“When all Americans are treated as equal, we are all more free.”
— Barack Obama, 44th president of the United States
Just last week our team diagnosed a 16 year old with HIV. She was assigned male at birth, but identifies as female. From a young age, she felt forced to be something that she is not — forced to be a male when she identified as a female. She felt suffocated, trapped and unable to be herself. At 13 years old, she told her mother that she was a girl. Instead of offering her the support she desperately needed, her mother kicked her out. On her own, as a teenager, she had few options for survival and felt forced to have sex to have a place to sleep at night. She frequently feels isolated, alone and abandoned, and drinks alcohol to cope.
Across the United States, nearly 150,000 American teenagers from 13 to 17 years old — one out of every 137 teenagers — report being transgender or gender non-binary. The story of our patient is not uncommon; transgender youth experience higher rates of anxiety, depression and suicide. Unfortunately, higher rates of physical and sexual violence, discrimination, ostracism and homelessness contribute to these symptoms. Such experiences predispose youth to circumstances that may put them at risk for HIV by limiting their options for protecting their health and well-being.
Data suggest that youth who receive family and community support, have less distress and improved health outcomes. Yet, the current administration is considering narrowly defining gender as a biological, immutable condition determined by genitalia at birth, making family and community support less accessible to transgender youth. Such action would not only invalidate the lives of both transgender youth and youth born with ambiguous genitalia but also further isolate these youth by potentially reversing essential federal and state protections in education, health care and employment.
Gender identity originates from the brain. Persons who are transgender or gender non-binary have existed in society for centuries. They do not have a choice in who they are. The narrowly determined definitions of gender proposed for implementation by this administration would undermine the progress we have made to increase tolerance and acceptance. Policies like this one further marginalize and isolate youth like our patient increasing their risk of poor health and social outcomes. They additionally undermine the care we provide to those patients, their families and the communities they live in. As adolescent medicine/young adult specialists and mental health providers who care for transgender youth, we fear that such action would codify the immense stigma and discrimination affecting this population and expose the children, adolescents and emerging adults to even higher rates of violence, hatred and discrimination. As health care providers, our job is to “do no harm.” We believe that public policymakers share in this responsibility for the people they serve. This action would not only harm, but potentially endanger lives.
A narrow definition of gender would threaten not only one’s civil but also one’s human rights. If we cannot protect a person’s right to be who they are — then what kind of society have we become? Such action would threaten the thread of what defines our nation — a country for all persons, regardless of race, ethnicity, religion, age, socioeconomic status, sexual orientation or gender identity. It is critically important that we communicate to our national leaders the devastation this policy change will bring to our country. Leaving any person behind because of gender non-acceptance is simply unethical, un-American and ultimately results in great loss and cost to our communities.
Dr. Renata Sanders (firstname.lastname@example.org) is on the faculty at the Johns Hopkins University School of Medicine and is the co-director of the Pediatric and Adolescent HIV/AIDS Clinic and the Emerge Clinic for Gender and Sexuality in the Center for Adolescent and Young Adult Health. Dr. Errol L. Fields (Errol.Fields@jhmi.edu) is a member of the faculty at the Johns Hopkins University School of Medicine and is the co-director of the Emerge Clinic for Gender and Sexuality in the Center for Adolescent and Young Adult Health. Kathryn Van Eck (email@example.com) is a member of the faculty at the Johns Hopkins University School of Medicine and a clinical psychologist at the Emerge Clinic for Gender and Sexuality in the Center for Adolescent and Young Adult Health as well as at Kennedy Krieger Institute. The views expressed here are their own.