Choosing a physician for a child is one of the most important decisions a parent makes. Imagine learning that your kid is gender-diverse. Finding a doctor who provides an affirming safe space while delivering trans-competent care is key to addressing your transgender child’s health needs.
A transgender patient may present in a number of ways. While some are more comfortable than others to articulate their gender identity, they must all be made to feel safe from the initial contact with the medical team. Not all trans persons will require the same care or take the same road should they decide to socially or medically transition; but medical staff must realize that transgender medical care is not specialized care – it’s primary care.
Some trans patients will require attention from other medical professionals to address their gender identity needs. The primary care physician may recommend an endocrinologist, mental health professional, or plastic surgeon. Each case is different and must be approached as such. There is no blanket solution when providing primary care and that holds true in treating transgender patients; and education of the medical staff is key – from frontline staff to the physician. Everything from current terminology to available surgeries for transition to current regulatory matters may need to be factored when providing best-practice care – evidence-based care.
Not all doctors administer patient care the same way. Some doctors put their personal beliefs before the patients’ needs; a practice which was green-lighted by the Trump administration in 2019 when they expanded the “conscience rule” giving new protections of conscience rights for physicians, pharmacists, nurses, teachers, students and faith-based charities who oppose abortion, sterilization, assisted suicide and other medical procedures on religious or moral grounds. This 440-page rule was issued by the Department of Health and Human Services’ Office for Civil Rights and paves the way for medical care givers to discriminate against gay and transgender patients and their children.
This rule puts transgender patients at great risk by allowing caregivers the right to deny patient care based on their religious beliefs. A number of religion and faith-based organizations are using this rule to push their agendas regardless of patient risk.
CREDO of the Catholic Laity in St. Louis is one such group. In an effort to continue their mission to restore orthodox Catholic Culture they hired Dr. Paul W. Hruz to – as CREDO describes it – ‘speak on the critical and timely issue of “Transgenderism,” which directly impacts virtually every extended family.’ The talk was held at the St. Anselm Parish Center at the St. Louis Priory this afternoon to an audience of over 200 primarily older white adults with a handful or so trans expansive family and allies in attendance. A Q and A session with the doctor followed the lecture.
Paul W. Hruz, M.D., Ph.D.is employed by Washington University in St. Louis, Missouri as an Associate Professor of Pediatrics, Cell Biology & Physiology and Endocrinology and Diabetes. He would have you believe that he treats transgender patients. He does not.
When I contacted Washington University, I was given this information:
“Dr Hruz is NOT a member of our DSD team, NOR is he an expert in transgender health as he has never taken care of a transgender person. Dr. Hruz admits that he has not treated any transgender patients, patients with gender dysphoria, conducted peer-reviewed research about gender identity, transgender people, or gender dysphoria; and is not a psychiatrist, a psychologist, nor mental health care provider of any kind, who could speak knowledgeably of transgender health.”
Dr. Hruz was careful to begin his presentation today by showing a slide and communicating that his lecture was not connected to Washington University or St. Louis Children’s Hospital.
Dr. Hruz is renowned for his lectures and publications regarding the treatment of gender dysphoria. His lectures are hosted by faith-based organizations rather than sanctioned by medical facilities. He is not a friend of trans children, and his actions may be dangerous.
When inquiring about his personal stance a few days ago, I asserted to Dr. Hruz that he doesn’t believe that transgender kids exist. He corrected me with, “I in no way deny the existence of children who experience a gender identity that is discordant with their biological sex. I am well aware of the current epidemiologic evidence for the number of children who have been identified as having this experience and the quality of this data.”
In an interview with Laura Ingraham, Dr. Hruz suggested that transgender treatments and therapies have potential to cause “very serious harms to their bodies throughout the rest of their life without even considering whether there are alternative options…” He went on to say that “a large number of children that question their gender identity are going to, if merely left alone, are going to realign their identity with their biological sex.”
Today’s talk echoed the same messages that Dr. Hruz has conveyed in previous interviews and lectures. In fact, Dr. Hruz often returned to those ideas throughout his presentation. As often as he stressed the importance of science and research to support treatment of gender dysphoria; he pulled away from using much documented data, claiming not enough research exists and relying heavily on his personal views. It was clear that the doctor is a fan of the “watch and wait” approach to treatment as well as reparative therapy or conversion therapy.
Dr. Hruz even went so far as to claim that passing laws that prevent conversion therapy by a practitioner is an injustice and that it’s also an injustice that we don’t further test the hypothesis in a controlled study because – as he generalized – many ideas that are dismissed later turn out to be beneficial.
This is where the danger part comes in. He accepts that trans adolescents exist and states that we need to be respectful and have compassion, but he would choose to withhold treatment. Dr. Hruz claims his approach is science-based. That’s all well and good when you use current research outcomes. Dr. Hruz claims 85% to 90% of children no longer experience feelings of gender dysphoria after having gone through puberty. This is old data.
The methodology of “growing out of” their gender identity or “desistance” studies is very flawed because the researchers didn’t study gender identity maintains Diane Ehrensaft, director of mental health at UCSF’s Child and Adolescent Gender Clinic. “Those desistors were, a good majority of them, simply proto-gay boys whose parents were upset because they were boys wearing dresses. They were brought to the clinics because they weren’t fitting gender norms.”
Thomas Steensma, a researcher and clinician at the Center of Expertise on Gender Dysphoria in Amsterdam co-authored a study in 2013 that indicated that approximately 65% of kids no longer experienced gender dysphoria. That is significantly lower than the numbers Dr. Hruz tosses around which is information that can be found in a 1995 study by Zucker and Bradley.
Steensma claims that using the desistance numbers from his study is wrong-headed as the study was designed to predict persistence. As medical professionals continue their research it is reasonable to consider that statistics may vary from study to study. Wouldn’t it then be reasonable to act in the best interest of the child?
According to a study published in the Official Journal of the American Academy of Pediatrics performed by the Department of Family Studies and Human Development, University of Arizona in 2018, adolescents that identify with the gender they were born, are significantly less likely to attempt suicide.
Nearly 14% of adolescents reported a previous suicide attempt; disparities by gender identity in suicide attempts were found. Female to male adolescents reported the highest rate of attempted suicide (50.8%), followed by adolescents who identified as not exclusively male or female (41.8%), male to female adolescents (29.9%), questioning adolescents (27.9%), female adolescents (17.6%), and male adolescents (9.8%). Identifying as nonheterosexual exacerbated the risk for all adolescents except for those who did not exclusively identify as male or female (ie, nonbinary). For transgender adolescents, no other sociodemographic characteristic was associated with suicide attempts.
These are just the kids we know about. Can our medical professionals and parents really afford to be dismissive of the children experiencing gender dysphoria? Look at the numbers. You claim you need statistics, Dr. Hruz, well there are your numbers. How is not providing treatment helpful?
Kelly Storck, LCSW who works with gender-diverse youth and adults shares, “My ten years of extensive clinical experience working with transgender and non-binary people have led me to a few important truths. First, the continuum of gender is brilliantly and naturally expansive and every space within the spectrum is valid and beautiful. Second, all humans, even the tiny ones, have both the power and inalienable right to best know their deeply personal relationship to their gender. No opinion or person or policy should stand in the way of young people growing gloriously into their most authentic selves. To do so is a clear violation of our code as medical professionals and a breach of an unspoken social contract that all of us humans work to support the health and well-being of our children.”
When word of the CREDO event reached the St. Louis trans community Sayer Johnson, Executive Director of Metro Trans Umbrella Group (MTUG), had this to say, “It’s vital that we interrupt the narratives about us that are not true, that are not accurate, that are harmful. We as trans-expansive folks need to self-advocate and no longer stand for the abuses the medical establishment continues to put in our ways. And we especially need to interrupt on behalf of youth.”
Gloved hands carried messages of support and unity on placards reading ‘Protect Trans Kids’ and ‘Stop the Madman’ as the community rallied to protect their own. Led by Jordan E. Braxton, Vice President of St. Louis Black Pride and Dr. Heather Brown-Hudson, Lindenwood University Gender Studies Program Chair; members of the metro area trans family, allies, and community leaders braved the cold winter winds to greet and enlighten lecture-goers as they arrived to hear the doctor speak. Under the watchful eyes of our local law enforcement who were called in to secure the site, protesters held their signs high and shouted messages of trans support and demands to stop the doctor as motorists championed the cause with enthusiastic horn honks.
In talks with trans people from the community and read in questioning posts being shared across social media many wonder how Dr. Hruz fits into such an affirming facility like Washington University when his work is clearly not in line with other doctors and departments when it comes to transgender care. I wish I had that answer. Many who are concerned have kept the phone at the dean’s office at Wash U has been ringing all week.
The number of transgender medical centers worldwide continues to grow. St. Louis is fortunate that Dr. Christopher Lewis, Instructor in Pediatrics, Endocrinology and Diabetes, Medical Director of Differences of Sexual Development Clinic, and Co-Director of Pediatric Transgender Health and Dr. Sarah Garwood, Assistant Professor of Pediatrics, Adolescent Medicine worked together to establish the Washington University Transgender Center at St. Louis Children’s Hospital. As Co-directors of the Transgender Center they and their staff ensure the highest quality patient care across the region.
The Transgender Center eschews the practices of Dr. Hruz and gave this assurance:
Dr. Hruz is not part of our transgender team and does not see transgender patients. Washington University School of Medicine supports evidence-based care.
Washington University School of Medicine and St. Louis Children’s Hospital are both ranked nationally as leaders in their fields. St. Louis Children’s Hospital has received perfect scores on the HRC Healthcare Equality Index for the past two years showing their commitment to Promoting Equitable and Inclusive Care for Lesbian, Gay, Bisexual, Transgender and Queer Patients and Their Families.
Washington University School of Medicine is committed to providing excellent, multidisciplinary, patient-centered care to LGBTQ+ patients. They provide a directory of providers who have self-identified as having an interest in providing culturally competent care to LGBTQ+ patients.
I asked Dr. Hruz how he sees himself fitting into the overall landscape at Washington University knowing it houses one of the most affirming and respected transgender medical facilities available and he stated that his, “speaking and writing on gender dysphoria is to draw attention to the major deficiencies in scientific evidence for medical management of gender dysphoria. True concern for the well-being of all of our patients, including those who present seeking medical interventions to alleviate suffering associated with sex/gender discordance, requires a desire to provide truly effective and sustained benefit while minimizing risk. When evidence is lacking, scientists and physicians propose novel hypotheses and design rigorous experiments in working toward this goal.”
Dr. Hruz does not recognize guidelines from the World Professional Association for Transgender Health (WPATH) or the American Psychological Association as beneficial, reiterating his frequently expressed view that not enough research has been done; although as a member of The Endocrine Society he validates their research.
For someone who insists that we need more information, one would think the doctor would respect the work done by WPATH since they work to develop evidence-based medicine and strive to promote a high quality of care for transsexual, transgender, and gender-nonconforming individuals internationally. I guess since the standards they’ve set for treating gender dysphoria differs from the doctor’s he dismisses their validity.
Health professionals agree that evidence is no longer lacking and that the days of rudimentary surgeries and experimental treatments have passed. In 1979 WPATH published the first Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People which outlined the recommended protocol for treating transgender patients. The document has been updated six times since in order to include the most current practices.