Health
EXCLUSIVE: Meet the director of Johns Hopkins Center for Transgender Health
Dr. Fan Liang on politicizing healthcare, fear among patients
The topic of gender affirming healthcare has never attracted more attention or scrutiny, presenting challenges for both patients and providers, including Dr. Fan Liang, medical director of the Johns Hopkins Center for Transgender and Gender Expansive Health and assistant professor of plastic and reconstructive surgery.
Speaking with the Washington Blade by phone last week, Liang shared her perspective on a variety of topics, including her concerns about the ways in which media organizations and others have shaped the discourse about gender affirming care.
Too often, she said, the public is provided incomplete or inaccurate information, framed with politically charged and polarizing language rather than balanced and nuanced reporting for the benefit of audiences who might have little to no familiarity with the topics at hand.
“This is an evolving field that requires input from many different types of specialists,” Liang noted, so one issue comes when providers “start to comment outside of their scope of practice, or extrapolate into everybody’s experience.”
A more intractable and difficult problem, Liang said, is presented by the fact that, “issues with transgender health have really taken center stage with regard to national politics, and as a result of that, the narrative has really been reduced to an unsophisticated representation of what’s going on.”
“I think that is dangerous for patients and for the community that these patients live in and have to work in and survive in because it paints a picture that is really inaccurate,” she said.
Conservative state legislatures across the country have introduced a record number of anti-LGBTQ bills this year, passing dozens, including a slew of anti-trans healthcare restrictions. The Human Rights Campaign reports 35.1 percent of transgender youth now live in states that have passed bans on gender affirming care, many of which carry criminal penalties for providers.
A big part of the Center’s work, Liang told the Blade, involves working closely with trans patients and organizations like Trans Maryland and the Trans Rights Advocacy Coalition “to make sure that the community’s voices are being heard, so that we’re able to represent those interests here.”
She described “a generalized sense of anxiety and fear,” concerns that she said are “pervasive throughout the community,” over “access to surgery and to overall gender healthcare.”
“I get a lot of questions about that,” she said.
While Liang has not yet worked with any patients who traveled to the Center because gender affirming care was banned in the states where they reside, she said, “I do anticipate that will happen in the relatively near future.”
Challenges for clinicians
The political climate “really interferes in physician autonomy and basically using our training and discretion to provide the best therapies that we can,” based on research and evidence-based guidelines from medical organizations on best practices standards of care, Liang said.
“I earnestly believe that people who go into medicine try to do right by their patients and try to provide exceptional care whenever they can,” she said. “When I speak to other providers who are engaged in trans care, the reason they entered the field was because they saw patients that were suffering and had no other providers to go to and they were filling a need that desperately needed to be filled.”
“It is unfortunate that their motives are being misinterpreted, because it is causing significant emotional harm to these providers who are being targeted,” Liang said, noting “there is so much vitriol from the anti-trans side of things,” including “this narrative out there that physicians are providing trans care because of financial reasons or because of some sort of politically motivated, I don’t know, conspiracy.”
The political climate, along with the realities of practicing in this speciality, may threaten to stem the pipeline of new providers whose practice would otherwise include gender affirming care, said Liang, who serves on the interview board for incoming residents who are looking to specialize in plastic surgery.
Many, perhaps even most, she said, are eager to explore transgender care, often because, particularly among young trainees, they are friends with trans and non-binary people. “I don’t know how much of that interest persists as they move through the training pipeline, because — especially if they are at an institution that does provide trans care — they do see a lot of the struggles that physicians encounter in being able to offer these services.”
Liang noted the “significant hurdles from an insurance standpoint” and the “significant prerequisites in order to access surgery,” which require “a tremendous amount of back-end coordination and optimization of the logistics for surgical readiness.”
“And then,” she said, “they see a lot of the backlash in the media against trans providers, and I think that that does discourage residents who otherwise would be interested in the field because physicians, by and large, are a pretty conservative bunch. And having them start their practice where they’re sort of stepping into a political minefield is not ideal.”
Speaking up can be beneficial but risky
“Some physicians feel like they can make the most amount of impact by being advocates for the patient population on a national stage or being more vocal about how anti-trans legislation has been impacting their patients,” Liang said.
“My goal, as the director for the Center for Transgender Health here at Hopkins is really to normalize this care to allow for the open conversation and discussion amongst providers to create a safe space for people to feel comfortable providing this care,” she said.
Destigmatizing gender affirming care and connecting clinicians who practice in this space will help these providers understand they are not “functioning in isolation” and instead are part of “a national effort and a nationally concerted effort toward delivering state-of-the-art health care,” Liang said.
“It’s important,” she said, to “bring the generalized healthcare community to the table in offering these services and have a frank discussion when it comes to education, research and teaching.”
Other providers, however, “do not feel comfortable putting themselves into that place of vulnerability,” Liang said, “and I don’t fault them for it because I personally know people who’ve received death threats and who have been targeted because of what they say to the media,” in many cases because their comments were reported incorrectly or out of context.
In July, Liang participated in an emergency trans rights roundtable on Capitol Hill with representatives from advocacy groups like the Southern Poverty Law Center and the Transgender Law Center, as well as members of Congress including U.S. Reps. Mark Takano (D-Calif.), Barbara Lee (D-Calif.), and Sara Jacobs (D-Calif.).
She told the Blade it was “a really wonderful experience” to “hear the heartfelt stories” of the panelists advocating on behalf of themselves, their friends, and their families, earning the attention of members of Congress.
“I do think advocacy is important,” Liang told the Blade. “I try to make time for it when I can,” she said, “but I have to balance that with all of my other clinical obligations.”
Finding compassion and lowering the temperature
On Aug. 1, The Baltimore Banner reported that the director of the Mayor’s Office of LGBTQ Affairs in Baltimore filed a discrimination complaint with the city’s Office of Equity and Civil Rights against the Hopkins Center for Transgender and Gender Expansive Health. (The story was also published by the Washington Blade, which has a media partnership with the Banner.)
Asked for comment, Liang said “it was an upsetting article to read,” adding, “I was upset that there wasn’t more due diligence done to investigate a little bit further” because instead the article presents “just this one person’s account of things.”
She noted there is “not much I can say from a physician standpoint because everything is contained within HIPAA,” the federal Health Insurance Portability and Accountability Act, which prohibits providers from even acknowledging which patients they may or may not have worked with.
The Banner article underscores the importance of journalists’ obligations to “make sure there is due diligence to confirm sources and make sure things are accurate,” Liang said, including, of course, when covering complicated and politically fraught subjects like gender affirming care.
“On the one hand, it’s really wonderful that there’s a fair amount of press being dedicated to trans issues around the country,” Liang said, but what is “frustrating for me is these conversations always seem to be so loaded and politically charged, and there doesn’t seem to be much space for people to ask earnest and honest questions” without taking heat from either side.
There is “compassion to be offered for patients who are struggling to receive basic health care” as well as for “people who are struggling to understand how this issue is evolving,” those for whom the matter is “uncharted territory” and therefore likely to “cause consternation and fear,” she said.
“Most of the time, the way to overcome” this is to cultivate “relationships with people who do identify as transgender or non-binary” on the grassroots level, she said, while leaving room “for people to ask earnest and honest questions.”
Removing the artificial “us-versus-them” paradigm provides “opportunity for more compassionate interactions,” Liang said.
At the same time, she conceded, amid the heightened polarization and escalation of an anti-trans backlash over the last few years, efforts to fight sensationalization with compassion and understanding have often fallen short, presenting hurdles that have long plagued other areas of science and medicine like abortions and vaccines.
Health
Developing countries to receive breakthrough HIV prevention drug at low cost
Announcement coincided with UN General Assembly
Philanthropic organizations on Wednesday announced two agreements with Indian pharmaceutical companies that will allow a breakthrough HIV prevention drug to become available in developing countries for $40 a year per patient.
The New York Times notes Unitaid, the Clinton Health Access Initiative, and Wits RHI reached an agreement with Dr. Reddy’s Laboratories to distribute lenacapavir. The Gates Foundation and Hetero brokered a separate deal.
Unitaid, the Clinton Health Access Initiative, Wits RHI, and the Gates Foundation announced their respective agreements against the backdrop of the U.N. General Assembly.
Lenacapavir users inject the drug twice a year.
UNAIDS in a press release notes lenacapavir in the U.S. currently costs $28,000 a year per person.
“This is a watershed moment,” said UNAIDS Executive Director Winnie Byanyima in a statement. “A price of USD 40 per person per year is a leap forward that will help to unlock the revolutionary potential of long-acting HIV medicines.”
The State Department earlier this month announced PEPFAR will distribute lenacapavir in countries with high HIV prevalence rates. A press release notes Gilead Sciences, which manufactures the drug, is “offering this product to PEPFAR and the Global Fund at cost and without profit.”
Health
Don’t just observe this Suicide Prevention Month
Crucial mental health are being defunded across the country
September is Suicide Prevention Month, a time to address often-ignored painful truths and readdress what proactivity looks like. For those of us who have lost someone they love to suicide, prevention is not just another campaign. It is a constant pang that stays.
To lose someone you love to suicide is to have the color in your life dimmed. It is beyond language. Nothing one can type, nothing one can say to a therapist, no words can ever convey this new brand of hurting we never imagined before. It is an open cut so deep that it never truly, fully heals.
Nothing in this world is comparable to witnessing someone you love making the decision to end their life because they would rather not be than to be here. Whether “here” means here in this time, here in this place, or here in a life that has come to feel utterly devoid of other options, of hope, or of help, the decision to leave often comes from a place of staggering pain and a resounding need to be heard. The sense of having no autonomy, of being trapped inside pressure so immense it compresses the will to live, is no rarity. It is a very real struggle that so many adolescents and young adults carry the weight of every day.
Many folks in our country claim to uphold the sanctity of human life. But if that claim holds any validity or moral grounding, it would have to start with protecting the lives of our youth. Not only preventing their deaths but affirming and improving the quality of their lives. We need to recognize and respond to the reality that for too many adolescents and teenagers, especially those who are marginalized and chronically underserved, life does not feel so sacred. It feels damn near impossible.
Today, suicide is the second leading cause of death for Americans ages 10 to 24. That rate has almost doubled since 2007. Among queer-identifying youth, the statistics are crushing. Nearly 42 percent have seriously considered suicide in the past year, and almost 1 in 4 have attempted it. These are not just numbers. These are the children and teens we claim to care for and protect. These are kids full of potential and possibility who come to believe that their lives are too painful or meaningless to go on.
For our youth who identify as both queer and BIPOC, the numbers soar to even more devastating heights. Discrimination, housing insecurity, trauma (complex, generational, or otherwise), and isolation pile on the already stacked mental health risks. Transitional times like puberty, continuing education, coming out, or even being outed can all become crisis points. And yet, the resources available to support these youth remain far too limited, particularly in rural and underfunded communities.
We must also call out a disheartening truth. Suicide is not just a mental health issue but also a political one. Despite years of advocacy and an undeniable increase in youth mental health crises, funding for prevention is barely pocket change in regard to national budgets. In 2023, the federal government spent an underwhelming $617 million on suicide prevention efforts. To provide some perspective, that’s less than what we spend each year defending the border wall.
Meanwhile, school-based mental health services, one of the most effective means of reaching children and teens early, are being decimated. A $1 billion mental health grant program, which began after the Uvalde school shooting aiming to increase school counseling services, was recently pulled from hundreds of school districts. In some places, that left over 1,000 students for every one mental health provider. And in others, it left entire counties with zero youth therapists.
This rollback is not an isolated agenda. It operates in tandem with a cultural and legislative attack on the LGBTQ community and our access to affirming education, healthcare, and visibility. Programs that create safe spaces and lifelines are being wiped away. The LGBTQ line of the 988 suicide hotline, created to offer identity-affirming, culturally competent crisis support, was recently defunded, despite having provided help to over 1.3 million callers. The political message here is unmistakable. Only some lives, some pain, and some needs of a select group are worth the money and care.
I can’t help but contrast this with how our country controls the process of childbirth. Over the last decade, particularly following growing awareness and resulting concern around maternal mortality rates, the U.S. has consistently increased investment in maternal health. Federal funds now support initiatives like Healthy Start, safety improvements in birthing facilities, and dedicated maternal mental health hotlines. In 2022, the Into the Light Act was passed, allocating $170 million over six years for screening and treatment of postpartum mental health conditions. These are great and necessary efforts. But even here, we fall short. A study published in “JAMA Psychiatry” in November 2023 examined drug overdose deaths among pregnant and postpartum women in the U.S. from 2018 to 2021. The findings revealed that suicide and overdose were the leading causes of death during this period.
Yet even this limited progress for new parents shows us an undeniable contradiction. As a nation, we have shown we are capable of legislating support for life when we are politically and morally motivated to. We can pass bills, allocate funds, and create crisis hotlines. What’s missing is the motivation to extend that same urgency to the mental health and well-being of young people before they become statistics.
At the same time, astonishing amounts of public money have been directed toward restricting reproductive freedom. Since the overturning of Roe v. Wade in 2022, states have collectively spent hundreds of millions of dollars enforcing abortion bans, funding legal battles, surveillance infrastructure, and crisis pregnancy centers that often provide misleading information.
In 2023 alone, Texas allocated over $140 million to the Alternatives to Abortion program, while at the same time slashing funding to health providers that offered comprehensive reproductive care. Nationwide, anti-abortion lobbying and litigation have received sustained state and federal backing, often at the expense of preventive care, contraception access, and the very maternal health supports that claim to be prioritized. Only the willful can ignore the blatant contradiction here. While suicide and overdose silently claim the lives of mothers post-childbirth, far more political and financial energy is funneled into controlling whether people can become mothers in the first place.
Real prevention should not be limited to easy words and good intentions each September. Real prevention should be about intrenching mental health support into the daily lives of young folks. It means funding school counselors and social workers so that every child has someone to talk to. It means restoring services that center the needs of queer, Indigenous, and BIPOC youth, who are far too frequently left behind. It means guaranteeing that crisis lines are open. It means creating and nurturing environments where vulnerability is not discouraged but invited.
We also have to stop criminalizing mental health crises. Way too often, suicidal and struggling youth are met with handcuffs or hospitalization that adds layers to trauma rather than with compassion. Prevention must be proactive, not punitive. We need peer support groups, trauma-informed teachers, and trusted adults who are trained to notice the signs before the worst happens.
We are also overdue for a culture shift. A society with the alleged aim to value life does not shame those who are struggling to hold onto it. Contrary to popular unsaid belief, strength is not stoicism. Strength is connection. It’s knowing when to ask for help.
If we as a country actually and honestly cherish life, we have to prove it. We have to prove it not with words but with resources, policy, and compassion. Suicide prevention cannot begin and end with simple slogans and annual awareness. It has to mean a continuous investment in systems of care that affirm life, especially for those who are most vulnerable.
This September, as we recognize Suicide Prevention Month, I dare us to do more than to just memorialize those lost. Let’s start fighting for those living. Let’s create a world where no child, teen, or young adult feels that their only way out is to stop living. They are not expendable. They are not alone. And their lives are sacred. If only we had the heart to act like it.
I am almost ashamed to say that it wasn’t until I lost someone I love to suicide that I began volunteering my time to the American Foundation for Suicide Prevention. The work that the AFSP does is not only needed, it’s imperative today more than ever. If nothing else, please hit this link and donate.
Health
GLP-1s can help address LGBTQ healthcare barriers: experts
Queer people more subject to body dissatisfaction
Dana Piccoli tried everything to lose weight.
She frequented the gym, went on and off diets and hired a personal trainer. When Piccoli decided to get on a GLP-1, it wasn’t a “short cut” to drop weight – it was a way for her to live her life comfortably.
“When I told someone I was on it, they were like, ‘I’m going to the gym because I want to do it the right way,’” said Piccoli, managing director of queer media collaborative News is Out. “Obviously that kind of stung because for me, this is the right way.”
GLP-1 drugs have caused quite a stir since becoming more integrated into mainstream medicine. The newness of some brands, like Ozempic, have led to stigmas and mistrust surrounding them. These stigmas disproportionately affect the LGBTQ+ community since queer people are more subject to body dissatisfaction and have more trouble finding accessible healthcare.
Through all the noise, however, experts say taking GLP-1s are safe with the right counseling, and LGBTQ+ people could largely benefit from them.
So, what’s all the ruckus about? Are GLP-1s an “easy way out” to lose weight? And how do they really impact the LGBTQ+ community?
How GLP-1s work
GLP-1s, or glucagon-like peptide-1, mimic the actions of a GLP-1 that is released by the gut after eating. It can help people with Type-2 diabetes by lowering blood sugar through the release of insulin, and can help those with obesity by slowing down digestion and, in turn, reducing one’s appetite.
Like any medication, there are some side effects to consider. Sangeeta Kashyap, assistant chief of clinical affairs at Weill Cornell Medicine, said symptoms like nausea, diarrhea, and vomiting can occur. However, Kashyap said these side effects are less severe than past GLP-1 brands – a reason that contributes to their newfound popularity – and can be better managed with proper guidance.
Since the drug causes a loss of both fat and muscle loss, she said doctors should inform patients to do strength training to maintain any deteriorating muscle, and to eat high-protein diets, since fatty foods increase the risk of vomiting or nausea.
Getting on a GLP-1 isn’t just about shedding a few pounds. Kashyap said it’s a commitment to your health and body, which is why talking with a doctor and understanding the risks are crucial.
“We give patients appropriate guidelines,” Kashyap said. “We do blood tests, we monitor things, and give a lot of counseling to these patients. I don’t think you could just give the medicine out like candy.”
Piccoli, who started her GLP-1 journey with her wife, said the medication helped turn off “food noise.”
“Your motivation for things, your reward system with food is kind of disabled,” Piccoli said. “That really helped me understand my relationship with food.”
Turning down food noise
Losing weight isn’t as easy as getting on a GLP-1 and eating less. Piccoli said turning off the food noise in her brain led to a complete lifestyle shift.
“I had to completely change everything about the way I eat, everything about the way I approach food,” she said about her experience taking Mounjaro. “This has been one of the hardest things I’ve ever done.”
Kashyap said the lifestyle change that comes with taking a GLP-1 is why it’s important to consult a doctor first to understand how it could affect you not just physically, but also emotionally.
Kashyap said she sees higher rates of mental health disorders in transgender women, a community that already faces more barriers in finding accessible healthcare.
This could lead to someone getting on the drug for the wrong reasons, Kashyap said. She noted that those with eating disorders or body dysmorphia could face more severe side effects. Body dysmorphia and body image concerns are already an issue for the LGBTQ+ community, Kashyap said, so prescribing GLP-1s needs to be handled with care.
One way to ethically prescribe a GLP-1 to a patient would be to conduct a mental health screening, according to Kashyap. Mental health screenings aren’t required to get on a GLP-1, but Kashyap said they would be beneficial to patients who may be prone to negative effects by taking the drug.
Although some people may see more severe side effects, Caroline Apovian, co-director of the Center for Weight Management and Wellness at Brigham and Women’s Hospital, said GLP-1s are a completely safe and rigorously tested drug.
If a person faces negative side effects from taking a GLP-1, it’s more about how their body or brain is reacting to it than the drug itself being unsafe.
“Any kind of weight loss is going to affect your mood, either positively or negatively,” Apovian said.
With the queer community already facing increased barriers to healthcare, there’s another issue to consider: GLP-1s aren’t cheap.
Depending on where you get it from and whether or not insurance covers it, you could pay hundreds or even thousands of dollars for a limited supply.
Piccoli said she paid out of pocket and had to make sacrifices for her and her wife to both get on a GLP-1.
“I didn’t renew my car lease,” Piccoli said. “We decided to go down to one car so that we had some extra income monthly to be able to pay for it.”
On the other hand, Matt, who requested to be identified only by his first name due to the sensitivity of the topic, said he was shocked at how easy it was to get the cost of his GLP-1 covered by insurance. He had been warned by his doctor about the difficulty of getting it covered, and expected an “uphill battle.”
“[My doctor] wrote out the prescription for me, and on my way home, I got a text message from the drugstore saying it was ready to go,” said Matt, who’s lost 48 pounds on Ozempic since June 2024.
Matt said experiences like his, although not the standard, are why it’s important to talk with your doctor about getting on a GLP-1 and see for yourself rather than taking advice from social media stigmas.
Kashyap said the drug is also becoming more accessible through websites like Lilly, which provide vials for about $300-500. While that isn’t pocket change, it’s significantly cheaper than retail pharmacies.
You may have to make sacrifices like Piccoli did, but getting access to modern GLP-1s for weight loss isn’t only for the Hollywood elites like it seemed to be a few years ago.
Through all the social stigmas and uncertainty, Kashyap and Apovian agreed that GLP-1s are a major benefit for the queer community.
Trans women have increased rates of obesity, Type-2 diabetes and metabolic syndrome, according to Kashyap. Estrogen treatments increase fat mass and insulin resistance, leading to higher obesity rates in trans women. Kashyap said GLP-1s could be helpful in mitigating those effects.
GLP-1s also reduce alcohol cravings, so Kashyap noted that anyone struggling with alcoholism may see improvements with that condition upon getting on the drug.
Getting on a GLP-1 isn’t the walk in the park some may make you believe it is – it’s a lifestyle change and health commitment.
But it’s also a change that can provide good and healthy results if you seek the appropriate guidance from a professional.
While social stigmas in the queer community may lead to misinformation on who should use it and what it should be used for, GLP-1s are safe and can be a much-needed relief for a community facing significant healthcare obstacles.
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