Gender-Affirming Care Isn’t Just for Adults, Say AMA Delegates

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One pediatric endocrinologist called it “lifesaving” for her patients

by
Joyce Frieden, Washington Editor, MedPage Today
November 12, 2024

Gender-affirming healthcare shouldn’t be limited to adults, members of the American Medical Association (AMA) House of Delegates said Monday at the delegates’ interim meeting in Orlando, Florida.

“As a pediatric endocrinologist myself, I’ve seen how appropriate, guideline-based [gender-affirming] care for my patients can be lifesaving,” said Brittany Bruggeman, MD, of Gainesville, Florida, an alternate delegate for the American Academy of Pediatrics who spoke for the delegation. “I have really seen the tremendous effects that when this care is done right by physicians and is based on guidelines — which is what this report calls for — it can dramatically improve the health of my patients. For this reason, the AMA should support doctors who are providing this care in a guideline-based way.”

The delegates were discussing a resolution offered by the Virginia delegation related to a report from the AMA Board of Trustees on “Advocating for the Informed Consent for Access to Transgender Healthcare.” The report, which an AMA reference committee had recommended that the delegates vote to adopt, stated that the association supports the provision of medically necessary gender-affirming care (GAC) but does not take a position on whether determination of medical necessity needs to include a gender dysphoria diagnosis.

The report further noted that the AMA “does not wish to … endorse one particular model of care over another. Rather, the AMA vigorously advocates for equitable payment policies while relying on the evidence-based professional guidelines and recommendations set by professional medical associations, as well as individual physician clinical judgment, on questions of appropriate clinical criteria.” The authors added that “GAC may be provided during or before adolescence; however, recognizing that providing GAC for children is fundamentally different than for adults due to differences in biology, psychology, and autonomy, the scope of this report is limited to gender-affirming medical interventions provided to adults.”

Tom Eppes, MD, of Forest, Virginia, speaking for the Virginia delegation, at first tried to get the report referred to the Board of Trustees for further study, with a report due back at the delegates’ 2025 annual meeting in June. He noted that “This report was released Saturday morning … less than 2 hours before the reference committee began. And unless you’re a speed reader, you didn’t have any chance to get through it. There was no chance to read it, no chance to discuss with delegations [or] comment online … We feel that this report needs to be reviewed in our House of Delegates in the same order that all other resolutions and reports have, and [the trustees should] report back next June for a vote.”

When that effort was voted down by delegates, Eppes, this time speaking for himself, then proposed that the new policy proposed in the board report — which said that the AMA “unambiguously supports access to and insurance coverage of medically necessary GAC” — include the words “for adults [over age 18]” at the end of that phrase. He added that the amendment “is to clearly delineate that this is about adults, not children. In the body of the report, it states there is a difference in children and adults, but later conflates adolescents as [sic] adults. I believe this addition makes clear that the intent of this report is for adults only.”

That proposal received a lot of pushback. “I don’t think that this amendment is necessary,” said Sophia Spadafore, MD, of New York City, a resident and fellow sectional delegate for the American College of Emergency Physicians, who was speaking for herself. “The words ‘medically necessary’ already appear in this report. This House of Delegates should defer to physicians who do this care … We have many adolescent physicians in this house — pediatricians who know what is medically necessary. I think that is fully covered. We don’t need this amendment.”

Catherine Gutfreund, MD, a family physician in Santa Rosa, California and alternate delegate from California who spoke for herself in opposition to the proposal, said she was the mother of a trans child “who was suicidal until she was able to get the treatment … And I can tell you with the biggest heart that now that she’s getting gender-affirming care, she’s doing fabulous.” Joanna Bisgrove, MD, of Evanston, Illinois, an alternate delegate for the American Academy of Family Physicians and the mother of a non-binary child who spoke for herself, said her family “changed states for a number of reasons, but the primary one was that my now-17-year-old could not get the care that they need, and we now have an ability for insurance to cover them.”

Frank Dowling, MD, of Islandia, New York, who spoke for the New York State delegation, said that “We have policy in New York that says that we will support physicians and other professionals who are providing gender-affirming care … I ask that we finally stop persecuting my children and their friends, myself, and others who identify as gender minority people, and just give us what everyone else has.”

No one besides Eppes spoke in favor of the amendment. In the end, the House of Delegates voted 127-486 against adding the phrase and then voted in favor of accepting the report as is.