A New York City doctor said he will continue providing gender-affirming treatments to his patients younger than 19 despite President Donald Trump\u2019s executive order aiming to ban such care, because, the doctor said, these patients\u2019 lives depend on it.<\/p>\n\n\n\n
\u201cUntil somebody calls me away, I\u2019m just going to keep doing it,\u201d said Dr. Jeffrey Birnbaum, a pediatrician and adolescent medicine specialist. He doesn\u2019t think that will happen, he added, noting that New York Attorney General Letitia James issued a statement Monday telling doctors<\/a> that state law requires them to continue providing such care.<\/p>\n\n\n\n However, as a result of the order and the decision by several hospitals to voluntarily cancel appointments for individuals 18 and younger, Birnbaum said his patients are scared. He said about 20 of his patients could be affected by the order.<\/p>\n\n\n\n \u201cThey\u2019re terrified that their treatment is going to be interrupted, and they\u2019re going to lose their treatment, plain and simple,\u201d he said. \u201cAnd for them, it\u2019s life-sustaining.\u201d<\/p>\n\n\n\n Trump\u2019s order, \u201cProtecting Children From Chemical and Surgical Mutilation<\/a>,\u201d aims to prohibit federal funding from being used for transition-related care \u2014 including puberty blockers, hormone therapy and surgery \u2014 for trans people under 19 years old. It also states that medical schools and hospitals receiving federal research or education grants have to \u201cend the chemical and surgical mutilation of children.\u201d<\/p>\n\n\n\n The White House announced Monday, about a week after Trump signed the order, that hospitals in New York City<\/a>, Colorado<\/a>, Virginia<\/a>, Illinois<\/a>, Pennsylvania<\/a> and Washington, D.C.<\/a>, have either suspended or announced that they are reviewing their transition care programs for minors. On Tuesday, Children\u2019s Hospital Los Angeles also announced<\/a> that it was pausing the initiation of hormone therapy for gender-affirming care patients under 19.<\/p>\n\n\n\n Birnbaum said Trump\u2019s executive order seeking to restrict care, along with another that describes the idea that someone can be trans as \u201cgender ideology,\u201d denies the realities of the people he treats every day.<\/p>\n\n\n\n \u201cIf somebody says the sky is green, just because they say it, doesn\u2019t make the sky green,\u201d Birnbaum said. \u201cI\u2019m looking at the medical literature, research that\u2019s been done. I\u2019m looking at real people in front of me. I\u2019m not looking at some right-wing, religious ideologue who is referring to this as \u2018gender ideology.\u2019 It\u2019s no ideology. They have the ideology. I\u2019m dealing with science and medicine.\u201d<\/p>\n\n\n\n Trump\u2019s executive order seeking to restrict trans care for <\/strong>those under 19 argues that the country has an obligation to protect children from \u201cirreversible medical interventions.\u201d<\/p>\n\n\n\n \u201cCountless children soon regret that they have been mutilated and begin to grasp the horrifying tragedy that they will never be able to conceive children of their own or nurture their children through breastfeeding,\u201d the order states, using inflammatory language to describe transition-related care.<\/p>\n\n\n\n Research shows that only a <\/strong>tiny percentage of minors in the U.S. access gender-affirming treatments. A study published in JAMA Pediatrics in January found that less than 0.1% of adolescents with private insurance<\/a> are trans or gender-diverse and are prescribed puberty blockers or hormone therapy.<\/p>\n\n\n\n One of Birnbaum\u2019s patients, Akoni Drysdale-Ash, a trans 17-year-old living in Brooklyn, said starting testosterone nearly three years ago has dramatically improved his quality of life. He said he felt a misalignment between his birth sex and gender identity around seventh grade, when he started having periods that made him feel \u201ctotally dissociated\u201d from his body.<\/p>\n\n\n\n He compared not being able to access testosterone to trying to run a car on something other than gas. The idea of losing that access is scary, he said, even though he feels like his care is relatively protected in New York.<\/p>\n\n\n\n \u201cIt does leave you with fear, because it\u2019s like you\u2019re taking away my visibility,\u201d Drysdale-Ash said. \u201cYou\u2019re taking away my care when all I want to do is live. Sometimes getting that care is all people need to live, being themselves. If I can\u2019t be myself, who else can I be?\u201d<\/p>\n\n\n\n His mother, Jasmine Aldridge, added that her son hasn\u2019t received any irreversible treatments. If he stops taking testosterone, for example, he will experience the puberty associated with his birth sex, undoing many of the changes brought on by testosterone.<\/p>\n\n\n\n In response to people who ask why trans minors can\u2019t wait until they\u2019re adults to receive transition care, Aldridge said, \u201cThere\u2019s that reality of your child might not even be here to see 19 if you don\u2019t support them.\u201d<\/p>\n\n\n\n Standards of care developed by medical organizations, including WPATH, a nonprofit association dedicated to transgender medical care that develops guidance that is widely used by health care professionals, recommend that trans minors are treated on a case-by-case basis. <\/p>\n\n\n\n The standards don\u2019t recommend any medical transition prior to puberty. <\/p>\n\n\n\n At the onset of puberty, minors can begin puberty blockers if they have persistent gender dysphoria, which is the severe emotional distress caused by the misalignment between one\u2019s gender identity and birth sex. Teenagers might start hormone therapy, and, in rare cases, some teens may receive a double mastectomy, where both breasts are removed.<\/p>\n\n\n\n Most major medical associations, such as the American Medical Association<\/a>, the American Academy of Pediatrics<\/a> and the American Psychological Association<\/a>, support access to transition care for minors and oppose restrictions on it.<\/p>\n\n\n\n The American Civil Liberties Union and Lambda Legal, an LGBTQ legal advocacy group, filed a lawsuit to block Trump\u2019s orders<\/a> regarding trans care and \u201cgender ideology\u201d last week on behalf of two transgender young adults and five families of trans minors. Three Democratic states also sued<\/a> Friday to block the transition care order. New York\u2019s Letitia James and 12 other attorneys general issued a statement<\/a> Wednesday reaffirming their commitment to protecting access to such care for minors.<\/p>\n\n\n\n The Department of Justice and White House did not immediately return requests for comment regarding the lawsuits.<\/p>\n\n\n\n Omar Gonzalez-Pagan, senior counsel and health care strategist for Lambda Legal, noted that Trump signed a flurry of executive orders targeting trans rights during his first weeks in office \u2014 including a ban on trans people serving and enlisting<\/a> in the military \u2014 which he said is proof that the order restricting care for minors is not actually about protecting children.<\/p>\n\n\n\n \u201cThey\u2019re attacking adults as well,\u201d he said, adding that the other executive orders targeting trans rights all \u201cspeak to gender identity being considered a false belief \u2014 that a person having a gender identity inconsistent or incongruent with your sex assigned at birth is something that is dishonorable, even in one\u2019s private life. That\u2019s the language of these executive orders, and the disdain, the cruelty just drips out of the page.\u201d<\/p>\n\n\n\n As the legal battle begins to play out, Birnbaum said he\u2019s shared the same message with many of his patients.<\/p>\n\n\n\n \u201cI\u2019m saying that this is also a safe space. We\u2019re going to protect them,\u201d he said. \u201cWe\u2019re not going to interrupt their care, and we\u2019re going to help sustain who they are as human beings, plain and simple.\u201d<\/p>\n\n\n\n