'Polarizing' and 'Life-Saving': What Actually Is Gender-Affirming Care? An Ohio Doctor Explains

Dr. Crystal Cole, medical director at Akron Children’s Hospital’s Center for Gender Affirming Medicine - Akron Children's Hospital
Akron Children's Hospital
Dr. Crystal Cole, medical director at Akron Children’s Hospital’s Center for Gender Affirming Medicine

The phrase “gender affirming care” gets tossed around a ton these days.

In many LGBTQ+ circles, the phrase is a (literally) life-saving grace. In more right-wing gatherings, it is apparently akin to profanity, something to be fought against legislatively at every opportunity.

But what actually *is* gender affirming care?

The Buckeye Flame recently sat down with Dr. Crystal Cole, medical director at Akron Children’s Hospital’s Center for Gender Affirming Medicine, to talk about the realities of gender affirming care, the joys and challenges of her work with young trans and gender diverse patients, and the dangers of legislation like Ohio House Bill 454 — which could ban this life-saving care for trans youth.

So what exactly is gender affirming care?
Gender affirming care is any care that we provide to transgender and gender diverse patients that allows us to affirm their gender identities.

It can be something as simple as having a gender-informed primary care doctor who understands that it’s important to use someone’s chosen name and pronouns. It can be getting involved with a therapist who understands the needs of trans and gender diverse youth, and who understands the types of experiences that many of them go through.

[Gender affirming care] can also be medical care that is more trans specific, like puberty blockers — or when patients get older, gender affirming hormones or different gender affirming surgeries they can get.

The kind of care you’re describing is holistic — focused on the full person.
You really need a comprehensive care team to take care of transgender youth. The needs are so great and the risks are so high. The way that you have to approach their care is so involved.

Our initial intakes are 2 hours long. They involve a physician, a social worker and a behavioral health professional — whether that be a psychologist or a counselor.

So many people focus on the medical side [of gender affirming care], but there are so many patients who don’t even need or choose to pursue medical treatment. That’s only a small piece of their care.

So what do researchers say about the effects of gender affirming care?
Unfortunately, what we do is a very polarizing topic.

Modern medicine and research shows that gender affirming care is life-saving.

At the end of the day — in spite of all the other controversial things coming from the media or the government — what we’re really doing is providing healthcare to a population that is high risk for poor mental health outcomes.

Among this population, the risk of suicide is very high. Many [trans and gender diverse youth]have depression and anxiety. There’s an increased risk of bullying, intimate partner violence, addiction, sexual assault. More than 40% of all homeless youth are LGBTQ+.

Multiple studies have shown that gender affirming care can have a significant impact on decreasing those risks. That’s why we do it.

What can young trans and gender diverse people and their families expect when they come to the center?
Even though the kid is the top priority, you don’t just treat the kid.

At our center, we understand that the family dynamic plays into how well our patients do — and if, when and how they’re going to receive medical care. So we’re also working with the family as a whole to build a healthy environment for our patient.

As part of that, we often have to provide social services and supports — like introducing them to services in the community, or making them aware of legal aids that might help them when it comes to things like legal name changes.

My job as a doctor is to present evidence-informed care and [explain]the guidelines and the outcomes, how these things can benefit your child and why it’s important.

We know [the risks], and we know that one of the most protective factors against them is being in an affirming environment at home, so my goal is to meet patients and their families where they’re at and bring them onto the same page.

So we heard testimony on Ohio House Bill 454 back in February, 2022. It goes against recommended standards of care for trans youth, so what will happen in Ohio if it becomes law?
HB 454 puts the mental health and lives of transgender and gender diverse children at risk.

The people supporting this bill are clearly very misinformed about what gender affirming care actually is. They read none of the guidelines, nothing about what our clinics actually do.

There are several pediatric based gender affirming programs in the state of Ohio. I’d say there are probably about 6,000 young people that receive care at these clinics. If HB 454 [becomes law], Ohio would have to close [gender affirming]clinics and thousands of children would no longer be able to receive care.

The bill also makes it very explicit that [providing gender affirming care]to youth would be illegal, and hospitals and providers would be penalized very harshly.

House Bill 454 will be something that will set back our ability to take care of children. If you [agree], please talk to your state representatives and tell them not to support the bill.

What about your work with these young people brings you the most joy?
The [Center for Gender Affirming Medicine] has been open for almost 3 years now, so I’ve had the opportunity to follow some patients over time. It’s just so rewarding to see that the care you’ve provided has [helped them].

I’ve interacted with so many patients and families. I love the patients and I love their stories. I love being able to see them grow.

I’ve seen how these patients transform. I’ve seen it with my own eyes, and the gender affirming piece is really that missing link that’s preventing them from being who they are.

I have all different types of patients, but they’re all my type of people. A lot of them have cool hobbies or interests. They’re just cool patients to take care of. There’s just a certain way you look at life when you’ve kind of always been the odd one out. In that way, I feel like I can really connect with these kids.

And knowing I played a part in a patient really thriving? That’s so rewarding.

Not everyone who practices medicine has the opportunity to feel that level of fulfillment, so I think that’s really wonderful.

Originally published by The Buckeye Flame. Republished here with permission.
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