It’s not unusual for Rachel Levine as assistant secretary for health to visit medical facilities on behalf of the Department of Health & Human Services. But her visit last week to the LGBTQ youth clinic at the Children’s National Hospital was special because she was able to meet with transgender youth as an openly transgender presidential appointee.

The visit on Thursday by Levine at the D.C.-based hospital comes not long after the U.S. Senate approved her appointment, making her the first openly transgender presidential appointee to win a Senate-confirmed position. As such, her visit to the LGBTQ youth clinic, where transgender kids come for transition-related care and health services, held particular significance for the patients.

Levine, speaking with the Washington Blade at the end of her visit, said having the opportunity to speak with both transgender youth and medical professionals testing them was “tremendously, tremendously rewarding”

“It’s tremendously gratifying to be able to speak to the medical professionals and the clinic personnel, but particularly to the youth and their families from my experience,” Levine added. “So I have two aspects of that. One is that I’m a pediatrician and adolescent medicine specialist. So I’ve been teaching to children and their families my entire career, but the other is coming from my lived experience as an openly transgender woman, and so I find it tremendously rewarding.”

The warm environment of the hospital for children is readily apparent upon entering the main atrium of the building. Lights dressed up as hot air balloons fill the tall ceiling while a nearby TV shows music videos consisting of squares of kids’ faces singing, followed by easy-listening country music and Asian K-pop. Children and their parents await their appointments seated in comfy plush red chairs before white blocks meant for use as tables.

Key to Levine’s visit was taking part in a discussion at the hospital auditorium with three transgender youth and their families who obtain services at the clinic. During the question-and-answer period, Levine shared her experience as a transgender person who underwent transition later in life and went on to tremendous success as a high-ranking presidential appointee.

For the transgender youth, Levine’s presence at the hospital — at a time when state legislatures are busy enacting bills to restrict their access to medical care and school activities — serves as a reminder that barriers based on gender identity are breaking down and the sky’s the limit for their future.

After the question-and-answer session, Levine told the Blade she “learned a lot” about Children’s National, which she called “a world-renowned children’s hospital and academic medical center.”

“I’ve known about it before,” Levine added. “I’m a pediatrician, adolescent medicine specialist, but I learned more about what they’re doing. And I learned specifically about their gender clinic, where they take care of transgender and gender non-conforming youth and got to meet some of the staff as well as the kids and their families.”

The Youth Pride Clinic, which opened in 2015, is one of the few clinics in the nation to provide primary care and mental health services to LGBTQ youth from ages 12 to 22. Among the services offered are hormone replacement therapy, STP/STI treatment and PrEP services as well as individual and family therapy for transgender youth.

Among the transgender youth patients at the clinic who spoke to the Washington Blade was Amir, a 15-year-old Georgia native whose last name as a minor is being withheld for confidentiality purposes.

“I started out in fifth grade coming out as lesbian,” Amir said. “I didn’t even really know, but when I came out to my grandma in Georgia, where I’m from, I still didn’t feel like myself. So then, later on, me and my friend researched, and next thing you know we came across the term transgender, and I was like, ‘This is who I am. This is me.’”

Amir said he began taking shots as part of care regimen in January. Being able to receive care from the Youth Pride Clinic, Amir said, means a lot because he has an opportunity not available to other transgender youths, who face challenges and even hostility as they make the journey to transition. The staffers at the Youth Pride Clinic, Amir said, are “like a second family” who work hard to provide the services they offer.

Sonia Murphy, Amir’s aunt who became his legal guardian, said when she began reaching out for medical help for Amir she found a two- or three-year wait list to get access to treatment, which she said makes her “saddened” such care isn’t widely available.

“There’s a population of kids and parents out there who need the services and just can’t access it because there’s not enough bandwidth, not enough manpower,” Murphy said.

Amir said he’s getting other avenues of support from his two cousins, one who is older at age 18 and one who is younger at age 12. “They’re like sisters to me, so I call them my sisters,” Amir said. Amir also identified two other male cousins as well as his uncles and his aunt.

“They’re all very supportive of me,” Amir said. “My auntie Tonya, for example, Pride month came up, first day, she sent me a paragraph, saying, ‘I’m glad you’re yourself and you’re open to who you are and things like that,” and that I’m not afraid to be who I am around anybody. It’s just things like that. And for my birthday, I had tons of Pride shirts, and I got a rainbow shirt with the fist in the middle for Black Lives Matter, and it was a ton of different things.”

Lawrence D’Angelo, director of the Youth Pride Clinic and an occupational health adolescent medicine specialist, told the Blade being able to start the facility in 2015 in and of itself was one of the key victories for the initiative, although he said the Children’s National has been providing transition-related care since 1998.

“When we started it…we thought that we were going to be running a PrEP clinic, that we were going to be providing preventive services to LGBTQ kids,” D’Angelo said. “The first day, the first patient actually came in and asked for PrEP, and the other six patients that were scheduled that day all wanted transgender services. So, suddenly, it became obvious what we were going to be spending 90 percent of our time doing, which is exactly what we think we should be doing, because that’s where the need is the greatest.”

Despite the advantages of having access to the Youth Pride Clinic, transgender youth have clear challenges and face hostility based simply on their gender identity, especially in a year when state legislatures have in an unprecedented manner enacted legislation against them. The Youth Pride Clinic, in many ways, is an oasis of support.

Arkansas, for example, enacted a measure that would make criminal the kind of services provided at the clinic. Other states have enacted measures prohibiting “biological boys” from participating in sports, which essentially bars transgender girls from participating in sporting events.

While anti-trans measures aren’t being enacted in D.C. or any nearby states, the advancement of anti-trans legislation in states has had a negative effect on transgender patients at the Youth Pride Clinic.

D’Angelo, based on conversations he’s had with the patients, said they’re aware of the wave of legislation, which he said has led to fear, anger and being “unable to understand what is happening and why it’s happening.”

Amir said watching states enact legislation against transgender youth “makes me feel some type of weight,” pointing specifically to the anti-trans sports measures because he said he’d welcome the opportunity to participate in athletics.

“I’m athletic,” Amir said. “I do all types of sports. I play basketball, soccer, I’m going to do boxing…With sports and stuff, I just feel like I want to be able to do everything, just as a regular cisgender person will be able to do,”

Amir, despite the enactment of anti-trans laws, has an optimistic outlook and said the enactment of state measures against transgender youth demonstrates they’re now “on the radar” of the social conservative movement.

“I feel like if everybody who’s a part of LGBTQ and trans together, we can stand up and we can overcome this because the thing is, there are so many people out there who don’t understand what we do, and the thing is that they’re noticing us, so that’s a start to something big.”

With many states hostile to transgender youth, others are looking to the federal government for support under the Biden administration. On his first day in office, Biden signed an executive order directing federal agencies to implement the U.S. Supreme Court’s decision against anti-LGBTQ discrimination to the fullest extent possible.

Levine cited an announcement from HHS that resulted from this order on implementing regulations prohibiting anti-LGBTQ discrimination in medical care, reversing a policy under the Trump administration that green lighted discrimination, as one of the ways it has answered that call and helped families like the Youth Pride Clinic.

“So the Affordable Care Act says that you cannot discriminate based upon sex,” Levine said. “The Department Health & Human Services and the Office of Civil Rights has interpreted sex to include sexual and gender minorities, to include sexual orientation and gender identity, which means LGBTQ individuals under that. So we need to look at all aspects of the Affordable Care Act, and to work to implement that interpretation of the statute. That was only done a month or so ago, so we’re going to be working on that now.”

Is there anything more the federal government can do to support the clinic? D’Angelo cited a number of key things already secured, including the hospital being able to offer insurance to patients and the affirmation from HHS against anti-LGBTQ discrimination. More research dollars and greater focus from the National Institutes of Health on gender diverse and sexual minority individuals, D’Angelo said, would also be welcome.

“There are things out there that the federal government can do, but I think…there are limitations of what they can do,” D’Angelo said. “They can’t, unfortunately, effect what’s going on in individual states, which is, in some cases draconian. That’s an awful thought if we were practicing medicine in Arkansas, we could be in jail.”

Meanwhile, Levine said the Biden administration, including Secretary of Health & Human Services Xavier Becerra, is working on both internal and external policies to facilities like the Youth Pride Clinic to help them secure their place in the health system and reach transgender youth.

“The secretary and I will be doing everything we can to advocate for the LGBTQ community,” Levine said. “So I think we’re going to be working externally, in terms of advocacy, and then we’re going to be working internally in terms of policy.”

LANSING, MI. – Democratic Michigan Governor Gretchen Whitmer signed an executive order Monday that prohibits use of state funds for the practice of conversion therapy on minors.

Erin Knott, the Executive Director of Equality Michigan was present for the signing ceremony telling the Blade by phone afterwards, “Since Day 1, she has said she do what she could to stop this barbaric practise. She had worked with us in 2019 getting started on this issue but then the pandemic hit and other issues surrounding that [COVID19] in the state so it was delayed till now.” 

Knott reflected that the Executive Order, 2021-3, prevents a discredited practise noting that, “it has been used on too many young people in our community to make them feel like there is something wrong with who they are. These children have been subjected to abusive and hateful practices when they should be held and loved.”

“Since day one, I have made it clear that hate has no home in Michigan,” said Whitmer. “My administration is committed to addressing the systemic barriers faced by young LGBTQ+ Michiganders so that our state is a place where they are able to reach their full potential. The actions we take today will serve as a starting point in protecting our LGBTQ+ youth from the damaging practice of conversion therapy and in ensuring that Michigan is a reflection of true inclusion.” 

By signing the order, the governor said that she plans to ensure that taxpayer funding is only used for research-based medical and mental health practices. She has also asked the Michigan legislature to draft a ban on conversion therapy.

“As a pediatrician who works with LGBTQ+ adolescents, I have seen how patients thrive when they are able to be themselves and when their identities are supported,” Dr. Maureen Connolly, a pediatrician in Detroit who specializes in adolescent medicine and caring for the LGBTQ+ community told Detroit ABC News affiliate WZZM 13. “Conversion therapy is the exact opposite of what young people need and has been shown to have long-lasting negative effects including depression, self-harm and decreased self-esteem. I am grateful for this executive action and I know it will have a positive impact on the health of young people across Michigan.”

“LGBTQ youth are beautiful the way that they are and deserve to be loved and respected — not subjected to the dangerous and abusive practice of conversion therapy. Thank you to Governor Whitmer for taking action to protect LGBTQ youth,” said Sam Brinton, Vice President of Advocacy and Government Affairs for The Trevor Project. “While there is still much work to do in the Great Lake State, this is an amazing step forward that will help save young LGBTQ lives in Michigan.” 

Research: 

• According to The Trevor Project’s 2021 National Survey on LGBTQ Youth Mental Health, 13% of LGBTQ youth reported being subjected to conversion therapy, with 83% reporting it occurred when they were under age 18. LGBTQ youth who were subjected to conversion therapy reported more than twice the rate of attempting suicide in the past year compared to those who were not.
• A peer-reviewed study by The Trevor Project, published in the American Journal of Public Health, found that LGBTQ youth who underwent conversion therapy were more than twice as likely to report having attempted suicide and more than 2.5 times as likely to report multiple suicide attempts in the past year.

BISMARCK, ND. – The North Dakota House Administrative Rules Committee voted 8-7 on Tuesday, June 8, to authorize the rule proposed by the North Dakota Board of Social Work Examiners, implementing new regulations prohibiting licensed social workers from subjecting LGBTQ youth to the widely discredited practice of conversion therapy.

The North Dakota Board of Social Work Examiners, which oversees licensing for social workers in the state, created the new rule which states that “it is an ethical violation for a social worker licensed by the board to engage in any practices or treatments that attempt to change or repair the sexual orientation or gender identity of lesbian, gay, bisexual, transgender, and questioning individuals.”

The West Hollywood based Trevor Project, the world’s largest suicide prevention and crisis intervention organization for lesbian, gay, bisexual, transgender, queer & questioning (LGBTQ) young people, had worked with Democratic House Minority Leader Rep. Josh Boschee, the National Association of Social Workers ND Chapter, the North Dakota Human Rights Coalition, and local advocates like Elizabeth Loos to advance these critical protections for LGBTQ youth.

 “This rule change will stop the vast majority of mental health providers in North Dakota from subjecting LGBTQ youth to the dangerous and discredited practice of conversion therapy. This practice is not therapy at all— it’s abusive and fraudulent,” said Troy Stevenson, Senior Advocacy Campaign Manager for The Trevor Project. “There is still more work to be done in North Dakota, but this bold action will help save young lives. The Trevor Project is committed to an every state strategy to protect LGBTQ youth from conversion therapy and North Dakota has proven that progress is possible anywhere.”

“Thank you to the North Dakota Board of Social Work Examiners for restricting licensed social workers in North Dakota from being able to practice conversion therapy! LGBT North Dakotans, especially youth, are safer now as you hold licensees responsible to the NASW Code of Ethics,” said Minority Leader Boschee. 

The proposed ban on therapist-administered conversion therapy in North Dakota was met with opposition by several of the committee’s most socially conservative members, the Grand Forks Herald reported.

Rep. Dan Ruby, R-Minot, told the paper that he worries the new prohibition is limiting because it would prevent people seeking “some kind of treatment” from getting help. Bell said the rule is written so clients who are LGBT or questioning their sexual orientation or gender identity are not inhibited from seeking care.

Rep. Bernie Satrom, R-Jamestown, said he’s concerned the rule would interfere with religious counseling, adding “there are some cases where people want to change.”

“There are licensed counselors that are also Christians, and basically my concern in all of this is that we’re telling the Christian counselors ‘you can be a licensed counselor, but you can’t practice your Christianity,'” Satrom said.

Satrom and West Fargo Republican Rep. Kim Koppelman said approving the social workers’ ban on conversion therapy is outside of the committee’s scope and ought to be scrutinized by the full Legislature.

Boschee, the North Dakota Legislature’s only openly gay member, told the Grand Forks Herald that he was disappointed in some of his colleagues for standing behind the “harmful” practice of conversion therapy and trying to muddy the conversation over what is a simple self-imposed rule for social workers. The Fargo Democrat said he was ultimately pleased that seven lawmakers joined him in upholding the proposed ban.

Research: 

• According to The Trevor Project’s 2021 National Survey on LGBTQ Youth Mental Health, 13% of LGBTQ youth reported being subjected to conversion therapy, with 83% reporting it occurred when they were under age 18. LGBTQ youth who were subjected to conversion therapy reported more than twice the rate of attempting suicide in the past year compared to those who were not.
• According to a peer-reviewed study by The Trevor Project published in the American Journal of Public Health, LGBTQ youth who underwent conversion therapy were more than twice as likely to report having attempted suicide and more than 2.5 times as likely to report multiple suicide attempts in the past year.