Opinion: Withholding gender-affirming care from children violates the Hippocratic Oath

As pediatricians in Colorado, we are appalled by the tidal wave of radical and harmful anti-LGBTQ+ – and specifically, anti-trans – policies being implemented around the country. Like all young people, LGBTQ+ youth should be made to feel welcome and supported in their communities, not ostracized.

Given our role as health care providers, we feel strongly that all transgender youth deserve access to gender-affirming medical care that is comprehensive, developmentally appropriate, safe, and inclusive. We work closely with individual children and their caregivers to do what is best for each child, and importantly, we do so free of political interference.

Right now, our patients and the sanctity of our patient-doctor relationships are under attack.

In February, Texas Gov. Greg Abbott directed the Texas Department of Family and Protective Services to investigate gender-affirming services as child abuse. In response, the American Academy of Pediatrics and its Texas chapter released a statement strongly opposing this policy because it directly threatens the wellbeing of transgender youth and the caregivers who love and support them.

Fortunately, a judge has temporarily halted this directive. However, other policies that negatively impact LGBTQ+ youth have continued to emerge across the nation.

On March 8^th, the Idaho House of Representatives passed an egregious bill that would criminalize gender affirming care for young people. During the past two weeks, legislatures in Utah and Florida have passed bills to restrict trans kids’ access to sports teams that align with their gender identity and to limit discussion of LGBTQ+ topics in schools.

As members of the Colorado Chapter of the American Academy of Pediatrics, we stand with our colleagues across the nation in condemning these harmful, dangerous policies. Furthermore, we call on our elected leaders at all levels of government to reject any policies that endanger transgender and other LGBTQ+ youth, who are among our most vulnerable patients.

A robust body of scientific evidence and our own clinical experiences make it clear that transgender adolescents experience higher rates of depression, anxiety, and suicide attempts than their cisgender peers. This increased risk of mental health problems is not inherent to a given child’s identity as transgender; rather, it reflects the challenges of facing internal conflict between one’s appearance and identity and enduring ongoing discrimination, stigma, and social rejection.

For pediatricians, this is personal. In our daily work in hospitals and clinics, we routinely see the pain that transgender children suffer due to bullying at school, lack of acceptance at home, and a deep-seated feeling that they just don’t belong. Here in Colorado, we watch as these experiences lead our patients to perform poorly in school, experiment with substance use, engage in self-harm, and attempt suicide.

Too many times, we have stood beside parents as they grapple with the unimaginable pain and sorrow following their child’s completed or attempted death by suicide. We would do anything in our power to prevent these tragedies from happening.

Fortunately, the tools to combat stigma against LGBTQ+ youth are at our fingertips. Transgender youth who live in communities with a culture of acceptance are more likely to have parents who also affirm their identity. When transgender youth feel accepted by their parents and other trusted adults, their risk of attempted death by suicide is dramatically reduced.

Accordingly, it is our responsibility to foster communities that celebrate children of all identities. Ill-conceived policies such as those recently put forth in Texas, Idaho, Utah, and Florida do the exact opposite.

In addition, these policies put doctors in a terrible position. They force us to balance our obligation to provide the best possible care for our patients against the threat of exorbitant fines, forfeiture of our medical licenses, or incarceration.

We believe that stopping or withholding gender-affirming care is a violation of our Hippocratic oath to “do no harm” because doing so will lead some children to endure profound mental anguish and even attempt suicide. However, when faced with such threats to our livelihood and our personal freedom, how can we possibly uphold our professional obligation to do what is right for our patients?

As pediatricians, we have dedicated our lives to promoting the health and safety of children in our communities. We denounce efforts by politicians across the country to interfere with that mission. We are committed to helping parents understand and embrace their transgender children, ensuring that trans youth have access to medically appropriate gender-affirming care, and helping build communities that are welcoming and inclusive.

Ultimately, it’s up to all of us to ensure that LGBTQ+ young people are treated with dignity and respect.

To our LGBTQ+ youth in Colorado, throughout the country, and around the world: we want you to know that we see you, we value you, and will stand up for your right to live as your true selves.

Dr. Matt Guerrieri is a resident physician in Denver. Dr. Lucas Morgan is completing his first year of residency in Denver. Both live in Denver and are members of the American Academy of Pediatrics, Colorado Chapter.