Too Many Pediatricians Fail Their Trans Patients. Here’s How We Can Change That.
No medical provider likes to confront the thought of having failed a patient. None of us are perfect, and any honest one of us can think of situations where we missed a diagnosis, should have communicated better, or simply didn’t deliver care as best we could have. It’s not a comfortable place to dwell, but acknowledging where things went wrong is a necessary part of learning how to do better.
When it comes to trans kids, I worry there may be patients I am failing. I worry that I don’t even know when I am failing them.
In August, the St. Louis Children’s Hospital opened a clinic dedicated solely to the comprehensive medical needs of trans children and adolescents. St. Louis is the closest major city to the small town in Missouri where I grew up, and when I read the news I was happy to think about trans kids in my own hometown having a place to access expert specialty care. But before they arrive at a specialty clinic, the care of most trans kids will begin with a pediatric generalist like me, and many may not have feasible access to specialty care at all.
Are general pediatricians doing enough to recognize and treat their trans patients?
All too often, the answer is an easy and obvious “no.”
By Excluding LGBTQ People, the Growing Cannabis Industry Is Betraying Its Roots
After decades of prohibition and an ardent fight for legalization, 2017 may go down in history as the year cannabis went mainstream. The majority of states in the U.S. have passed some kind of positive reform of the federal government’s ban on cannabis, and recreational adult use is now legal in eight states and the District of Columbia. On top of that, various polls have found that the majority of Americans support widespread marijuana reform, the latest of which reports that 86 percent of respondents supported either medical or recreational legalization, or both. On top of that, the industry is poised to explode into a huge moneymaker: Sales in North America are expected to hit $50 billion by 2026 compared to $6.7 billion just last year. Conventional investors are jumping onboard, and the tech industry is quickly infiltrating.
But the burgeoning industry has one glaring problem: The gatekeepers of cannabis’ culture and commerce are overwhelming white, cis, straight, and male—not to mention downright bro-y. White-appropriated rasta colors and women clad in weed-leaf bikinis abound, and on the buttoned-up side of things, the ubiquitous influence of the tech-bro is essentially turning the cannabis industry into the next Silicon Valley—a space not exactly known for its inclusivity.
AIDS, It, and the Horror of the 1980s
1988 was a weird time to be a 14-year-old gay kid in America. One could find representations of gay men all over the place. They were profiled in Peoplemagazine, discussed in segments on the national news, and interviewed by a doggedly sympathetic Phil Donahue before a live studio audience.
But they were also dying.
I sat next to my parents in our living room as we watched a sobering television news report detailing how Provincetown, Massachusetts, a queer utopia we had once visited, was being ravaged by the AIDS epidemic. My classmates and I were herded into the Nashua High School auditorium to listen to a gay man, an earring dangling from his right ear, tell us about the precautions we needed to take in order to avoid contracting the virus that was attacking his body. When I first held a boy from school in my arms, I became convinced that somehow our chaste intimacy would kill me. If earlier generations of gay youth had associated sex with anxieties about loneliness or social rejection, our sexuality in the 1980s emerged alongside a palpable fear of death.
The Michigan Attorney General’s Sneak Attack on Civil Rights
The ongoing battle for LGBTQ equality in Michigan suffered a significant setback this week. On Monday, after a months-long process, Michigan’s Civil Rights Commission finally seemed set to issue an “interpretive statement” as to whether Michigan law prohibits discrimination against LGBTQ people. Then, just moments before the commission was to vote, Attorney General Bill Schuette’s office derailed the proceedings—orally informing the commission that it lacked the authority to make such a statement.
The attorney general’s last-minute interference leaves Michigan among the states where someone can marry the person they love Saturday and be fired for whom they love on Monday. Yet almost as disturbing as what Schuette did was how he did it. With little legal justification, Schuette, a Republican, effectively barred Michigan’s Civil Rights Commission from speaking on the issue of LGBTQ equality. As a result, Michigan became the latest state in which government actors have been strong-armed as they stand on the cusp of exercising their authority to extend basic civil rights to LGBTQ persons.
A bit of background. By law, Michigan’s Civil Rights Commission is responsible for enforcing Michigan’s Elliot-Larsen Civil Rights Act. That Act seeks to ensure equal treatment in housing, education, employment, and public accommodations. Unfortunately, Michigan’s Civil Rights Act does not expressly prohibit discrimination on the basis of sexual orientation or gender identity. The results are sadly predictable. Hundreds of LGBTQ Michiganders have reported discrimination since 2000. A state-sponsored2013 report concluded that LGBTQ Michiganders have been the victims of “widespread” discrimination in housing and employment. And all of this undermines the Civil Rights Act’s central purpose: protecting civil rights, and prohibiting discriminatory practices.The attorney general’s last-minute interference leaves Michigan among the states where someone can marry the person they love Saturday and be fired for it on Monday. Yet almost as disturbing as what Schuette did was how he did it. With little legal justification, Schuette effectively barred Michigan’s Civil Rights Commission from speaking on the issue of LGBTQ equality. As a result, Michigan became the latest state in which government actors have been strong-armed as they stand on the cusp of exercising their authority to extend basic civil rights to LGBTQ persons.
A bit of background. By law, Michigan’s Civil Rights Commission is responsible for enforcing Michigan’s Elliot-Larsen Civil Rights Act. That Act seeks to ensure equal treatment in housing, education, employment, and public accommodations. Unfortunately, Michigan’s Civil Rights Act does not expressly prohibit discrimination on the basis of sexual orientation or gender identity. The results are sadly predictable. Hundreds of LGBTQ Michiganders have reported discrimination since 2000. A state-sponsored 2013 report concluded that LGBTQ Michiganders have been the victims of “widespread” discrimination in housing and employment. And all of this undermines the Civil Rights Act’s central purpose: protecting civil rights, and prohibiting discriminatory practices.
How Louise Hay’s Spiritual Pseudoscience Harmed a Generation of Gay Men
When the New Age entrepreneur Louise Hay died at 90 on August 30, the internet lit up with people praising her healing powers for often-desperate physical and psychological ailments, prescribing healthy living and major doses of self-love. But the people celebrating Hay largely ignored or brushed past the pernicious side of her prescription—the place where self-love slides into self-blame. Hay’s spiritual schema had its reasons for being, and it helped some people. But it failed to offer its era a genuine and enduring spirit of care, perhaps in no case more so than that of gay men and those who loved them during the desolate early years of AIDS.
Arizona Supreme Court Unanimously Affirms the Equal Rights of Same-Sex Parents
On Tuesday, the Arizona Supreme Court issued a highly anticipated decision unanimously affirming the equal rights of same-sex parents in the state. The ruling will require Arizona to extend the same presumptions of parentage to same-sex and opposite-sex couples, ensuring that the state cannot use the pretext of biology to discriminate against gay residents. It is also an important confirmation of Obergefell v. Hodges at a time when marriage equality is under increasing judicial assault.
Tuesday’s ruling in McLaughlin v. McLaughlin involves an Arizona statute that creates a “presumption of paternity” in opposite-sex relationships. Under the law, the husband of a woman who gives birth is presumed to be the child’s legal parent—even if the birth mother conceived through artificial insemination. But what about married lesbians who conceive via artificial insemination? Two lower courts grappled with that question and reached different conclusions in light of Obergefell. One held that Obergefell required the birth mother’s wife to receive the same presumption of parentage that a husband would. The other held that it did not.
Who Gets to Make Movies About Gay Sexuality?
In the summer haze of the Coney Island boardwalk, a teenage boy begins to wonder, and worry. He easily picks up girls under the fireworks, but he can’t perform when he brings them home. At night, he snaps pictures in front of a mirror, shirtless, jaw and chest contorted, eyes burning forward with a hook-up site beginner’s misplaced aggression. He smokes and partakes in petty crime with the local tank-topped miscreants his own age, but alone, he can’t stop cruising a gay sex site, where he always seems to pause on men many years older than him. Soon he agrees to meet one of them, and his first won’t be his last.
Elegy for Edie
One of the first things that Edie Windsor ever told me was that she only had a few more years left to live. That was more than eight years ago, in 2009. And she wasn’t kidding. After her spouse Thea Spyer passed away, Edie had suffered from a series of heart attacks, which were diagnosed as “broken heart syndrome.” Indeed, Edie asked me and other lawyers on our team to carry her nitroglycerine tablets for her when we attended events—just in case.
Because of her heart condition, I became completely neurotic about making sure that Edie’s case got decided as quickly as possible. I felt like any time we managed to shave off the process, however slight, might be the margin between Edie living to see a victory in her case, or not.
Looking back on this today, I have to admit that the strategy I chose to try to accomplish this goal was somewhat unconventional. Less than two weeks after we filed the complaint in the case that became United States v. Windsor, I wrote the district court judge, Barbara Jones, a letter stating that, “Given Edie’s coronary disease … she seeks to pursue this action as expeditiously as possible.”
And then I sent Judge Jones another letter. This time, I informed the court that Edie was suffering from an allergic reaction. Once again, I asked Judge Jones to expedite the case in any way possible.
And then I sent another letter. And another. And then one more. Believe it or not, over the next year and a half, I would write a dozen of these letters, each time begging Judge Jones to speed up the process. My co-counsel and noted constitutional scholar Pam Karlan aptly characterized them as my “Edie has the sniffles” letters. Although I knew there was a risk that we might be annoying the judge, I kept sending them anyway. As our son says when we catch him eating chocolate first thing in the morning: “I couldn’t help myself.”
Hillary Clinton’s Eulogy for Edie Windsor Is Also an Impassioned Call to Resist Injustice
On Friday, hundreds of people came together at New York City’s Temple Emanu-El for the funeral of Edie Windsor, the “mother of marriage equality” who died on Tuesday at age 88. Windsor sued the United States government when it refused to recognize her marriage to Thea Spyer; her suit ultimately toppled the federal ban on same-sex marriage and paved the way for nationwide marriage equality. Among the luminaries who paid tribute to Windsor was Hillary Clinton, whose beautiful eulogy also functioned as an impassioned call to resist injustice with Windsor’s indomitable positivity and joy.
Clinton began by asking: “Doesn’t it just feel great being here to honor and remember someone who had such a positive, lasting influence on our country and the world?” That might seem like an oddly cheerful start for a eulogy, but Friday’s proceedings had a celebratory air given Windsor’s extraordinary accomplishments and richly lived life. (She remarried last year.) Windsor, Clinton said, “didn’t set out to make history”—but the love she shared with Spyer was “its own quiet revolutionary act.” When Spyer died in 2009 and the government demanded that Windsor pay an immense estate tax, “she knew she had two choices: Accept this painful injustice or fight back. She chose to fight back, all the way to the highest court in the land.”
The day Edie won, much of America cheered with her … with a recognition that a wrong had been righted. Through it all, her strength never wavered. … It is fitting that she will be immortalized in history books in that landmark decision synonymous with equal rights and dignity under the law. But she didn’t stop there. She continued to support the needs and the rights of the LGBT community. She helped change hearts and minds, including mine. And we are forever grateful to her for that.
When Researching Individual Engagement With the “Gay Community,” Numbers Only Tell Half the Story
“Gay community” is a phrase one hears tossed about all the time, from politicians and health officials to activists and everyday gays themselves. But what does it really mean? In some cases, “community” distinctly refers to a physical space, such as a neighborhood or collection of public venues and community gathering places; while in others, the term invokes a constellation of interconnected individuals with shared beliefs, concerns, or cultural reference points. What's more, depending on whom you ask, the “gay community” can be anything from an open-minded, affirming environment where gay people find acceptance and outlets for self-expression, to a judgmental or even hostile one that offers few opportunities for connection and many for frivolous, even self-destructive excess.