Reduced trans health care access cause for concern

Members of Charleston’s LQBTQ+ community say it’s important for people to understand how dangerous it is to bar access to hormone therapy for gender nonconforming minors.

The Medical University of South Carolina Pediatric Endocrinology Clinic stopped offering hormonal therapy last July to gender transitioning individuals younger than 16 years old, creating another obstacle in an already hazardous path for those seeking transgender affirming health care.

“The reality is, in working with transgender youth or those who are questioning themselves, suicide is a high risk,” said former Charleston County Council member Colleen Condon of West Ashley, current board president of Alliance for Full Acceptance (AFFA).

MUSC spokesperson Montez Seabrook told the Charleston City Paper that discontinuation of hormonal therapy for gender transitioning kids was in response to the newly enacted state budget proviso 23.4 that prohibits MUSC from using the state funds it receives for “any action furthering the gender transition of a minor child under the age of 16.” It went into effect July 1, 2022, when the 2022-23 budget became law.

Alternatives available

Condon said there are health care agencies in the area that can provide hormone therapy treatment to transgender minors, but she won’t publicize the names due to the threats of violence against some medical providers in the LGBTQ+ community. You can call AFFA or We Are Family to learn more.

“If a child has the support and consent of his or her parents, in addition to the support and participation of a licensed practicing [physician] — then I think the best decision has been made for the child,” said a father whose 17-year-old son receives hormone therapy from MUSC and prefers to remain anonymous.

“There’s no conservative politician who should step in between and say, ‘This can’t happen.’ That’s just wrong.”

The change in access to hormone replacement therapy at the MUSC Pediatric Endocrinology Clinic followed pressure from the conservative state legislators and the conservative political organization South Carolina Freedom Caucus, Condon said.

“The Freedom Caucus is telling doctors that they can’t do what they think is medically appropriate for their patients,” said Condon, who is also an attorney involved in more than 200 name and gender confirmation cases for the transgender community.

People who stand to be most affected are those under the age of 16 who may need consultation and follow up appointments at MUSC or a continuing prescription for current hormone therapy, she said.

Condon said hormone therapy is considered a safe and reversible treatment in the national public health system. The options available to minors are puberty blockers and hormone replacement therapy.

“Puberty blockers are used as a tool when someone’s just having massive anxiety and problems with puberty approaching,” she said. “Then once puberty hits — that’s when it switches over to hormone replacement therapy.”

Harmful rhetoric

Condon said one hugely harmful aspect of the rhetoric surrounding gender affirming care for minors is equating it with surgery that alters sex organs or characteristics.

“We are talking about puberty blockers [and] hormone replacement therapy — there is not a doctor in the state who has done a mastectomy, hysterectomy or gender reassignment surgery on a minor,” Condon said. “It just isn’t happening.”

She said that those in custody of a minor must agree to hormone therapy, and calling it immoral invalidates parental authority.

“Certainly parents aren’t making the decision irrationally and quickly for their children,” Condon said. “They’re saying, ‘Let’s talk about it. Let’s think about it. Let’s understand the medical issues and then decide later whether we start it or not, and if so, when?’”

A 29-year-old downtown resident who asked to be anonymous told the City Paper he was “basically nonfunctional” when he hit puberty before receiving hormone therapy.

“I was so angry all the time and my emotions were so out of control. I couldn’t explain it because I didn’t have the information or language that was available to me. I was disruptive at school. I had to be put on psychiatric medication. I was just a mess. I was just totally non-functioning until I was able to start transitioning when I was 16.”

He said he started doing extracurricular activities and making friends, and the future became something he could work toward.

“It was just a night and day difference,” he said. “Not being able to transition earlier put my life on hold. It was not a neutral option. It was actively harmful to me. I hate that there are kids who are going through that — especially when they have the information, but the medical treatment available to them [is] being blocked because of outside interference from people who do not know what they’re talking about.”

The nuances behind hormone therapy

Chandler Massengale, family health coordinator for We Are Family (WAF) in Charleston, runs a parent support group that often discusses the ins and outs of gender affirming health care for minors who are unable to consent for themselves.

She said a central reference point for WAF is the World Professional Association for Transgender Health standard of care, which provides specific recommendations for different hormone therapies such as puberty blockers, also known as hormone blockers.

“You have to be within a certain developmental stage toward puberty before you’re able to do that,” she told the City Paper. “It’s a huge misconception [that] 4 or 5 year olds [are] getting hormone blockers — that’s just not true. You have to be 11, 12 or 13 depending on where you are in puberty.

She said the miscommunication surrounding hormone therapy within the general population is very detrimental.

“There are many requirements,” she said. “It’s not just parents and kids deciding to go to the doctor and say, ‘Alright, get [them] on hormones’ — that’s not at all how that works.”

Lee Anne Leland, co-facilitator for Charleston Area Transgender Support (CATS), said one thing she’s sure of in her 70 years as a gender-nonconforming woman is that hormone therapy helps young people discover the truth.

“Some may not transition, they may just say, ‘I’m happy just being gender diverse.’”

Leland said young children are aware if they’re struggling with gender identity and it’s not harmful to affirm it.

“If you don’t fit in that little box that society wants to put you in, where does that leave you? You’re an outsider.”

One 17-year-old’s story

The parent of the 17-year-old previously mentioned, who live in Berkeley County, shared some of his son’s journey at MUSC with the City Paper. He said the first consultation with a pediatric endocrinologist in June 2021 at MUSC was a life changing experience for his son.

“He walked out of there with his head high instead of [feeling] that the world is against him — especially in South Carolina … The environment in this state is not friendly for a lot of reasons.”

His son started hormone therapy February 2022 at 16, but started mentioning his journey with gender nonconformity at 11. He said he and his wife’s first response was to support their child.

“Neither my wife or I are transgender, but we can try to understand. You have to believe your child. You start from that position.”

They did everything they could to help their son as he dealt with serious anxiety, he said.

“As a teenager, once you start declaring this and wearing it on your sleeve — you start inviting the animosity and ugliness that we know happens among teenagers. He attempted to take his life in the spring of 2021.”

He received immediate care from the MUSC Institute of Psychiatry, and was then referred to the pediatric endocrinology clinic a few months later.

“[We were able to] start the process of what [my son] desperately needed and desperately wanted.”

He said the care his son received from MUSC not only helped him out of a crisis, but it also affirmed him as a human being.

“He started facing the world in a completely fresh and new way. He started making good grades again and couldn’t wait to get to work at a restaurant and get out there and be on a team and just be productive. He started [talking about] what [he wanted] to do after high school.”

Now his kid is healthy, he said, and even though there are challenges ahead, his son can face them.

“[Being] transgender — you can’t separate that from everything else that a teenager deals with, it is just an extra layer of difficulty.”