The COVID-19 pandemic only exacerbated challenges transgender people already faced at higher levels than the general patient population—challenges that often put their mental, physical and social well-being at risk.

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Before the pandemic, transgender patients had trouble accessing health care, faced a shortage of specialized health care professionals and had difficulty obtaining health care insurance. Those with insurance had trouble getting some services covered.

That made “it harder for transgender individuals to get gender affirming-medical care,” said Jesse Ehrenfeld, MD, MPH, immediate past chair of the AMA Board of Trustees. “In some cases, also because of the pandemic, gender-affirming care was put on hold because of prohibition on non-urgent or elective procedures. Because these were viewed by some as unnecessary or a lower priority, that just worsened these inequities, becoming more pronounced during the pandemic.”

Dr. Ehrenfeld talked about the challenges facing transgender people during the pandemic in a recent episode of the “AMA COVID-19 Update.”

Before the pandemic’s onset, many transgender people of color, especially women, were marginalized and rejected by their families and communities. They were discriminated against when it came to education, housing, employment and social services. It resulted in higher rates homelessness, unstable housing and sex work, and the economic pressures of COVID-19 have only made those things worse.

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On top of all of that, the past year has brought “divisive, dehumanizing rhetoric from anti-equality political leaders that has been contributing to really what’s a toxic mix of racism, sexism and transphobia,” said Dr. Ehrenfeld. He is senior associate dean, professor of anesthesiology and director of the Advancing a Healthier Wisconsin Endowment at the Medical College of Wisconsin.

Such hateful rhetoric is contributing to violence that rose during the health emergency.

“These issues are inextricably linked to an individual’s ability to live a healthy life. It’s just so important that we as physicians speak up about anything that interferes with that,” Dr. Ehrenfeld said.

In 2019, the AMA House of Delegates adopted policy to bring national attention to the epidemic of violence against the transgender community. The AMA has worked to create partnerships with other medical organizations, policymakers, law-enforcement agencies and stakeholders to educate the public, Dr. Ehrenfeld said during the interview.

The AMA is working at the state and federal level as well to combat legislation that perpetuates discrimination against transgender individuals and promote the importance of their health and well-being.

State legislatures across the nation this year have considered more bills targeting LGBTQ+ patients than ever before, Dr. Ehrenfeld said. Many were targeted at transgender youth who already face higher suicide rates and mental health disorders. Arkansas this year became the first state to ban gender transition-related care for those under 18. Twenty other states have considered bills prohibiting medical providers from prescribing medications or hormone therapy or from performing surgery on minors.

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“The AMA and our partners across the Federation of Medicine have been working hard to stop those bills,” Dr. Ehrenfeld said. He said efforts have been largely successful, with the exception of Arkansas, and that the AMA is considering next steps and hopes to challenge the Arkansas measure.

Discover why anti-transgender bills are a dangerous intrusion on medicine.

At the federal level, the Biden administration recently reversed a Trump-era final rule that had essentially erased discrimination protections for transgender individuals under section 1557 of the Affordable Care Act, a change for which the AMA advocated.

“We know that fear of getting discriminated against will lead individuals to forego care and that can have serious negative health consequences,” Dr. Ehrenfeld said. “Everybody—including LGBTQ+ people— should be able to access health care, free from discrimination or interference, period.”

Learn more about the AMA Advisory Committee on LGBTQ Issues.

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