\n<\/p>\n
Vanderbilt University Medical Center opened its Transgender Health Clinic in 2018 in order to, in its own words<\/a>, serve \u201ca high-risk population\u201d who \u201chave been consistently underserved by the U.S. health system.\u201d It\u2019s the first and only such center dedicated entirely to transgender health care in Tennessee, according to data<\/a> from the Human Rights Campaign.<\/p>\n But like so many clinics that offer similar services, it has become the center of a political firestorm, the focus of an attack by right-wing media that has stoked\u00a0the ire of Republican lawmakers and triggered harassment of clinic staff.<\/p>\n Last Tuesday Matt Walsh, a conservative pundit and columnist for the right-wing website The Daily Wire<\/em>, released what he called an \u201cinvestigation\u201d<\/a> into Vanderbilt\u2019s Clinic for Transgender Health to his over one\u00a0million Twitter followers. Among other things, he asserted that VUMC established the clinic in 2018 because gender-affirming surgeries were \u201cmoney-makers,\u201d that the center threatened \u201cconsequences\u201d for staff who declined to provide gender-affirming care and that it tried to \u201cenforce compliance\u201d from parents who might be hesitant to consent to care for their minor children. Snippets of video are presented as evidence for these claims.<\/p>\n The allegations spread far and fast. As of Friday, Walsh\u2019s Twitter thread had over 37,000 retweets. Fox News host Tucker Carlson picked up the story and ran it Wednesday night as the lead item on the country\u2019s top-rated cable news show, displaying the names and photos of VUMC\u2019s Board of Directors while railing against the clinic\u2019s \u201ccrimes.\u201d<\/p>\n VUMC issued a statement<\/a> saying Walsh\u2019s posts \u201cmisrepresent facts about the care the Medical Center provides to transgender patients.\u201d<\/p>\n \u201cWe have been and will continue to be committed to providing family-centered care to all adolescents in compliance with state law and in line with professional practice standards and guidance established by medical specialty societies,\u201d the statement read.<\/p>\n In an email to Inside Higher Ed<\/em>, Alyssa Cordova, The Daily Wire<\/em>\u2019s vice president of public relations, wrote that VUMC\u2019s defenses \u201cdo not specifically deny\u201d Walsh\u2019s allegations\u2014which include, in Cordova\u2019s words, that parents are \u201cconsenting to the drugging and mutilation of children.\u201d<\/p>\n Cordova also pointed out that the evidence for Walsh\u2019s claims is in video footage originally posted on the medical center\u2019s own website. That evidence includes a clip of the clinic\u2019s director saying that mastectomies, or top surgeries, could be \u201cmoneymakers\u201d because they require follow-ups.<\/p>\n Michelle Forcier, assistant dean of admissions at Brown University\u2019s Alpert School of Medicine and a pediatrician who specializes in gender care, said the presentation of these clips as representing an abnormal or immoral perspective in the world of health-care management is disingenuous.<\/p>\n \u201cAnybody who works in a hospital setting knows that there are budgets, there are looks at costs and expenditures, and more resources go to programs that bring in more money. That\u2019s the economics of health care,\u201d she said. \u201cAny cardiovascular center, for instance, looks at their surgical income versus outpatient, and surgery is always going to make more money than outpatient services. None of that should be shocking news.\u201d<\/p>\n A spokesperson for VUMC declined to answer any more specific questions, and employees associated with the clinic declined interview requests.<\/p>\n Walsh has targeted a slew of other trans health-care providers in the past, particularly those that offer care to trans youth. That includes the Boston Children\u2019s Hospital\u2019s Center for Gender Surgery, which for the past two months has received a barrage of harassment<\/a> and death threats<\/a>, as well as a bomb threat<\/a>.<\/p>\n It appears Vanderbilt has taken proactive measures to minimize the impact of threats and harassment. The university medical center removed the webpage<\/a> for its transgender clinic, and the clinic has temporarily shifted in-person appointments to telehealth<\/a>.<\/p>\n Whatever the ultimate goals of the commentators and lawmakers scrutinizing trans health clinics, the immediate impact of their work has been to intimidate professionals in the field into silence. Of the eight specialists in transgender health contacted by Inside Higher Ed<\/em> for this article, only two agreed to speak on the record.<\/p>\n All said they fervently believed in their work, but that the risks of openly defending their practice have become too great to make speaking out to defend it worth the dangers of harassment. Those working at public universities in red states also expressed concerns about drawing unwanted attention to their institutions.<\/p>\n Forcier said that when it comes to gender clinics, conservative\u00a0activists appear to be taking a page out of the antiabortion playbook: targeting individual medical centers and providers, creating a culture of fear that reverberates around the field, and drumming up political challenges for institutions that support the work.<\/p>\n Worst of all, she says, it seems to be working.<\/p>\n \u201cWhen programs are getting bad press, or programs are being threatened or harassed, the larger institution looks at that program and says, \u2018What\u2019s the cost and benefit of doing this?\u2019\u201d Forcier said. \u201cAnd it\u2019s also going to scare away many people who can and should be providing even basic gender care as pediatricians\u00a0\u2026 for most pediatric providers and pediatric hospitals, we\u2019re just not used to this type of targeted hate and violence. This is new.\u201d<\/p>\n In the days following Walsh\u2019s Twitter posts, members of far-right social media groups on sites like Reddit and 4chan<\/a> called for the murder or arrest of VUMC doctors and supporters and advocated for Nazi-inspired intimidation tactics like book burnings<\/a>.<\/p>\n The harassment is not new for providers of pediatric gender care.\u00a0Forcier herself has received so many hate emails during her years as a gender specialist that she has a special folder in her inbox where she keeps them\u2014\u201cin case they\u2019re ever needed to track down a threat,\u201d she said.<\/p>\n Michael\u00a0Haller, a professor and chief of pediatric endocrinology at the University of Florida, often works with transgender and gender nonconforming pediatric patients. He\u00a0told\u00a0Inside Higher Ed\u00a0<\/em>that he’s received emails, social media messages and physical letters sent to his home address calling for him to be “jailed for life,”\u00a0“drawn and quartered” and “castrated.”\u00a0One harasser\u00a0sent him\u00a0rants\u00a0comparing him to Nazi doctor Josef\u00a0Mengele;\u00a0Haller’s\u00a0grandparents were Holocaust survivors.<\/p>\n “While I will continue to be public and vocal in my efforts to protect the rights of trans people to exist and receive care, these attacks have undoubtedly quieted the voices of many advocates who are understandably afraid of being the target of verbal and written threats, or worse,” Haller said.<\/p>\n Forcier is personally familiar with Walsh\u2019s brand of misinformation and targeted harassment. A few years back, she agreed to be interviewed for his documentary What Is a Woman?<\/em> whose central thesis is <\/em>that transgender identity is a harmful and unscientific fad. Forcier said she agreed to the interview because she\u2019s passionate about the issue and a committed advocate for transgender youth health care, but that she was greeted with obstinacy\u00a0and bad-faith questions. She\u2019s been wary of doing any media interviews\u2014including with Inside Higher Ed\u2014<\/em>ever since.<\/p>\n \u201cWhen you\u2019re targeted in terms of hate crimes and victimization, you\u2019re careful where you go,\u201d she said. \u201cYou\u2019re careful who you talk to.\u201d<\/p>\n Research has shown that gender-affirming health care for youth who are questioning their identity can be lifesaving<\/a>; as a group, they are more susceptible to mental health problems\u00a0and suicide<\/a> than almost any other.<\/p>\n Haller said the culture war on\u00a0transgender health has had a repressive impact on expanding access to this kind of care, however effective it\u2019s proven to be.<\/p>\n \u201cThere are only three major pediatric gender clinics in Florida, a state of 20-something\u00a0million people. We have a backlog of more than six months… Patients are actually going out of state to get treatment, which then becomes an equity issue, because there are plenty of families who can\u2019t afford to do that,” Haller said. “These politically motivated culture wars have already had a major effect on the willingness of providers to see patients,\u00a0further exacerbating\u00a0the already limited access to expert care in most states.”<\/p>\n The consequences of the political backlash can be legislative as well. According to a Bloomberg News report<\/a>, lawmakers in 24 states have introduced legislation that would either outright ban or severely limit the ability of clinics or medical providers to offer gender-affirming care to trans youth; before 2020, there were no such bills<\/a> in state legislatures.<\/p>\n Those bills have become law in four states\u2014Alabama, Arizona, Arkansas and Texas\u2014although all but Arizona\u2019s have been temporarily blocked by federal courts. It\u2019s possible that the uproar over VUMC\u2019s trans health clinic could bolster support for a similar bill in Tennessee; already state lawmakers, as well as Governor Bill Lee<\/a>, have called for an investigation<\/a> into Vanderbilt\u2019s clinic.<\/p>\n \u201cIt\u2019s so destructive in the sense that there are already issues of access and equity,\u201d Forcier said. \u201cIn some of the states where the culture wars about bodily autonomy and gender identity are more prevalent, to shut down that single point of access or to make local health-care providers be afraid to partake, on whatever level, in providing pediatric-sensitive quality care, you\u2019re hitting the most vulnerable. You\u2019re hitting families and kids who already are struggling for access.\u201d<\/p>\n \u201cIt\u2019s beyond harmful,\u201d she added. \u201cIt\u2019s evil.\u201d<\/p>\n<\/div>\nA Tactic Both Frightening and Familiar<\/h3>\n
Threatening Access to Lifesaving Care<\/h3>\n