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Editorial Published In Annals Of Internal Medicine Calls For Greater Engagement Of Transgender And Gender Diverse People In Health Care Decision-Making

BOSTON, October 4, 2022—An editorial published today in the Annals of Internal Medicine asserts that all aspects of gender-affirming care must be informed by and led with the voices of transgender and gender diverse (TGD) people. The editorial draws on information from a new history of the closure, in 1979, of the Gender Identity Clinic at Johns Hopkins Hospital that was also published today by the Annals of Internal Medicine.

The meticulously researched account of the institutional circumstances that resulted in the pioneering clinic’s closure corrects long-standing, entrenched narratives claiming that the decision was informed by austerity measures, evidence showing that the clinic did not yield positive health outcomes for patients, and risk aversion.

“It turns out that transphobia, defamatory rhetoric, and strategic disinformation infused nearly all of the key decision-making moments that culminated in the closure of Johns Hopkins Hospital’s Gender Identity Clinic,” said editorial lead author Dr. Alex S. Keuroghlian, who directs the National LGBTQIA+ Health Education Center at The Fenway Institute and the Massachusetts General Hospital Psychiatry Gender Identity Program. “Those circumstances eerily parallel today’s sociopolitical landscape. A key lesson from this history that can be applied today is the necessity of engaging with transgender and gender diverse communities at every step in the process of designing, sustaining, and expanding clinical services, training curricula, research studies, and policy agendas related to gender-affirming care.”

The experiences, perspectives, and proprietary knowledge of TGD people can be incorporated through meaningful partnerships with local TGD community organizations, inclusion of TGD people on community advisory groups, and proactive recruitment, development, and mentoring of the TGD healthcare workforce.

“Medical professionals must also have the courage to resist and denounce decisions made at the individual, departmental, organizational, systems, and governmental levels that will result in making gender-affirming care harder for TGD people to access and more difficult for clinicians to deliver,” said senior author Dr. Asa Radix, Senior Director of Research and Education for Callen-Lorde. “All health care organizations should adopt well-established practices to train their staff in mitigating anti-transgender bias and creating culturally inclusive health care settings.”

The editorial titled, A Cautionary Tale,” is available online here. It is the latest in a series of opinion pieces by clinicians and researchers affiliated with The Fenway Institute at Fenway Health highlighting the urgent need for change across all levels of the health care system to create culturally responsive health care settings for TGD patients and members of the workforce. Recent pieces include “Supporting Transgender and Gender Diverse Medical Students,” published in September 2022 by The Lancet; “Clinician-Level Implications of Bans on Gender-Affirming Medical Care for Youth in the US,” published in August 2022 by JAMA Pediatrics on August 8, 2022; and “Achieving the Triple Aim for Sexual and Gender Minorities,” published in July 2022 by the New England Journal of Medicine.

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