Misconceptions abound in push to deny gender-affirming care

A doctor holding several PRIDE-themed heart decorations.
Helping transgender patients align emotionally and biologically with their gender identity through gender-affirming care has dramatically lowered the risk of suicide, especially among young people, notes Dr. Jaime Bowman of the WSU Elson S. Floyd College of Medicine.

Dr. Jaime Bowman has been practicing and teaching gender-affirming care for LGBTQ+ patients since she first became a medical doctor. 

By Bowman’s count, the clinical education director for family medicine at Washington State University’s Elson S. Floyd College of Medicine has mentored and taught about 10,000 healthcare professionals how to show up and care for patients across the gender and sexuality spectrum. 

As state after state enacts new restrictions on providing gender-affirming care for transgender people, there are a few misconceptions Bowman says need to be “mythbusted” about such care. 

The first is accessibility. “Some folks have painted a picture that a person can choose gender affirmation on a whim,” Bowman said. 

In reality, a great amount of clinical and behavioral testing and evaluation goes on before any part of the process of gender affirmation begins. 

A second misconception is that gender affirmation always means surgery. But many components of gender-affirming care are non-surgical and reversible, Bowman said. Those include counseling, social affirmation such as adopting gender-affirming appearance and pronouns, and medication therapy.  

Finally, Bowman said the issue of gender affirmation for young people is especially misunderstood. 

“All the same pieces apply — there are wraparound services and a comprehensive approach to care,” she said. “When you approach gender-affirming care for a young person comprehensively you often don’t need major surgical procedures to help that young person be authentic and find the mental health positivity of being themselves.” 

Helping transgender patients align emotionally and biologically with their gender identity through gender-affirming care has dramatically lowered the risk of suicide, especially among young people, she noted. With new legal restrictions, “I anticipate the rate of suicide will rise, and with it the other kinds of strategies humans use to cope with pain, like alcohol abuse and drug abuse,” said Bowman, who’s also interim associate dean for clinical education at the WSU College of Medicine in Everett.  

She was inspired to provide gender-affirming care for LGBTQ+ patients by her uncle, a gay man who was ostracized by members of her family after he came out. The family cut off her contact with her uncle, but she reconnected with him when she was in college. 

“It was my first glimpse of the cascade of pain that can happen for folks who are asked to assimilate,” Bowman said. Yet, she also had empathy for her family and “the honesty of their fears.” 

Her experience informed her approach as a medical professional and educator. 

She knows there are healthcare professionals and students, communities and employers with deeply held beliefs in conflict with the science of gender-affirming care. Bowman respects their perspectives. But she reminds her colleagues that they can set firm boundaries for themselves while still opening doors for their patients through referrals to ensure they get the care they want and need. 

“When I teach about sexuality and the gender spectrum, I don’t assume my audience are all allies who are ready to take up the charge of doing this care,” she said. “So this is what I ask of my students and my colleagues: as they reach down into their hearts and understand where they stand on these issues, they are exercising their autonomy to do so. I want them to extend the same privilege of being able to be honest, real and authentic to everyone else. It’s really that simple.”

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