideal to raise these children in an affirming way, she said, it’s “unrealistic” to expect that of “everybody in our society right now.”
As for Brown-King, they said surgery did not spare them from bullying, nor are they “worried about finding love” over the way they look. When asked whether those with CAH should be excluded from surgical delays, they posed a different question: “Why aren’t we having conversations with our children about the different ways to have a body?”
“There’s no such thing as having a clitoris that’s too large,” Brown-King said. “In the same way that penises come in all different shapes and sizes, so do clitorises. Why can’t we start to push that narrative instead?”
Anxiety. Depression. Stress. These are some of the emotions LGBTQ Americans experienced during the Trump administration, according to two recent studies. The reports, conducted independently, both landed on the same conclusion: There was a significant decline in the mental well-being of lesbian, gay, bisexual and transgender people while Donald Trump was president.
“Everybody’s worst fears came into reality,” Adrienne Grzenda, an assistant clinical professor of psychiatry and biobehavioral sciences at UCLA and lead author of one of the studies, told NBC News. “We were noticing this undercurrent of despair and hopelessness among our clients,” many of whom are LGBTQ.
While Trump is no longer in the White House, the ongoing introduction of anti-LGBTQ legislation in the states continues to expose LGBTQ people, especially children, to the risk of significant mental health consequences, according to some advocates and researchers.
‘Extreme’ and ‘frequent’ mental distress
A study scheduled to be published in the December issue of the journal Economics and Human Biology found that “extreme mental distress” — defined as reporting poor mental health every day for the past 30 days — increased among LGBTQ people during Trump’s rise and presidency.
The report, written by Masanori Kuroki, an associate professor of economics at Arkansas Tech University, compared the likelihood of extreme mental distress among LGBTQ and non-LGBTQ people by using data on more than 1 million people interviewed from 2014 to 2020 for the government’s Behavioral Risk Factor Surveillance System. https://iframe.nbcnews.com/9TzYQA1?app=1
This study found that the “extreme mental distress gap” between LGBTQ and non-LGBTQ people “increased from 1.8 percentage points during 2014–2015 to 3.8 percentage points after Trump’s presidency became a real possibility in early 2016.” Even seemingly small increases in extreme distress are important, the study notes, because such distress is not common.
While Trump was not the first president to advocate and enforce policies widely considered anti-LGBTQ, his tenure followed the relatively pro-LGBTQ Obama presidency. The possibility of removing recently gained rights and protections “might be more damaging to LGBT people’s mental well-being than simply not having equal rights in the first place,” the study states.
While Kuroki’s report does include a cautionary note about attributing the increase in mental distress among LGBTQ people to the rise and presidency of Trump, he does note that “the findings do suggest that the Biden administration may have inherited higher rates of mental distress among LGBT people” than they would have “if Trump had not run and won the 2016 election.”
In his conclusion, Kuroki suggests that future research examine LGBTQ mental health under the Biden administration, which has already implemented measures to advance LGBTQ rights and protections.
“If presidents affect LGBT people’s mental health, then we should expect that the extreme mental distress gap between LGBT people and non-LGBT people to narrow under the Biden presidency,” he stated in his report’s conclusion.
Grzenda’s study used data from the Behavioral Risk Factor Surveillance System to measure whether the 2016 election and transition to the Trump administration led to a change in the number of sexual and gender minority (SGM) adults reporting “frequent mental distress” compared to cisgender, heterosexual respondents (frequent mental distress is defined as feeling depressed, stressed or unable to control one’s emotions during at least 14 of the last 30 days). Between 2015 and 2018, LGBTQ respondents reporting frequent mental distress increased by 6.1 percentage points, from 15.4 percent to 21.5 percent, while non-LGBTQ respondents reported a 1.1 percentage point increase, from 10.4 percent to 11.5 percent.
“A clear association exists between the 2016 election and the changeover to a decisively anti-LGBT administration and the worsening mental health of SGM adults, although a completely causal relationship cannot be fully established,” the report, published this year in the journal LGBT Health, states.
The effects, however, were not seen evenly among lesbian, gay, bisexual and transgender Americans.
“We’ve got to start looking at sub-populations more,” Grzenda said. “When we break it down, it was bisexual individuals and especially transgender individuals who were really hit the hardest.”
Grzenda said the differential impact on gender minority adults may be because of the Trump administration’s targeting of transgender rights and protections in military service, health care and access to public facilities. At the same time, the focus on lesbian, gay and transgender rights may have “exacerbated feelings of bisexual invisibilty/erasure,” and compounded existing stress for bisexual respondents.
The study, which had a sample size of nearly 270,000 adults, approximately 5 percent of them LGBTQ, states in its conclusion that its findings provide “data-driven support for advocacy efforts toward the implementation of unequivocal antidiscrimination protects on the basis of [sexual orientation and gender identity] across all domains of daily living, immutable to sudden political realignment.”
Grzenda, like Kuroki, notes that a definitive causal link cannot be drawn between the Trump administration and the decline in LGBTQ mental health with existing data, though both studies controlled for likely competing factors.
‘Bullying by legislation’
The effect of politics on LGBTQ mental health is not just relegated to the federal government and national policies. The spate of anti-LGBTQ legislation in statehouses raises concerns about other sources of mental health strain, particularly for young people.
From 2015 to 2019, 42 states introduced more than 200 pieces of anti-LGBTQ legislation, according to a recent study by Child Trends, a nonpartisan research institute, and the introduction of these measures were found to have negative mental health consequences on LGBTQ minors.
The report notes that Crisis Text Line, a global nonprofit that provides free mental health texting services, saw an uptick in messages from LGBTQ youths in the four weeks after their respective states proposed anti-LGBTQ legislation.
“This suggests the bills are harmful whether or not they are passed,” Dominique Parris, director of diversity, equity and inclusion at Child Trends and lead author on the study, told NBC News. “We need to understand the full scope of what these laws do to young people.”
Among the most common types of anti-LGBTQ bills introduced during the 2015-19 timeframe were restrictions on single-sex facilities, the report states.
This year alone, there have already been over 200 anti-LGBTQ bills introduced at the state level, Parris said.
“Oftentimes the argument in support of [these bills] is to protect children, but what this research suggests is that that may not in fact be the outcome, and simply proposing this legislation may cause children distress,” Parris said.
“When there have been public policy decisions, we hear about that on our crisis line,” Amit Paley, the project’s CEO, told NBC News.
When Trump banned transgender people from the military, the Trevor Project saw an increase in trans and nonbinary people reaching out for crisis services, he said. This was not due to trans people necessarily wanting to serve in the military, Paley added, but because a powerful public figure was making judgments about their worth.
“Young people are listening,” he said. “When their message is discriminatory and hateful, that does have an impact.”
Trans and nonbinary youth are at particular risk for the most devastating consequences of mental distress, including suicide, according to Trevor Project research.
“That’s not because LGBTQ trans nonbinary people are born more likely to consider suicide,” Paley said. “It’s because of the discrimination, isolation and rejection they face.”
Paley said that Texas legislators this year have introduced dozens of anti-LGBTQ bills, many of which target trans and nonbinary people.
On Wednesday, a bill that would that would require student athletes to compete on sports teams corresponding to their “biological sex” advanced out of committee and heads toward a full vote on the state House floor where it is likely to pass. The bill advanced despite emotional testimony from parents and students regarding the toll such a law would take on trans children, something LGBTQ children’s advocates have been sounding the alarm about for some time.
“Trevor Project has received almost 4,000 calls, chats and texts from trans and nonbinary people in Texas this year,” Paley said. “This is effectively bullying by legislation. It is dangerous and it is wrong.”
‘Some steps forward and several steps backward’
Advocates hope LGBTQ mental health might improve under the Biden administration, which has made public statements and enacted policies in support of LGBTQ rights.
However, some, like Paley and Parris, worry about the message that certain signals — like the ongoing support for Trump among many Republicans, the onslaught of anti-LGBTQ state legislation and the failure to pass the Equality Act in Congress — will send to LGBTQ youth and adults.
“I think we are seeing some steps forward and several steps backward,” Paley said.
Health insurer Aetna Inc has been sued for allegedly discriminating against beneficiaries that are lesbian, gay, bisexual, transgender and queer by requiring them to pay more out of pocket for fertility treatments.
In a proposed class action filed Monday in federal court in Manhattan, plaintiff Emma Goidel said she and her spouse were forced to spend nearly $45,000 for fertility treatments as a result of Aetna’s policy, which required same-sex couples to pay for fertility treatment out of pocket before becoming eligible for coverage.
A spokesperson for Aetna, which was acquired by CVS Health Corp in 2018, did not immediately respond to a request for comment.
Goidel is covered through her spouse by Aetna’s health insurance plan for Columbia University students, which provides broad coverage for intrauterine insemination (IUI) or in vitro fertilization (IVF) treatments, according to the complaint.
However, while couples that can try to get pregnant through heterosexual intercourse can receive coverage simply by representing that they have tried for six or 12 months, depending on age, couples that cannot conceive through intercourse because of their sexual orientation or gender identity must first pay out of pocket for six or 12 months of IUI, according to the complaint.
Goidel alleges that beginning last year, she and her spouse paid for four unsuccessful IUI cycles, and one unsuccessful IVF cycle, before becoming pregnant through a fifth IUI cycle, all of which Aetna refused to cover.
She said she chose IUI despite previous failures in part because of the higher cost of IVF.
“Ms. Goidel has endured great emotional distress in having to choose a course of treatment based on cost, rather than based on her personal and medical circumstances in consultation with her doctor,” she said.
“Aetna’s discriminatory policy is an illegal tax on LGBTQ individuals that denies the equal rights of LGBTQ individuals to have children,” Goidel alleged. “At best, these individuals incur great costs due to Aetna’s policy language. At worst, these exorbitant costs are prohibitive and entirely prevent people who are unable to shoulder them — disproportionately LGBTQ people of color — from becoming pregnant and starting a family.”
The lawsuit cited a report from New York’s Department of Financial Services in February explicitly stating that policy’s like Aetna’s violated state law.
Goidel is bringing claims under the Affordable Care Act’s anti-discrimination provisions and New York state and city human rights laws, seeking to represent a class of people covered by Aetna student health plans in New York.
The case is Goidel v. Aetna Inc, U.S. District Court, Southern District of New York, No. 21-cv-07619.
Efforts to erase LGBTQ sex education topics from public school curriculum are growing in GOP-led state legislatures and sweeping moves are tightening in Arizona, Tennessee, Idaho, and Missouri. These policymakers would rather punish LGBTQ people for being who they are than provide them with information and educational resources to live healthy, successful lives. In what has become our nation’s latest culture war, it’s disheartening to know that LGBTQ youth stand to lose the most.
Already, there’s no national mandate for sexual education, and for the few states that do offer it, LGBTQ topics are disregarded or degraded. Non-profit organization Sex Ed For Social Change, states, “nine states require educators to portray homosexuality in a negative manner or do not allow them to speak about LGBTQ individuals.” This points to the dismal state of LGBTQ sexual education as-is. Additional efforts to hide this information will only further disempower queer youth.
One of the ways I can resist these recent efforts is by sharing my story of what I didn’t learn in sex ed. This article is a continuation of the first.
1. Pleasure can come in multiple forms.
For many people, sexual education de-emphasizes pleasure and emphasizes risk. Youth lose sight of the benefits that a healthy sex life can provide, and are unable to visualize the many ways they are able to please themselves and meet their needs for intimacy, play, and self-expression. There are also many ways that people can receive pleasure–polyamory, phone sex, adult toys, and more. Ethical Slut offers new ways of being in relationship with individuals. It’s the bible for non-traditional relationships. COVID-19 and our fear of physical touching taught us the power of phone sex, and these are learned lessons we can continue to carry with us. And with adult toys, there is a laundry list of do’s and don’ts. Do not, for example, use silicone lube on silicone toys, because the silicone of the lube can break down the toy’s material. Always use water-based lube on silicone toys.
2. How to give consent & How to say no
We may have at least been taught that consent is important, but we don’t learn the nuances of communication when we’re in the moment. As I’ve grown older, I realized that “I’m getting tired,” or “I have an early morning tomorrow” are indirect ways a potential sexual partner may revoke consent. It’s also important to understand that at any point, for any reason, a person can revoke consent. Even if we’ve begun ripping off each other’s clothes voraciously, any person can later decide that they no longer want to continue. It is vulnerable receive rejection, and it’s also extremely vulnerable to tell someone you’re no longer interested. It takes maturity to acknowledge that the best shared sexual experience comes from both partners being super, super, super excited about being together. Simply put, your experience won’t reach its full potential when your partner’s experience isn’t the most pleasurable. Sometimes it pays to wait for the right moment. And if just the thought of rejecting someone or hearing rejection scares you or angers you, please, please deeply consider choosing to not engage in sexual activity until you’re more comfortable navigating the level of communication needed to protect yourself and others. This video explains it succinctly:
The irony is that even if GOP politicians are unsuccessful in their attempts to further limit LGBTQ sexual health education, the mere discussion of the topic is enough to impact the sex lives of queer youth. Consider a 2020 Trevor report that found that “86% of LGBTQ youth said that recent politics have negatively impacted their well-being.” If we don’t feel safe, we’re not likely to fully realize our sexual potential. That’s because mental health is sexual health. No wonder so many drugs that impact our brain health also have sexual side effects. Mental health also determines if we believe we are worthy of sex and healthy sexual relationships.
4. You get to decide what sex means to you
I believe I lost my virginity the moment I had oral sex with my first partner. Because this person is still in my life as a friend, he once retorted, “We didn’t have sex.” To some people (e.g. Bill Clinton), I have realized that oral sex really isn’t sex, but to me it is. In fact, I don’t even think orgasming is necessary for sex to have happened. This happens to be my definition, and I believe it’s just as valid as the individuals who have more conservative interpretations of sex. Because I find sex to be such an intimate, personal experience I want to affirm young readers that they are allowed to determine what sex means to them–especially since as queer people the way we have sex is often explained within a heteronormative context which doesn’t work for everyone.
Trying to give readers a sex education in two 1,000-word personal essays is impossible. These thoughts are just my own experience, and it’s likely there are many other things you could add to this list as well. We can’t go back and time and give ourselves the sex education we needed, but we can continue forward remaining curious and doing all that we can to empower ourselves now. The topics in this two-part series only start the conversation. Continue following the links, questioning, and discovering your body.
Dr Michelle Telfer, who represented Australia in gymnastics at the 1992 Olympic Games, has described how she “made herself a big target” by becoming a global leader in caring for trans kids.
In a short documentary for ABC News In-depth, Telfer explained that after the end of her gymnastics career at the age of 18, she was inspired to become a doctor by those who had treated her various sports injuries.
She said: “I was trying to decide between doing paediatrics or doing psychiatry. And then in paediatrics, I found adolescent medicine, which is that perfect combination of paediatrics and mental health… I’d found the place I wanted to be.”
In 2012, after returning from maternity leave, Telfer took a job as the head of adolescent medicine at the Royal Children’s Hospital in Melbourne.
She oversaw various services for young people, but her life changed forever when she was asked to lead the hospital’s gender clinic for children.
“I was asked to take over this group of trans children in their care, and I jumped at it,” she said. “I’d never met a trans child before I started this job.”
One of the first children she met with, she was, was named Oliver.
She continued: “I said to Oliver, ‘How do you know that you’re a boy? When did you start thinking about yourself as a boy?
“He was 10 at the time, and he told me his story… It was such a beautiful story.
“And I thought, ‘I can help this child have a boy’s body. How many people can do that?”
Oliver went on to receive hormone treatment when he was 15, with the consent of both of his parents. Now 18, he told ABC News: “I’m in my final year of high school. I’m hoping one day to study medicine, cardiothoracic surgery or something similar.
“I’m really optimistic about my future. I’ve huge ambitions I want to do a lot of good in this world. And I think that, you know, I wouldn’t be in that place, I wouldn’t be able to have those dreams, if I didn’t receive support from Michelle.”
Another of the kids in Telfer’s care, a trans teenager named Isabelle, also appeared in the film. She said: “I don’t know where I’d be if I didn’t have Michelle and the Royal Children’s Hospital with me. I think I’d equate a large part of my being alive at the moment to them.”
Right-wing newspaper The Australian has written “nearly 50” articles about Michelle Telfer.
But, despite the huge satisfaction she gets from helping kids to be their true selves, as the “debate” over trans people’s right to exist gets louder, Michelle Telfer has has become a “target”.
“There have always been critics,” she said.
“You don’t go into this area of medicine without being warned about becoming a target. And I’ve certainly made myself a very big target.”
“From August, 2019, to the current time, The Australian newspaper has written nearly 50 articles about me and my work,” said Telfer
“The newspaper is inferring that clinicians like me are harming children, that it’s experimental, that the care is novel, and that they’re potentially mentally ill and they’re not really trans.”
In 2020, following fierce lobbying by right-wing media and anti-trans campaigners for a “national inquiry” into health care for trans kids, Australia’s health minister Greg Hunt referred the issue to the Royal Australasian College of Physicians.
The college shot down the idea of an “inquiry”, instead calling for greater access to gender-affirming services for trans kids.
However, even after the statement in support of her work, Telfer said the articles in The Australian continued and she began to struggle with anxiety.
Finally at the end of her tether, last year Telfer submitted a 42-page complaint to the Press Council over The Australian‘s coverage.
Despite everything, Telfer remains “absolutely optimistic about the future”.
“I know that what we’re doing is the right thing,” she said.
“Society has for hundreds and hundreds of years tried to ignore and dismiss trans people. But now that we’re affirming them, look at what they can do.”