Transgender Health and the Political-Sociocultural Framework

Medical prescriptions
Close-up of physician writing down prescription in the medical card by Storyblocks 

The stakes are high, and the morale is low. There was a time kids were hospitalized to have their tonsils removed at astonishing rates. A British journalist at the Daily Express in 1927 wrote that tonsillectomies were routinely performed on at least 80,000 schoolchildren annually. In the 1970s, public discourse claimed it was a practice that did not have the child’s best interest at heart. (Dwyer-Hemmings, 2018).

In 2019, a study focused on improvements in care delivery. It recommended education for clinicians and patients with actionable goals to optimize the tonsillectomy management of children pre and post-operatively, emphasizing reducing inappropriate or unnecessary operative procedures or variations in care (Mitchell, Archer, Ishman, et al. 2019).

Take the Eustachian tube debate among scholars and physicians. Once again, affecting the pediatric population, any child with frequent ear infections who does not respond to traditional treatment might be a candidate for eustachian tube dilation. A child who responds to conventional therapy is most likely not a candidate. Eustachian tube dilation procedure is guaranteed to minimize the risk of hearing loss caused by ear infections (Tisch, Maier, Sudhoff, 2017).

What about cesarean sections? Most commonly performed worldwide, mainly in the United States. Can we say C-sections are classified as major surgery and a risk to the birthing parent and the infant?

A Harvard Chan podcast at the School for Public Health held by two OB gynecologists agrees that risks correlate to hospital labor and delivery units’ management. (Shah & Leavitt, 2017).

The trends are not just about tonsillectomy, eustachian tube dilations, or C-section narratives; puberty blockers for prepubescent children allow a child time to decide.

Prepubescent children are not receiving gender-affirming surgeries. Prepubescent children are receiving plastic surgery who present with rare diseases or are born with cleft palates and congenital anomalies.

Debates about prepubescent blockers will probably continue for decades, turning the discussions into a political platform and a public health concern.  In an interview with pediatrician Dr. Raoul Sanchez, M.D., puberty blockers have been well-studied for years, given that the intersex population consists of individuals who don’t reach puberty until much later. Some present with Androgen Insensitivity, Congenital Adrenal Hyperplasia, and Kleinfelter’s, but not all are the same. Still, unlike the other examples, gender-affirming care does not receive the same consideration.

For the tonsillectomies, Dwyer-Hemming’s arguments point to the shifts concerning social determinants that have lasted over a century and remain in discourse among medical providers. To date, tonsillectomies continue.

Reducing risks for birthers and infants hinges on how hospital labor and delivery units manage care (Shah & Leavitt, 2017).

Despite reported deaths in tonsillectomies and C-sections,  the clinics weren’t cut off or shut down. Funds weren’t slashed. Doctors weren’t threatened with felonies, and people weren’t left without any care. There might have been some malpractice suits, but overall, the government did not step in and shut down access to care.

We could improve pediatric medical and mental health practices addressing gender-affirming care by tracking public health trends and studies focusing on three areas; the number of individuals receiving informed consent and counseling unhurriedly and competent medical care compared to those rushed through all three modalities. 

A study was done on why individuals chose to reverse their transition.

Fenway Institute and Massachusetts General Hospital (Harvard Medical School) published one of the first rigorous studies that showed 82.5% of people who reversed their transition did so because of family pressure, lack of affirming environments, sexual assault, and violence. (LGBT Health  2021).

We must be open to all conversations, including detransitioners who detransitioned for various reasons. Not everyone detransitions because of regret. We have a public health crisis identified in the Fenway and Harvard study.

Some who have braved coming forward to talk about having detransitioned did so at risk only to end up blamed by the trans community, who fear that these stories will end gender-affirming care. The fear is displaced, however. The rise in political sociocultural blind spotting originates from economics, religion, and political interests as opposed to the small percentage of detransitioners who have come forward to report alongside medical providers and parents concerned with a lack of medical and mental health due diligence.

We are responsible for improving the informed consent process as a continuum instead of a rushed one. We also must remember that what makes a pediatrician good at their job is when they take the time to address the child, the parents, and the family unrushed. The fashion of medical delivery has turned shabby because it is primarily rushed in a standardized way throughout most clinical settings. The hospital industry, by design, is all about money, time, and reputation. This is a bad combination because when time is money, the usual outcome will affect reputation at the end of the day. Someone will not feel adequately cared for or pleased with their care or treatment.

Budget slashes usually come at the cost of training, employing less-skilled individuals, and rushed consent processes and procedures to save time and money at the risk of medical errors.

Addressing social determinants in healthcare that potentially could result in delays in treatment requires changing the dynamics of social, cultural, and economic policies at the political level.

This article was updated on June 5, 2023.

Transgender Care is Needed

Apartheid in South Africa was racial segregation and politically driven, with consequences for anyone who opposed segregation. Apartheid existed in the U.S. as well, but we avoided using this term. 

We do not learn from our past mistakes. We continue to placate political agendas to spare our institutions.

Robert Otto Valdez, Ph.D., M.H.S.A., at the Agency for Healthcare Research and Quality, reported that we have “troubling trends” in healthcare quality and delivery. The report addresses intersections and social determinants that affect healthcare.

H.R.C., in October of 2022, in a press release, addressed the consequences of denying youth transition-related care. In youths aged 13 to 20 years enrolled in gender-affirming care, including puberty blockers and gender-affirming hormones, suicidality rates dropped over a 12-month follow-up by 73%.

We enhanced the mental health of kids and adults everywhere until Governor DeSantis’s latest Parental Rights in Education bill otherwise known as the anti-gay bill. Institutions, schools, and medical and mental health care face the consequences if they do not comply. The bill is anti-gay, shamefully dismissing the value of all the hard work of activists, healthcare and mental health providers, and organizations serving children and young adults.

Photo by Tima Miroshnichenko on

Many of us are deeply concerned with the changes imposed on Floridians. Others seem to have ignored the experts. Experts are usually the people who live as the person who is the least understood by mainstream communities. While DeSantis’s latest ruling is not necessarily racially driven, it segregates LGBTQIA2S people. His agenda will continue infiltrating every grant and state-funded educational program, including universities. When institutions and programs comply, the erasure of this population will take effect, and we will shut down narratives and history.

We already have whitewashing eliminating parts of truth in history in predominantly most schools. However, even in some tourist sectors, the names of slave markets have changed to avoid having conversations that these markets once housed and sold enslaved people. During the AIDS crisis, we refused to acknowledge people in grief, instead reinforcing stigma. Partners, families, friends, and communities grieved in silence as the world looked on in judgment criticizing and blaming gay men for the crises neglecting to recognize that AIDS did not discriminate, and children, Ryan White, for one, and his family endured hateful speech. Ryan White contracted AIDS because of a blood transfusion, and many others lived in isolation and silence. 

We have separation within Florida, driven by misinformation and misguided intentions to scare parents, teachers, mental health, and medical providers into complying with threats to criminalize anyone opposed. The anti-gay bill is damaging to children, and their families may be trans or sexual minorities will be unable to talk openly and honestly. How does a six-year-old share a story about his two dads?

Once again, Florida is at the helm of fueling biases within groups opposed to transgender care. The rhetoric that hormone blockers are irreversible is to intentionally misstate, misinform, and instill public fear. Parents whose transgender children are now adults are some of these experts who dispel the incited lies. However, despite over 7,000 people from all across the U.S. joining forces with HRC in condemning the attacks on transgender and non-binary youth and President Biden promising to have their backs cascading effect is in full force. Attempts to shut down conversations are another example of erasure. 

World Professional Association for Transgender Health (WPATH) and the United States Professional Association for Transgender Health (USPATH), in November of 2022, made a public statement opposing the Florida Draft Rule Banning Gender Affirming Care for Adolescents. 

Just as in South Africa during Apartheid, political agendas dismissed the consequences to POC. The radical curtailing of access to mental health and medical care and its toll on the Black community led to an economic crisis. It increased suicidal behavior in Black South Africans. Another example of political agendas harming people is in Kabul, Afghanistan; since the Taliban have taken control, measures to erase women and girls have been a long-standing practice.

What will the consequences be to the trans population of adolescents? We already have the data. We know there will be an increase in suicidal ideation and deaths by suicide. We know that individuals will suffer health and socioeconomic disparities. What about lower grades and the Parental Rights in Education bill? Is this really about parental rights or enforcing existing bias against sexual minorities and gender non-conforming and transgender youth and families? Will we see an increase in deaths by suicide, a rise in mental health illnesses, medical crises, family violence, and homelessness? Who will we hold accountable?

City Ordinances

two persons standing on the street
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Last year the HRO passed LGBT rights in Jacksonville. Last month I was invited to the Women’s Center’s Open Door celebration and given a personal tour of the facilities by one of the board members, who pointed out to me that they were supportive and all-inclusive of both LGBTQIA men and women despite the gendered bathrooms. She showed me two identical single-stall restrooms. One was for men, and the other was for women. To meet the city’s code, the single-stall New Human Rights Ordinance bathrooms could not be gender-neutral. It seemed odd, given the fact that the HRO had passed. I took note to think about this at a later time. This afternoon, I went and reviewed the ordinances online, which, by the way, was an incredibly tedious process. Some businesses, including one I visited in downtown Jacksonville, Chamblin Bookmine, have gender-neutral single-stall bathrooms. I decided to search the web instead. I came across this article.

“The law does not have any new requirements regarding bathroom usage.”

New Human Rights Ordinance
“Earlier this month, the Occupational Safety and Health Administration released a set of guidelines regarding bathroom access for transgender workers. The guidelines recommend providing better access to options for transgender individuals with gender-neutral facilities.”
Gender Neutral Signs
I’m not sure why the Women’s Center could not have single-stall restrooms, but maybe this is one of those situations where the inspector was misinformed. I don’t know, but it all seems ridiculous to me. Can you imagine if we were required to have gendered single-stall bathrooms at home? What about the campgrounds or art market? We seem to accept these gender-neutral bathrooms just fine, but we can’t or won’t allow the ones inside a building.

This article was updated on June 5, 2023

©An Goldbauer

Transgender Violence On College Campuses

architecture building campus college
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To some, colleges and universities are “ivory towers” isolated from the larger society. A closer look shows that this country’s academic institutions are reflections of our broader community, struggling with the same social issues and prejudices. Lorri L. Jean, Executive Director, National Gay, and Lesbian Task Force.

The Spinnaker, a News Source from the University of North Florida, released an article reporting an incident which involved a transgender student who was assaulted and verbally threatened by a male in a campus bathroom. The report red-flagged the failure of the UNFPD to release a Clery report. The incident took place February 6 of this year and was reported to the UNFPD on February 7th.

It isn’t unusual to hear that police are poorly trained in handling cases of LGBT assaults nor rare to hear of agencies, such as Victims Advocacy and LGBT groups reporting the way these types of incidents (as what happened February 6) are often minimized or dismissed.  The article stated that Chief Strudel’s response was “it is rare, and therefore, we aren’t going to do anything about it.” However, there were concerns expressed by Strudel that his statements were taken out of context when I spoke with him this afternoon. As someone who works as an advocate, activist and photojournalist on LGBT issues, my first reaction in reading this statement in the Spinnaker, was “Is this an accurately recorded statement?” My second reaction was to seek clarification since any incident involving an assault on campus would warrant a Clery report. If you aren’t aware of what a Clery report is, know that it is a set of federally mandated guidelines for universities. The Jeanne Clery Disclosure of Campus Security Policy and Campus Crime Statistics Act (20 USC § 1092(f)) is the landmark federal law, originally known as the Campus Security Act, that requires colleges and universities across the United States to disclose information about crime on and around their campuses. The law is tied to an institution’s participation in federal student financial aid programs and it applies to most institutions of higher education both public and private. The Act is enforced by the United States Department of Education.

Both Title 9 and the Clery report serve to protect students on campuses, so to have guidelines in place and not follow the protocols would be an act of non-disclosure and not help in the best interest of the population who are most at risk for hate crimes.  Strudel denied that he stated that the case was not a hate crime and in fact, insisted that he kept having to correct the reporter. Strudel noted that the reporter took things out of context. A similar complaint by Kaitlin Legg, when I spoke with her earlier this afternoon, was that she had to repeatedly correct the reporter on some statements taken out of context. Legg is acting director of the LGBT Resource Center.

According to the article, the cameras were not checked by the campus PD. Strudel stated that initially when the report came in on February 7, the day after the crime, some of the details were not available, such as where the offense took place nor the name of the victim. Once the PD received this information the Communications sector on campus reviewed the footage. According to Strudel not all the cameras on UNF campus are updated; some are around 7 years old and are analogs and clarity is an issue. Dr. Thomas Serwatka, VP at UNF, emphasized the concerns he and President John Delaney had regarding the delay in releasing the Clery report and investigated the falling out with the campus procedure as soon as they learned of the article in the Spinnaker. Strudel stated that he recognized that he should have released this report immediately, regardless of not having all the information and felt he was protecting the student. Serwatka noted that UNF does not tolerate hate crimes nor non-disclosures of these incidences and are implementing protocols to ensure that procedures are followed regardless of the sexual orientation or gender identity and expression of the individual. The UNFPD is now executing the process for all cases of assaults and had released the crime report later this afternoon. News coverage on First Coast News took place this evening at 11 p.m on the published crime report.

©An Goldbauer