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In this video, Joshua Safer, MD, executive director of the Mount Sinai Center for Transgender Medicine and Surgery in New York City, discusses how recent anti-trans sentiments from state governments can affect transgender youth, and how clinicians can support this vulnerable group.

The following is a transcript of his remarks:

Well, I think there are problems with what's going on in with regard to some of the comments by government leaders against transgender people and against care for transgender youth.

Some of our best data for harm to transgender kids is in the realm of the circumstance where they don't have support from parents and people around them. And that extends to government leaders, and hateful comments are only going to result in more difficulty for people who are already vulnerable.

It's not just a matter of being transgender; we're talking about high school kids and junior high school kids. These are people who already are having confidence issues in their lives, no matter who they are -- trans or otherwise -- and so this is exactly not a group that should be targeted by government leaders.

If these sorts of bans were to be put in place, then we're actually talking about denying necessary healthcare to people. It seems to me self-evident that if you deny care to people, then they will suffer. We have degrees of suffering that we have identified already when we've not provided care to transgender and gender-diverse youth. And certainly going back to that circumstance, is something that could be catastrophic for some kids.

There's a question about whether other states will follow suit, and I think the politics are pretty divided on that subject. I would hope that in most states the doctor-patient relationship and the relationships internal to families would be the priority. I think that tends to be a high-priority circumstance among Americans, and so I would hope at least that there wouldn't be states rushing to follow suit on that subject. I don't even think that that necessarily is something that is different between our conventional political parties in terms of respect for the doctor-patient relationship or respect for family autonomy.

Clinicians have two roles with regard to ensuring that transgender youth have care. First is simply providing evidence-based care based on current best practices from societies or from centers of excellence or whatever the appropriate resource might be. The second role is to serve as experts informing government leaders about the care that is needed; that's the position we take as medical providers in society, and we do have to fulfill that role too.

In the circumstance where the parents are not supportive, it is a challenge to provide gender-affirming care to minors. In most states, parents have a huge degree of power regarding care for their children. That really is something that we have to navigate. Sometimes it's a matter of educating parents, and sometimes it's a matter of youth who have already gone through puberty that might need some counseling, as they're going to be in a circumstance that they might not prefer until they reach age 18.

For providers who want to create a safe space in their clinic for transgender and gender-diverse youth, it's not always necessary for that to involve huge changes to practice. Some of it can be very simple, like putting pronouns on badges, or introducing themselves with pronouns or putting a rainbow flag or a transgender flag up on the front desk. Anything to let the patients know that it is a priority. While it's best for staff to be appropriately trained, even if people are making mistakes, if patients know that the intentions are good, that's still a much, much safer space than one where it's very unclear what people are thinking on the subject.

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