Middlesex Health Sees Growing Anxiety in

Transgender Patients Around the Country,

But Connecticut Has Their Backs

By Jane Latus

Taking direct aim at their hate-saturated bullseyes, red state after red state has enacted laws preventing transgender youths from playing sports, using the appropriate bathroom, and even using accurate vocabulary to describe themselves. 

Now, these states are implementing practices that can negatively affect trans kids’ physical and mental well-being by criminalizing gender-affirming health care. The trend is, unfortunately, continuing. Some of the restrictions now codified into law at this writing follow. Texas wants to charge parents and providers of gender-affirming health care with child abuse. This ruling is mired in litigation, and the outcome is anything but clear. Alabama has banned gender-affirming surgery for anyone under 18 and is charging providers to patients under age 19 with a felony, punishable by up to 10 years in prison and a $15,000 fine, despite the fact that such care is extremely rare. All gender-affirming care for minors is banned in Alabama, although there is a temporary injunction regarding hormone blockers. A provision in the law requires school officials to out transgender children to their parents. Florida is advising against any gender-affirming care for youth, and Florida announced plans to become the 11th state to deny Medicaid coverage for patients of all ages, including for puberty blockers and cross hormone therapy. 

The daily effects of these bans are in flux as they proceed through lawsuits and appeals. Meanwhile, trans children and their parents are justifiably living in fear.

Here in Connecticut, this year the legislature famously passed and Governor Ned Lamont signed the Reproductive Freedom Defense Act, which expands access to abortion and legally protects medical providers and patients traveling to Connecticut for abortions. 

But getting much less attention was what else Connecticut did this spring: enact a law that provides refugee status and protection from prosecution in other states, for anyone coming from out-of-state to receive, and for in-state providers who perform, gender affirming health care.

Even though Connecticut residents don’t need to worry about having their medical care taken away, this support from state government is a much-needed reassurance, says Kathryn Tierney, medical director of Middlesex Health’s Center for Gender Medicine and Wellness. The program has about 1,200 patients and includes primary care providers and a full array of other providers. 

“It’s a huge concern to the community. We’re in a good spot in Connecticut, but the difficulty is these laws give voice to people who are on the opposite end of the [political] spectrum. They become louder and more forceful. There’s a whole population that thinks we shouldn’t have this care,” says Tierney. 

Tierney wants to remind Connecticut’s trans and nonbinary residents that Middlesex is, without question, committed to them. 

“We see the general level of anxiety going up in our patients. The attack is very pointed. It’s directed right at them. The thing I hear most frequently is some version of ‘They’re coming for us.’” Even for Connecticut residents, states like Texas, Alabama and Florida are nearby in terms of who we communicate with, she adds. And people in those states are more emboldened to be disrespectful.

In proposing the ban on Medicaid funding for gender-affirming care, Florida’s Agency for Healthcare Administration dismissed studies citing this care’s positive outcomes as following a political agenda. The agency called standards of care in states that permit and fund it “experimental and investigational”, and the supporting studies “weak to very weak.”

Tierney couldn’t believe what she was hearing from Florida. It was the same argument that the federal Medicare program used years ago to justify not covering gender-affirming care. 

This especially angers her because, she explains, “the trans community has the poorest, most marginalized, in it, and the most-likely to access state health care.” 

The people behind the bans in other states say they are trying to save people from these treatments. But, Tierney insists, “Trans-affirming care is lifesaving.” A large and growing volume of studies confirm it, she says.

Tierney has patients who live in 10 different states who return to Middlesex at their own expense for treatment. “Not necessarily because of prohibitions but because they don’t want to risk their important care [to the hands of unknown],” she says.

Still, all the kids in Alabama, whose law Tierney calls “the worst,” won’t have the money or time to travel here. There, youths on puberty blockers have to stop mid-treatment, allowing the incorrect puberty to start. This situation is when trans youths have the highest rate of suicidal thinking. Those who are forced to stop taking cross hormones will see a return of their natal sex organs and secondary sex characteristics that are the opposite of their identity.

Last year, Middlesex expanded its gender program to include adolescents. “It’s very busy – it’s been phenomenal,” says Tierney. The new program opened the bottleneck that had been making Connecticut patients wait for a year for a first appointment; now they are seen in a month or two.

Middlesex continues—and doubles down on—its commitment to supporting all their patients in being their authentic selves.