DV Journal

(This column first appeared in Broad + Liberty)

The University of Pittsburgh Medical Center (UMPC) earlier this month announced the termination of “gender-affirming care” for children.

In a statement provided to Broad + Liberty, a UPMC spokesperson cited directives from the federal government as the reason for ending services such as gender transition surgeries, puberty blockers, and hormone therapies.

UPMC’s decision to comply with the President’s executive order comes at a time when many countries and other states have stopped or limited gender affirming care for minors.

The Cass Review, published a year ago, presented significant challenges regarding gender affirming care, the practice of supporting a patient who believes their gender identity is different from their biological sex. The comprehensive review found no scientific evidence to support medical interventions for children suffering from gender dysphoria, and perhaps more importantly, revealed these “treatments” may cause more harm than good. Dr. Hilary Cass, a pediatrician and lead investigator of the research, debunked the myth that suicide decreases with transition and/or hormones.

As a result of this groundbreaking review, many countries banned or significantly limited medical interventions for children, including Brazil, Argentina, England, Finland, Hungary, Ireland, Italy, and Sweden.

Here in the United States, 26 states passed laws or implemented policies to ban gender affirming care for children.

Despite the global opinion and policy shift regarding these medical interventions, some Pennsylvania legislators and activist groups continue to vehemently support gender affirming care for minors.

The UPMC announcement prompted the Pennsylvania Youth Congress (PYC) to issue a letter demanding the reinstatement of services.

“We are calling on UPMC to immediately restore access to protect gender affirming healthcare for trans youth and young adults currently being turned away. Gender affirming care for youth is medically necessary, life-saving healthcare, supported by every major medical organization in the United States based on decades of scientific, evidence-based, peer-reviewed research,” the letter reads. “Evidence shows that without access to these interventions, youth, especially those just starting puberty, will be harmed. This includes suffering physical changes that are not easily reversible, lifelong trauma in some cases, and when they have no hope of access to care, death. Evidence demonstrates the positive impact of gender affirming medical care, and also that behavioral health alone is not enough to save the lives of trans children and youth.”

As a statewide advocacy group for LGBT youth, I am not surprised by PYC’s “outrage” and demands, even though they fail to identify or link to any actual evidence to support their position.

What is surprising, although maybe it shouldn’t be, is the number of elected officials who signed on to support this demand that runs contrary to the prevailing science and public opinion.

Eighty-four elected officials, ranging from the mayor of Pittsburgh to state Senators and Representatives to council members, signed the letter to UPMC. Almost one fourth of all state Senators and Representatives signed the letter with the majority located in Philadelphia and the collar counties.

Eleven of the state’s 50 Senators signed the letter — nine from Southeastern Pennsylvania, including Nikil Saval (D-Philly), Sharif Street (D-Philly), Art Haywood (D-Montgomery and Philly), Steven Santarsiero (D-Bucks), Judith Schwank (D-Berks), Maria Collett (D-Montgomery), Amanda Cappelletti (D-Montgomery and Delaware), Carolyn Comitta (D-Chester), Tim Kearney (D-Delaware), Lindsey Williams (D-Allegheny), and Katie Muth (D-Berks, Chester, Montgomery).

Forty-seven of the state’s 203 Representatives also signed the letter, 31 of them from the southeast: thirteen from Philadelphia, nine from Montgomery County, four from Chester County, four from Delaware County, and one from Bucks County.

Other signers include the Lower Gwynedd Township Auditor, a Lower Merion Township Commissioner, the Montgomery County Clerk of Courts, the Montgomery County Prothonotary, a Perkiomen Valley School Board member, and an Upper Darby Township Council member.

The full list of individual and group signatures is here.

UPMC is one of the state’s largest health care systems, serving approximately four million patients annually with 100,000 employees. A spokesperson responded to a Broad + Liberty request for comment about the reason for the change in policy, but did not acknowledge or answer questions related to PYC’s letter.

“UPMC is fully committed to providing exceptional care for all our patients. We continue to monitor and comply with directives coming from the federal government that affect the ability of our clinicians to provide specific types of care for patients under the age of 19,” said the spokesperson. “We continue to offer necessary behavioral health and other support within the bounds of the law. We empathize with the patients and families who are directly affected by these ongoing changes.”

Based on what we know, or maybe more importantly, what we don’t know about these medical interventions for children, UPMC made the right decision — even if it was not for the right reasons. The agency should have stopped these practices for ethical, moral, and scientific reasons. Had they done so, groups like PYC would be hard pressed to call them out for folding to political pressure.

“UPMC must reject political pressure and fulfill its responsibility to provide healthcare without discrimination,” the PYC letter demands. “It is a moral atrocity to deny young patients medical treatment that saves lives.”

The real moral atrocity is the mutilation of children who are incapable of informed consent.

Maybe now that the first healthcare conglomerate has fallen, others will follow suit. The Pennsylvania Freedom Caucus issued a statement regarding UPMC and called out other state institutions.

“The Pennsylvania Freedom Caucus (PAFC) has voiced praise for UPMC after news broke of its plans to stop ‘gender-affirming treatment for minors,” the group wrote in an email. “The move shines light on policies at Penn State Health and Temple Health, two other university-affiliated health systems that receive state appropriations.”

With the threat of losing state and federal funds, Penn State and Temple may have no choice but to stop these interventions as well.

However, one of the largest providers of gender affirming care is Penn Medicine that includes both Children’s Hospital of Philadelphia (CHOP) and the University of Pennsylvania Hospital (HUP).

According to a database compiled by Do No Harm, a nonprofit created by healthcare professionals to keep radical ideologies out of medicine, CHOP and HUP treat the highest number of sex change patients who are minors. Since 2019, these entities saw 225 sex change patients, performed 99 surgeries, and provided hormones/puberty blockers to 126 children, writing over 800 prescriptions.

It is yet to be seen whether Penn Medicine will stay the course or do the right thing.

While it would have been far nobler for UPMC to stand up to the radicals and make the decision to stop these interventions based on the Hippocratic Oath, it is still a win for some of Pennsylvania’s most vulnerable youth. Whatever the reason, hopefully, the rest of the healthcare systems will follow suit.

Would the new legislation approved by the Pennsylvania House Judiciary Committee require doctors to participate in sex-reassignment medical treatment regardless of their personal beliefs?

Rep. Emily Kinkead (D-Bellevue) certainly thinks so. During the committee’s hearing, she gave an impassioned speech, at times pounding on her desk and affirming that the bill would require doctors to perform procedures that might violate their ethical or religious views.

“When you talk about whether physicians are going to be required to do X, Y, Z—yes!” Kinkead said. “If it does no harm. If it, in fact, helps people, and when we deny gender-affirming care to people who do not identify with the gender they were assigned at birth, that is causing harm, and absolutely we should be holding the doctors accountable who deny life-saving care to people.”

That was the basis of GOP objections to the bill, which amends the Human Relations Act. They said that setting aside views on LGBT issues, the law as proposed, would require doctors to participate in sex-change medical procedures, even if they oppose it on religious, philosophical, or medical grounds. Those procedures range from puberty-blocking hormones to surgeries to remove girls’ breasts and removing boys’ penises and testicles, as well as medically-unnecessary hysterectomies and shaving Adam’s apples.

Democrats brushed aside GOP concerns.

“No matter who you are or who you love, you are welcome here in Pennsylvania. No one should ever be discriminated against, treated differently, or made to feel less than a human being because of who they love or how they identify,” said committee Chair Tim Briggs (D-King of Prussia).

Sponsor Malcolm Kenyatta (D-Philadelphia), who is gay, said the bill was first introduced in 2001. He argued that in “too many” areas of the state, people can be discriminated against legally.

But Rep. Paul Schemel (R-Waynesboro) said he was concerned about medical freedom. He asked if doctors would be required to provide “a gender reassignment procedures such as a hysterectomy for a biological female who identifies as male?” He asked what protections were provided.

Kenyatta tried to brush aside those concerns, saying they were not “germane to the bill. What we are talking about is our Human Relations Commission” and adding “a number of protected classes.”

Schemel said a California court ruled that a law with “nearly identical” language to HB 300 required a Catholic hospital to perform a hysterectomy “on an otherwise healthy, biological female.” He also asked if the bill would require health care providers to prescribe puberty-blocking or cross-ex hormones.

“The language of this bill would put into jeopardy those who want to express their own liberty and freedoms not to require  (them) to provide puberty blockers, which is a program of treatment for gender dysphoric children, which is quickly in European nations becoming illegal.”

Kenyatta said, “I would urge you to be on the right side of history (and) reconsider telling all your constituents, no matter who they love or how they identify, that their representative represents them.” He accused Schemel of using “talking points.”

Schemel replied, “I think this is a personal attack.”

Rep. David Rowe (R-Middleburg) said there would be unintended consequences if the bill passes. A similar law is in effect in Canada, resulting in rape victims in a women’s shelter being raped again by two different men who claimed they were women to gain entrance. Under Canada’s law, they had to be admitted since they identified as women.

Rep. Chris Pielli (D-West Chester) said, “We could talk all day about the victims of our gay community and what they face.”

In the Army, many gay service members could not come out under the Don’t Ask, Don’t Tell law, he said. “The fact that we don’t have this bill is embarrassing. I’m doing this for all those soldiers. I’m doing this for my two kids who came out to me in high school.”

Rep. Chris Rabb (D-Philadelphia) said, “I don’t need to have a critical mass of lesbian-headed households in my district to do the right thing. I don’t need to be the father of a queer son to know what’s right. I know that none should be a second-class citizen. I’m old-fashioned that way.”

Rep. Melissa Shusterman (D-Paoli) said doctors take an oath “that includes serving and making sure people get well.” And that oath “is between them and their patients.”

It is “not something people without medical degrees should be speaking about,” Shusterman said.

Schemel spoke again, saying the legislation is not just about ensuring the rights of LGBT people, but rather, “is much more broadly drafted. It impacts a lot of areas of the law, some in conflict with others. It has broad implications for individuals who provide services.”

It “requires those in certain occupations and professions to do things they might find philosophically or morally, religiously, ethically, or medically impossible,” said Schemel. “That’s why I oppose this legislation. It’s much more broad than what’s being presented.”

Please follow DVJournal on social media: Twitter@DVJournal or Facebook.com/DelawareValleyJournal